#210 | April Q&A: PPH, Tipping Doulas, Vitamin A in Pregnancy, Surrogacy, Postpartum Rage, After Birth Pains, GDM, Age Over 35, Cholestasis

April 26, 2023

Hello everyone! We are back with our April Q&A episode, and it is loaded with your excellent questions! Don't forget you can subscribe on Apple podcasts Patreon to hear the extended, ad-free versions.  

Here's what we are talking about today:

  • Is it safe to plan a birth center birth if someone has a history of pre-eclampsia, HELLP syndrome and a postpartum hemorrhage?
  • Is it appropriate and/or expected to tip your doula?
  • Other than placenta accreta, what other reasons are there for retained placenta?
  • Can I take beef liver supplements in pregnancy? And do I need to worry about getting too much Vitamin A?  What is safe and what is not?
  • In the case of surrogate and adoptive mothers, who should hold the baby first after the birth?
  • I am experiencing postpartum rage and resentment toward my partner. How long does this last?

And in our extended version (available on Apple subscriptions & Patreon):

  • What can I take for after birth pains?
  • If I have an elevated fasting blood sugar and a diagnosis of Gestational Diabetes, is my baby really at risk? If so, what can I do without going on medication?
  • Is being over age 35 really a risk factor in birth?
  • Is there anything you can do to prevent Cholestasis in pregnancy?

And of course, everyone's favorite: Quickies!

Thanks for joining us, and remember you can call our phone line with your questions 24/7 at 802-GET-DOWN. (That's 802-438-3696)

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View Episode Transcript

Almost an hour had passed after the birth of my son and my placenta had not yet come out. And it had to be manually removed by an OB. By the way, a full grown woman's arm up my uterus was way worse than giving birth to my seven and a half on baby. Nice. Again, Trisha, I have a question about high risk pregnancies. So I have heard people say several times that being over the age of 35, does not necessarily make a woman in her pregnancy high risk. Does ACOG say anything? Do they say definitively that women over the age of 35 are automatically high risk, but I will say the last, you know, six months of of being parents, it has tested our relationship in ways I had no idea. You know, I'm finding myself with postpartum rage. And I've even put a hole in my wall with my foot. We're just so unlike me, I've been there.

I once put my foot through a wall, and you're super chill, super chill. Not in that moment at that moment and push me to the edge.

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.

Welcome to the April q&a.

All right. I am happy to be here. This lovely April day.

We got some really good questions this month. Be sure to answer these me too. Well, it's worth mentioning, we just did a 75 minute live q&a on our Patreon platform where we're women submitted, we answered 25 questions in 75 minutes. And anyone who's raving for more can go on our Patreon page at patreon slashed down to birth show and get into tier two. And you can watch all of the events we've ever done there right there on demand. And the last one that we just did is yeah, that 25 questions answered live. So that was a meaty one.

That was good. That's a lot of questions for April between the q&a and Patreon you guys can get like 40 questions, you're gonna have a whole bunch of 1000s of birth experts walking around the earth. And all this. Yeah, so. Okay, and other news. Yeah, just kidding. I don't have any. Let's get on with questions. Do you have something?

I was just thinking about how the news came out that during COVID The expected happened and mortality was up 40% during COVID. This came as no surprise to any of us because of the abuse women and their families endured with really awful policies like keeping families separated, even separating babies, keeping women in masks forbidding doulas in some hospitals forbidding partners, just keeping absolutely posses, and keeping people from going to appointments. I hate. I'm a big fan of telehealth, but you can't eliminate seeing people in person.

Yeah, which is exactly what happened. So that harmed women and their families. And it's no surprise that we could see that coming from from a long way away. And we need to know this. And we need to remember this for the next time. Something like this happens, we need to remember what were the true risk lies, and what keeps births safe. And none of those policies make birth safer.

What keeps her safe is continuity of care.

And not putting a mask over women who need to breathe for the sake of life and for their babies that just I can't even believe that I couldn't handle wearing a mask from

it is official minutes masks do not work.

It's like my least favorite topic. Let's move on. Okay, so upsetting. Alright, so questions. Let's go.

Hi. I wanted to ask a question. My sister had a midwife taking care of her. And in the course of her pregnancy, she had to be transferred to a hospital at 30 weeks because she was preeclamptic. And then it progressed to help and they had to induce her and do all sorts of things to help her and then she was on like a magnesium drip and a bunch of other things. After she gave birth they were mashing her abdomen and saying that it was it was not long after she gave birth they were smashing it and saying that it wasn't going down and that she might have retained placenta. So they said they needed to go inside and sleep. And so they did that when the doctor reached in and reached back out, it caused excessive bleeding, and she hemorrhaged. And she had to have a blood transfusion. And there was so much that happened to her. And she is considering, after working through a lot, had another baby, and she really wants to go through a birthing center. But the doctor said, when she was after she'd given birth, that because she had preeclampsia, and he pointed to it as a sexual partner, the same sexual partner, her husband, she's more likely to get it again, do you think? And he said, she shouldn't have a Person Center birth, she should only give birth at a hospital. So I just want to see what you guys thought about that. Do you think all of that disqualifies her from going to a birthing center? Thank you so much. Have a good day.

Well, where should we begin with this one? There's a few different things to address in this question. Yeah, the sexual partner thing. Oh, that has to do with the fact that the we now know that preeclampsia is maybe related to the sperm. So what OB is saying is that because it's the same partner, her risk of preeclampsia may be higher.

So the OB recommends that she go find another partner. Exactly. Right to help you accept the risk with a new partner puts you at higher risk of preeclampsia.

Okay, don't take our advice on that one. A couple of things. One, I, her question is, Can her Her question is can this woman have a birth center birth? Or does she have to birth in the hospital? And I would absolutely say she can plan a person or birth? Yes. Is the risk of preeclampsia reoccurring, greater because she had it the first time? Yes, there is. You know, like a two to three fold increase. If you've had preeclampsia in a previous pregnancy, that it could happen again, of course, we know that there are things that you can do that may reduce may reduce the chances of preeclampsia occurring in a subsequent pregnancy. The other thing here is that she said that the OB was pushing down on her abdomen, and that caused a postpartum hemorrhage. So maybe avoiding aggressively massaging the fundus when the placenta has not separated, yet, massaging the fundus is harmful, and does lead to risk of postpartum hemorrhage. So there are different things that can be done to mitigate the risk of this happening again, a second time, we get so many questions in the category of Am I safe to have my next baby because I experienced this the first time, whether it was low fluid, or a big baby or postpartum hemorrhage, and other so there's no end to how many things fall into that category. And what it's so hard, I think, for women to understand and believe is so many of those things are very likely linked to your provider and not your body, nothing inherent in your body, but you were led to believe, or the provider potentially caused some of those things. So we have to remember that you may have been treated very differently and had a different outcome if you had a different provider. It we always walk away thinking that this was bound to happen no matter who the provider would have been. But yes, fondle massage, can be precisely what caused the hemorrhage and hemorrhage in general. More women are told that they hemorrhage then who actually is hemorrhaging. So there's also that.

Hello, my name is Cara. Thank you so much for creating your podcast. First of all, it's been an honor to listen and I've been listening for the past few months during my first pregnancy, learning so much. I will have a doula for my birth. And I'm super excited. But my question is, Is it normal to pick up your doula I kind of am new to this realm and didn't know if I should have a thank you card with like a gift card or some sort of tip ready for her. But after my birth, I can bless her with that, but I wasn't too sure and wanted to ask, or you thought Thank you.

That's a fun one. We should definitely ask on Instagram asked the doulas who follow us and the women, whether that's a common practice, I personally I remember giving you and Amy a gift of jewelry after my birth. So I am a fan of tipping as a way of thanking but I like the idea of a more personal gift than cash so any doula listening might say to me, but I like the idea of selecting something that I wanted you guys to own. I don't know what do you think?

I have some very, very special cards that I really really value and appreciate that were given to me from you know, mothers after attending their birth I really value that. I certainly don't feel like I anticipate or expect gifts whatsoever in attending bursts. But when you do receive one it's it's really special. One woman actually gave me a photo album of the birth of all the photos Those and that was awesome.

Wow, that's nice. And your wife. So doulas midwives. I got it. How do you think doulas typically get gifts?

I honestly don't know. I really don't know. I think probably many do. But I don't know that it's like standard industry practice that you you know, feel like it's like tipping a waiter like a must do thing.

Yeah, I would say at a minimum give a heartfelt written card testimony. Yeah, just something that you're giving them from the heart as long as you had a good experience. Yeah, of course. I mean, in terms of gifts, what you say with your words is always going to be more valuable, I think, than anything that I agree. Yeah. Totally.

Hi, Cynthia en Trisha, this is Emily from Oakland, California. And I have a question regarding retained placenta. So I'm a first time mama who just gave birth to my darling baby boy five weeks ago, and I was actually an attempted home birth, but I required a hospital transfer, after 96 hours of prodromal labor and five hours of pushing. So I went to the hospital for Pitocin. And after they started the drip, my baby was born about 40 minutes later, however, almost an hour had passed after the birth of my son and my placenta had not yet come out. And it had to be manually removed by an OB. By the way, a full grown woman's arm of my uterus was way worse than giving birth to my seven and a half on baby. Anyway, I guess my question is, are retained placentas ever a result of anything besides placenta? accreta. No one made any mention of placenta accreta in my circumstance, and I can't find that term in any of my medical records. Also, I'm not sure if this is important, but I had very little blood loss after they removed my placenta. And isn't it true that with manual removal of placentas, in cases of true placenta accreta, that there's often a lot of blood loss and is a major reason for postpartum hemorrhage. Just because hemorrhage and major blood loss was not my experience. I'm curious for my next pregnancy because I fully intend to birth at home. And I just wonder if this is likely to happen again. Thank you so much for everything I love you both so much, have a good day bye.

Well, there are multiple reasons for retained placenta, it is certainly not always a placenta accreta placenta accreta is actually pretty rare. And a placenta accreta means just that the placenta has embedded so deeply inserted in appropriately into the uterine wall that when it's time to birth, the placenta, it can't separate normally. So as the uterus is contracting down, it's supposed to sort of shear the placenta off the uterine wall. And in a placenta accreta, that doesn't happen, you can sometimes get a partial separation, and that's where the bleeding really comes in. If it hasn't separated at all, you may not actually bleed. So I don't know that she had a placenta accreta. There are other things that can cause retained placenta, the most common is a uterine adenine, which means that the uterus is just tired and baggy and not contracting properly after birth. So the placenta isn't sheared off the wall. That is a result often of induction and overuse of oxytocin, or Pitocin. Excuse me. Men, women who have had more pregnancies are a little bit more at risk for this. If you had a uterine surgery, and you have scar tissue, you're a little bit more at risk for this also. Sometimes IVF is associated with retained placenta.

It's sort of like we said last time, did she really have placenta? accreta? Or do we assume she had placenta accreted because it didn't come out within the hour? Right? And then the other questions would be, how did they try to get the placenta out before resorting to the extreme measure of manual extraction of the placenta, which just pains me to think about, and I remember in our episode with Barbara Harper, Episode 200, she said, she initially said that is never necessary. And she just barely bent and said, virtually never ever necessary. So how else could they have gotten that listened to? And then? Did they wait long enough? Did she sit upright? What were they doing before? That's right, and is it actually retained placenta? Because we didn't give it enough time. So it's getting the diagnosis of the retained placenta? If you go in after 30 minutes and manually remove it. Now you're calling it a retained placenta? Right? When if you would have waited 15 more minutes or half an hour or whatever it might have taken. I've had placentas, I've seen placentas take two to four hours to come out and after birth. That's not the norm. And that's not ideal. But it does happen. So we have all these placentas that we're calling retained. But maybe they really are not retained. We just were impatient.

I think part of the risk we have the way we practice obstetrics in maternity care in United States is we're always talking about what's normal. And then that's how we sweep women into all of these interventions. For example, to say it's normal for a placenta to come out between, let's say 15 and 40 minutes, then when it's an hour long, we can only conclude that Oh, this isn't normal. So it's bad, but when you read Look at what's normal. The range is vast. It's like some placentas come out immediately after the birth within moments, and others can take, as you just said, a few hours. So the assumption that normal, which just means the most common is the only safe way something should happen is where we go down this other path of all this other intervention. And we're doing that with women, everything normal baby weights, normal baby sizes, normal due dates, it that's not to say that this wide range with these tail ends of the bell curve aren't also as safe as the most normal outcomes in the middle.

And we're not comparing physiologic birth of the placenta to physiologic birth of the placenta. In a normal undisturbed physiologic birth, the placenta typically shears off the uterine wall on that third contraction, that's sort of the standard expectation. That's the average time that's what's supposed to happen. And there are many other factors that play into our labor that can influence whether or not that happens, most notably, induction and the use of Pitocin which creates that tired uterus so the uterus can't do its job after birth to contract on that third contraction and separate the placenta.

Highlight ladies, this is Nicolette from Houston and I have a question a niche question about vitamin A. I had previously been supplementing with my normal prenatal a probiotic and some grass fed beef liver capsules. In the real food for pregnancy book by Lily Nichols. She recommends increasing beef liver intake in general and help for health and for pregnancy. And I don't really like the taste. So I've been having these capsules. And I recommended them to someone on one of my due date, Facebook groups and a couple of mums from other countries I think Iceland and somewhere else somewhere in the UK had said oh no beef liver is a big no no here, we actually are encouraged not even to eat like carrots because of the increased the level of vitamin A. So of course then I did some digging and calculated out how much vitamin A I was taking a day with my prenatals which is 5000. I used Amman like the full well ones, I think clinical is recommended those two. And if I take the max dose, which is six capsules of the beef liver, also 5000 I use that 10,000 Total a day. And with a healthy branded diet, I'm sure I'm getting vitamin A through my food and I I do love carrots. And I'm you know, other meat products and stuff. So I was just wondering, I mean, I know there's a risk if you have a super high amounts of vitamin A, that I've never heard of this until I was on my group. And I just wanted to see if you had any thoughts that stopped taking the beef liver? Or are these a safe level? I'm in my second trimester of pregnancy. And yeah, hope that you can help. Thanks so much.

I think the first thing to say here is that with vitamin A, the bigger concern is generally that women are vitamin A deficient. Vitamin A toxicity is a lot less common. So most people do need to be focusing on getting a little bit of extra vitamin A plus she did say she's in her third trimester, the risk of too much vitamin A is that vitamin A can be teratogenic. So it that that means it can cause birth defects. Oh, so you don't you do want to be careful in the first 60 days. That's why things like retinae skincare products are not recommended in pregnancy, because those are retinol vitamin A based. So she's well past that time period. First of all. Second of all, like I said, most people are coming into pregnancy somewhat vitamin A deficient. I can't imagine ever avoiding carrots. That sounds crazy. You're just not going to overdose on vitamin A eating carrots.

Right? You'd have to have so many carrots, but it is fat soluble. So I guess the question is if you keep having 10,000 I use a day or if you keep having a lot of it. It could potentially be serious for anyone whether they're pregnant or not. So the question if you keep taking high doses for almost a year, is there a point at which you just should really cut back? Or have it tested? I think everything is in moderation. You know, maybe you don't take a vitamin A supplement every single day even something like vitamin D, I don't I don't take every single day. I take it because we're mostly deficient in it, but I don't take it every day. But in general 80% of women of childbearing age are actually vitamin A deficient. So taking some vitamin A is actually probably a good idea. The risk is much less than the risk of being deficient. The risk of excess vitamin A is much less than the risk of being deficient.

Hi, I'm I woke up with the weirdest question and I thought you guys could give it a go. You all mentioned on the previous podcast that there's so much importance in the first couple hours after you give birth that holding the baby and the golden hour, it's so valuable. And the day's following about helping with hemorrhaging, and just all sorts of health benefits. And I'm wondering how that applied to surrogate mothers, women who decide to give birth to someone else's baby, and as they give that baby to the other mother? How does that translate to their health? And what does that look like for them? You guys are great. I love your show. And just super interested in this question, and would love to hear your thoughts? Have a good day? Bye.

That's an interesting question. My first thought is that the mother giving birth, should have that baby until the birth is over. So when the baby is born, I still think that that baby should probably be put on the birthing mother's chest to help with the birth of the placenta. As soon as that happens, the birth is over. I don't know. I mean, I just think for the physiology of birth and the birth of a placenta. That's kind of what the body expects and anticipates. What do you think?

What was her question? Specifically?

What at what point should the the so the surrogate mothers giving birth? And at what point should the adoptive mother get the baby after birth?

I don't know, the correct answer to this. But my my inclination is that the baby should be with the birth mother, at least until the placenta is out. And ideally, a little more time there is that golden hour to cherish where that birth mother and the baby get that surge of endorphins. I guess we're presuming the surrogate mother isn't breastfeeding. So I'm not sure about breastfeeding, because that would be the next thought process here. But I would say, up to an hour would be wonderful. Unless breastfeeding is with the other mom. And is the priority, I don't know. But I think the important thing is how should that transition go when it does happen. And in the absence of knowing the perfect, precise time, because we know what we know, is physiologic birth, and that does mean the birth mother is the mother. So we really don't know about this, but how should that transition go, we would want to see that Mother of the baby, taking off her shirt, and taking her baby skin to skin as soon as she does get her baby and pick up from where the baby left off with bonding. And make a while the baby is with the surrogate mother have a little article of clothing of the mothers there so the baby can start to smell the mother at the same time while that bonding is initiating. And then the transition might feel a little smoother for the baby. I don't know I'm sure there isn't much science on this yet. Because it's just not something there's no science on this, I would say anything to ease the transition when the transition happens, I think would be the most beautiful thing. Like moment of transition, I think you have to protect the birthing mothers safety by keeping the baby on the birthing mother until that placenta is born. And then whatever you want to do after that whatever feels right at that point, but I'm sure the adoptive mother is right there through the whole thing in the room. You know, being part of it, you can be touching and holding, being close to the baby too. So interesting question. Yeah.

Hi Trisha and Cynthia, I wanted to ask a question about spousal relationships with partum. My husband and I have been married almost seven years, and we are just that weird couple that we just don't argue like, we're just we're best friends. We're both like very similar personalities. But I will say the last, you know, six months of of being parents, it has tested our relationship in ways I had no idea. And, you know, I'm finding myself with postpartum rage. And I've even put a hole in my wall with my foot. We're just so unlike me, and he knows that I'm struggling with postpartum emotions and just kind of up and down. So I guess my question is, when does it get better? There are times where we are just like, really at each other and, you know, 10 minutes later, we could be fine, but it is stressful because we've never we've never really had problems like this. But you know, once the day became it just it's like, everything tighten. You know, we're losing sleep. I feel like I'm sacrificing a lot more than he is naturally because you know, breastfeeding and you know, Well, I'm a stay at home mom. And he worked. So really, I'm sacrificing you know, my time at the gym, and I walk my dogs because I'm taking on a lot of roles. Whereas, like, when I look at it, it's like, his life hasn't really changed. And I think that's part of where, you know, my frustration comes from, because he'll act tired. And I'm just like, buddy, even though. So I guess my question is, is there any advice on how to navigate getting into these new roles? And I don't know, not having resentment towards him, just because he's not really, you know, not much has changed for him. And that's okay. But a lot has changed for me. And I'm trying to help them understand that. You know, that everything has changed for me. So I guess I'm just curious if other women or other moms go through this shift, where, you know, there's just a lot more tension postpartum. Like I said, things are getting better. And, you know, baby trying to get in a better schedule, so we're doing good, but it was something I was totally unprepared for was the tension in a relationship. After a baby, I was so not prepared for that.

Well, the first thing is, make sure you look up our mini episode on postpartum rage. It's episode 87. A lot of women have been listening to that episode lately, because I've got a lot of rage going on in my Postpartum Support Group. And I know some of those women are recommending that episode to other women. The interesting thing about rage is that it has a trigger. And then it has an outburst. And it has guilt. Like it's the only postpartum situation where we have this cycle. So you're recognizing your husband? Is the trigger the husband? Yes, that you love and adore? Yes. This is why it's a special condition called postpartum rage. Your language is pointing to the fact that that's what you're suffering from a little bit. I mean, you said like, this is totally out of character for you. You've probably never bought a sheet kick through a wall. You've probably never put your foot through the wall before. You're loving. Trisha, you did? You did, right?

Yeah, I've been there. I once put my foot through a wall, a closet door, actually. Yeah.

And you're super chill, super chill. Not in that moment, at that moment, push me to the edge.

Yeah. So that when you recognize behavior that isn't normally yours, including language that isn't normally yours, like swearing or something, and then you feel guilty. And that's why you're calling into down to birth show and you want to talk it out. So you're aware of it. And that's why you feel guilt. Because you know, you don't want to feel this way toward the husband that you love. The most helpful thing to do, you actually hit the nail on the head, you realize his life hasn't really changed all that much. That's a realization most women and it's a very difficult one to sit with. Your life has completely changed. And you might recognize your partner's life, even though they feel their life has changed, the biggest way your partner's life has changed is probably that you have changed. So for you, it's just that your life is revolving around the baby. So recognize that it's a normal response to realizing that you're temporarily powerless over the situation you're in that your life has changed, you have to sit in it right now. And that you are probably sleep deprived as well. You're aware of this cycle happening, you're aware that your partner is the trigger, and just keep doing what you're doing, recognize what you're feeling. And if you can change that trigger at all, that's where we can control the rage a little bit. So I don't really know if you want to change that alpha cycle so much as just if you're wondering why your relationship with your partner has changed. But that is the norm right now. This is in the in, in the case of a long decades long marriage. This is known to be one of the most difficult phases of life for a marriage. So you've been there Trisha, would you want to say about it? Do you still kick your foot through walls and closets?

Not at all? No, I haven't had I haven't I haven't had any feelings like that. And many, many years. When you start sleeping again and when you get past those exhausting, exhausting days of early motherhood, you know that underpins the rage so that for me it was sleep deprivation I just could not function like a normal person because I was so sleep deprived. Now I sleep amazingly well and plenty so it passes Yes. And the
other thing is to realize it's happening because none are so few of your needs are being met right now. Like going to the bathroom you need a whole strategy or you need to bring the baby and use one hand to pull your pants down or something and you need to find your your husband or your partner and have them hold the baby everything is difficult right now. So you can often think about how do you get that little bit of self care into your daily life don't think in terms of manicures and pedicures and massages we have another mini episode dedicated to self care because I think that's really problematic that we always give women this illusion that they need to go have a special date night and or they need to go get a pedicure Do you need something in your daily life where you get a break? So it might be worthwhile to talk to your husband about what point in the day is he always going to step up and take care of the baby and view is he always going to have the baby, the first hour of the day, maybe before he starts his workday and make you breakfast in the meantime, is he always going to come home and take the baby right off of your hands, and do bath and bedtime, you really need to find that reprieve in your daily life so that you keep getting reprieve. It can't be a special one time event that costs money and requires logistical planning that has to be worked into your day. So if you haven't done that with him yet, this is the time.

manicures and massages are almost anti self care, because most of the time we feel guilty doing them and we feel guilty that we're way we've made me feel guilty spending the money. And so it's like it's not even that relaxing. True Self Care is finding that thing that is incorporated every single day into your life that you can count on as knee time that makes you feel more yourself that makes you feel more at peace that makes you feel like you're filling up your cup. That's different for a lot of people, but it really it always involves time out for yourself.

Okay, so that's a wrap for the regular episode. And now for our Patreon subscribers and Apple subscription now on to the questions in our extended every episode. Otherwise, on the quickies. Here we go. Are you ready? I'm ready.

Should we see how quick we can be on our quickies today?

I know you like them quick.

That's the point of the quickie. Well, not too quick. They're not one word answers are too quick, isn't it? Wouldn't that be fun? No. Does it balance? That'd be fun to just like force us ourselves to answer every quickie in five words or less.

Should we do the first five like that?

Oh, it'll be too hard. Let's try. Okay, we can definitely answer the first one in this way. Okay, ready? Here we go. Okay, quick one. Is a glass of beer good for breast milk? Yes, really? It can help.

But it's so surprising. I had no idea. Okay.

Can I prevent tearing with oil and stretching?

All right, under fewer than five words. I'm not a fan. Probably not see, but now women are wondering why and they liked the details. And I would be saying Why aren't you a fan. So many experts say no to this because the argument is a that it's unnecessary, be that it's painful and see that it's likely ineffective. We're not looking to weaken and soften the tissue. It's supposed to be taught and strong. When the baby touches the perineum, you get a surge of relax into the perineum that allows it to yield at the moment of crowding and birth. So we don't have to do it just as the mountain goats and the pigs and cows aren't inserting their hooves vaginally and stretching their perineum. So nor do we have to there wasn't five birds or fewer. But it was can't do it. We can't do it in one word.

Chances are second baby being early if the first baby was three weeks early. Right? Well, we hire maybe we hire slightly higher but not definitely not a guarantee.

Definitely not a guarantee.

Definitely I guarantee and my family my mother, all three of the daughters were born at 37 weeks and the son was born at 40. What are the best early labor distractions other than walking? distractions, distractions and early labor.

What are we what is this question about distractions? Well, how to when you're in early labor? How do you kind of distract yourself? I went to New York City. That was a good one.

Remember when Yvonne Strahovski was on our podcast and she talked about walking around. And people were recognizing her so she couldn't get the peace and quiet. She really wanted to walk around. You don't want to think about it too much. When you're in early labor. You you want to just go about your day and act like it's kind of not happening. All right, your thoughts on bed sharing? Do it.

Yeah, pro bed sharing. That's easy. If anyone tells you it's risky or dangerous. That's because there are specific things that can point to that like having the baby between you and a wall is dangerous. If you're obviously a drinker or smoker, that's dangerous. There are ways to do it safely and responsibly. And that is what we're advocates of
no pets in the bed. All right, can you can you get Botox while breastfeeding? You can really nobody will do it.

You can sure Botox toxin though.

If it doesn't travel in the body. It doesn't. Where does it go to get into your breast milk? Really the minute Botox is injected into your skin, it binds to the muscle receptor. And there it stays.

All right. I just want to tell this woman you're young you're having babies you don't need Botox. Botox, that's my answer. You're beautiful and you're radiant and I don't care who you are. That's my quickie response.

All right, do newborns really need to be fed every three hours overnight? Yes, in the beginning, they do in the first two weeks, they should not go more than three hours. That's how you ensure that you get a good milk supply going. Because every three hours is really only eight times in 24 hours and newborns should feed 10 to 12 times in 24 hours.

Next, Next, who's on your bucket list to host on the show?

Ina may Gaskin okay. I met her. You know, I met her right. Yeah, I had breakfast with her for two hours in Virginia, about 10 years ago. Nice. And I didn't think to take a picture. And I it's one of the only times I had a very meaningful conversation and almost immediately forgot everything I learned as soon as the conversation was over. Because you were so starstruck. I was I was just so happy. I was just so happy being with her intuition pictures, her grandchildren. And I asked her all the questions. I had about reach vaginal births and twin births. And yeah, I just, it was very special. But it was a very momentary thing in my life, and I have almost nothing to show for it. Now.

Who else is on our bucket list?

Think about this. Oh, I know who Atlantis Atlantis Morissette. I would be so happy to have her. We would totally be friends with her. Yeah, I know we would be we would totally be friends with Linus Morissette. And she had homebirths. Very simpatico, right.

Yeah, we need to create that bucket list. Let's get on that. We do. Next question,

Alanis, if you're listening call us.

We know you're listening. Bubble bath or long hot shower. That's an easy one.

You're gonna say bath. Of course.

I don't actually use bubbles. I would probably say salt bath.

I don't know. I usually venture toward a shower, but they're both nice.

I think about this just more relaxing than a shower. You're laying down and you're relaxed. What did you do with your placenta? I buried each one of mine in a different location because each of my children were born in a different home. So each of their placentas is buried in the yard in that home where they were born and planted a tree. Actually one is buried under a lilac bush.

Who can who can top that? Anyone follow that?

Next, is it really best to never wash? Your vulva was soap?

Where do you hear that?

Is that a thing? Yeah, that's a thing.

Because soap can alter the pH and I like to keep a nice healthy, balanced pH. So yeah, no soaps, water only. It doesn't need it. It does not need no no, you know, humans bathed with water for years and for millennia, but that's funny. How does a woman know if she doesn't have a nice balanced pH?

She gets yeast infections and bacterial vaginosis and odor. Okay, itching discomfort. Okay, next is the best herb to help milk supply. Well, the most commonly one most commonly used herb for milks by is fenugreek. But not everybody loves fenugreek some people it bothers some people believe that it actually decreases their milk supply. I have almost never seen that. But a few other herbs that are great are fennel, Moringa Shatavari, goat's Rue, nettles, red raspberry. You know people respond differently to different herbs. So I think that trying a variety of herbs when we're talking about helping milk supply is a good idea. Hops. That's why beer works.

Very impressive list. There's more.

But it's a quickie. True. So we got to move on. Final one. What are your astrological signs?

Libra. You're a

Libra. I'm a Virgo. But I'm a cancer rising.

And I'm a Leo rising. You're Leo rising.

Yeah. My mother is a Leo with a Libra rising. So we're highly compatible.

Yeah, I feel much more into my rising sign than my son's on at this stage of my life.

What's your rising sign cancer. Oh, I love cancers. I get along very well with cancers. That explains it. Yeah. Yeah, I've I've said that forever. Yeah. I feel that I feel I've lost a lot of my Virgo tendencies over the years. Well, guess what?

It's a full moon tonight.

So that means babies will be a coming.

Have a good one see you guys next week.

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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