#215 | May Q&A: NSTs, Short Cords, Boundaries, Fetal Ejection Reflex, Decels in Labor, Artificial Rupture of Membranes, VBAC, Postpartum Doulas

May 31, 2023

Hello! We are back with the May Q&A.  This month we kick things off with a short conversation on obstetrical rhetoric around the risks of cesarean birth and induction, followed by your excellent  questions on:

  • Short cords and small placentas
  • Setting boundaries with well-meaning parenting advice-givers
  • The necessity or not of Non-stress tests (NST) in late pregnancy
  • True medical indications for artificial rupture of membranes (AROM)
  • VBAC labor contractions and an interesting tidbit on the impact of eating dairy in pregnancy 
  • Supporting the fetal ejection reflex (FER)
  • Can coffee (yep, you read that right) prevent tearing in labor?

And in our extended version of this episode, we dive into:

  • Ultrasounds in late pregnancy
  • Pap smear recommendations
  • Fetal heart rate decelerations in labor
  • Postpartum doulas and how they can best support breastfeeding
  • Umbilical cords as bungee cords or not?
  • And of course, everyone's favorite, a round of quickies!

Pitocin Episode #134 here.

Join us over on Patreon or subscribe on Apple podcasts for the extended version of this episode. 

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View Episode Transcript

I personally am not seeing the evidence for having artificial rupture of membranes take place, certainly not routinely during birth. This is when doctors and even some midwives say, Alright, time to break your water. And the implication is that it's going to help things along, which is always a red flag. I'm wondering if non stress tests at the end of your pregnancy are necessary, especially if you've had a normal pregnancy with
no issue, there are certain deceleration patterns that do indicate that a baby might be getting into a dangerous situation. However, it still is true that electronic fetal monitoring routinely and continuously does not improve outcomes in babies and does increase the risk of C section and NICU admission.

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.

Before we get into this month's q&a. Trisha and I have just been looking back on some of the birth story sessions we've been doing with with women in which they work with us privately on Zoom and a 75 minute session to go over their births and the stories we hear. I mean, Trisha, we've got you and I have a ton of experience between us. But sometimes we're both so surprised. Are we not by the things we hear doctors say and and such.

Well, we know it's we know what's out there. But then when you really hear that it's actually still happening. Yeah, sometimes it's still a little shocking.

It's concerning because any of us would be inclined to believe the the doctor that we're sitting there with, right? So let me just share the example that that we very recently heard. There was a mom with her with her obstetrician at the end of pregnancy considering because of course the conversation was prompted by the doctor considering whether to schedule a C section or have an induction the choice of the choice of the century is of the two evils, right and but here, but listen to this, listen to this really bad information. The mom wisely asked, What are the risks to the baby have a C section? And what did the doctor say? There on? The words were absolutely none. And the World Health Organization has reported through all the studies, they've done a 400% to 1,000% increase in adverse outcomes for babies who are born by C section. And of course, that's not to say every C section is more dangerous than if that hate baby had been born vaginally. It's statistically all things equal it is significantly more dangerous. Absolutely none was the response. Then the mother asked, and what are the risks to induction? Oh, so the doctor said absolutely none. Only to only you, we could accidentally nick your organs, but there's absolutely none to the baby. Okay, and then she said and what are the risks to induction? And then the doctor flipped it. There are none to you only to the baby. I mean, Trisha. Trisha? No, I'm looking at you. But see something. That's unbelievable. Yeah. How long is the list of risks to every single induction drug? A couple dozen items long. But they don't run to the baby? Well, I think we could probably ask pretty much any woman who is being offered induction, especially in elective induction at 39 weeks, what her doctor or midwife says are the risks to it. And they're going to say it's better to have the baby on the outside than the inside.

But here's my concern. These women are following the smart protocol to get information and all it takes is a doctor to give bad information and the woman feels she did what she can do. She asked, but who's there to stop her from receiving bad information from an unethical or uninformed doctor. very concerning.

Yeah, I think we just closed that conversation with you know that. In the case of the unnecessary in we're talking about the case of the unnecessary cesarean the risks are significant to mom and baby. And the same in the case of the M necessary induction, which is so so many of them because so many are offered for non medically indicated reasons. Now, we're not talking about the the needed C section or the needed induction, where there are more significant risks. There are an abundance of risks in both situations to mom and baby. So for a doctor to just dismiss red flag, rhetoric, borderline malpractice, just how would one know is that is the problem? How would one know she's receiving that bad information? That's where we're still stuck listening to us? Yeah, no, just keep getting informed. That's right. Try to try to recognize when you're not working with someone who's who's got the information straight. And you know, doing your own research online, like look up, look up the risks, they're very easy to obtain. And they're very, they're very serious, no matter how rare or they're very serious. All right. Shall we start with our first question? Now, Trisha, let's do it. Alright.

Hi, Cynthia. And Trisha, I first wanted to thank you guys, for your amazing podcasts. I listened to it for months leading up to my birth, first birth in December, and had an incredible birthday, I felt had a ton of informed consent, and was just wonderful. And I owe a lot of that to you guys. And my question is, my baby was born a little over 37 weeks, he was full term and all of that. But when he was born, I was squatting and caught him. And the midwife had said, short cord. And so he was placed on my stomach, rather than on my chest until seven or 10 minutes later, when they were able to cut the cord. They did note that the cord was, as I said, short, and the placenta was smaller than normal. And he was healthy and perfectly fine and had was, you know, born without any issues, and is a healthy, chunky baby now. But I do wonder if that's something that you ever have experienced and what it could possibly mean, the midwives were not concerned at all. And like I said, he's healthy and wonderful now. But I was just curious if that's something that you've seen before. Thank you guys so much.

So short cords are possible. umbilical cords can be between one and three plus feet long, which is an enormous barrier once again, talking about what's normal, right? I mean, when in the future, are we going to be measuring the length of cords in utero and saying your cord is too short or too long? Right? That's is that the probably common, right? I mean, you know, anything they can think of be cut, but that's normal. So yes, when you have a short cord, the baby comes out and goes quite low down on your stomach. And that's just you know, you just wait until the placenta is out. And that's fine and normal. She did mention having a smaller than usual placenta, I guess they told her that. And usually, it's my understanding placentas sizes are kind of commensurate with the baby's weights. And she didn't mention her baby's weight. All we know from her question is that her baby was normal and fine, but her baby might have been on the smaller side and the placenta accordingly might have been on the smaller side that doesn't indicate at all that there was anything wrong with the placenta, we can see that there wasn't because she had a normal birth and a healthy baby. Did you ever hear anything to the contrary in your training at Yale, Trisha like that? Isn't the cord length, a random arbitrary component of pregnancy and birth?

Well, we do know that cord length correlates with activity level of the baby in utero. So really active babies tend to have longer courts. Really?

I mean, that's what I was doing. Yes. Interesting. Because the level lengthens the cord or, or maybe they're more active because the cord is naturally longer.

That's what I'm wondering if there's a correlation as a fact what right what is the what is the nature of the correlation, I think is the question. Very interesting. Okay. But yeah, do you agree with everything I said? I do. Yeah. Okay. shortboards happen. Shorts, they just they happen and short chords are a variation of normal. Hi, ladies. I wanted to submit a kind of a relationship question for spouses and family members, etc. I recently had a baby back in October, and you know, the first time mom and I feel like people around me don't really trust my mom instincts that maybe they know better because they've had more kids or whatever. And I'm struggling to set a boundary of what I know best for my daughter because I do I do know her best. And, you know, being kind because I understand that their point is to help but I'm finding it really difficult to kind of establish my role with other people. You know, obviously my husband is great dad, amazing husband, but I'm trying to help him understand that like nobody can read this day better than I can not even him and I don't want it to offend him or hurt his feelings. But as a mom and a woman I I'm very, very good at reading people, even my dog. But my baby girl, there's been several times where he goes, you know, oh, she's fine or no, she's used to two ounces. I said, No, no she can use for. And of course, you know, 30 minutes later, she's screaming because she's not full. So I'm trying to figure out a way to balance, being able to kind of take the reins, I am a stay at home mom. So this is my full time job, if you will take the reins without offending or hurting anyone's feelings. You know, it's difficult when my mother in law's in town or my husband is trying to do something that I already know is not going to work. And I have to just sit back and like, watch my daughter cry until he realizes that I was right. And, you know, it's not it's not about being right, me. But I do know what's best for my daughter. So I guess my question is, how do I navigate this? I'm the mom. I'm the boss kind of role, while also letting others like help and contribute. But I'm struggling to kind of get that respect as like, okay, deafness that, you know. So that's all?

Well, first of all, my heart goes out to her because, and my heart goes out to her husband, honestly, because this is a very common situation, I think it's totally, I actually think it's totally universal. What in any heteronormative relationship where that mom who gave birth is home with the baby, if not full time for at least several weeks or months. And what happens is she gets so much experience so quickly with her baby, she just knows she understands how to read the baby, how to understand what the baby needs, what the baby will respond to, why the baby is acting a certain way. And then incomes her partner for that one or two hours per day, if they're lucky if that if they have that time to dedicate after, let's say after work each day. And what what's going on for the partner is they just want to bond and they just want to feel valuable. And they just want to feel like they have a role in the baby's life and let it be said not feel marginalized. So sometimes what happens is they they take a stab at it or they say no, no, I think this is what they need, or I think this is I think they're good now or I think this will make them happy. And that mom is standing by just thinking like, Okay, do I hold my tongue and go through the, like the complete frustration of watching the baby, start crying in a couple of minutes because this isn't what they need. Or do I speak up and hopefully prevent a crying outburst from the baby and risk offending or hurting my partner. And it's just it's, there's really almost no advice we can give. Because this is such an expected situation. In a relationship where one parent is getting lit quite literally 24 hours a day of experience, where the other parent is racking up if you're lucky, one or two hours a day of experience. And usually that experience is shared with the baby, they're not even the sole parent for that one or two hours. So it's just so hard.

I think there's always the element to of like picking your battles a little bit like there's going to be certain things that you are just going to be the boss of like just no questions asked like this, I'm the mother and I'm making this choice. And then there are other things that you might bend a little on, you know, like, what the baby wears, or how to change the diaper or how often to change the diaper. Some of that some of those little are things that you can just sort of pass off to to other people and take their input. But you don't have to, you can just do it all your way.

I do think it's a different situation with the in laws, I think when they're giving opinions that you really don't need, you just have to find a polite way of drawing a boundary. I think sometimes as new moms, we can want to be really firm in that. Like I'm the mother now kind of tone. I don't think that's necessary. And it might be something you will wish you were softer about years later. But I do think drawing a boundary is very important. And just politely extricating yourself from the conversation and remembering that to explain yourself. When it comes to your decisions. You don't have to argue about your baby. You don't have to assert why you're making your decisions for your baby, right? So you just have to politely remove yourself. And by default, you get to make all the decisions anyway, when you made that comment about struggling to get the respect as the mother, I do think that it's not something you need to take personally when it comes to your partner. They're really trying to find their place in this incredibly intimate bond between you and the baby. And they need to find their place in that. And I think that wanting respect from everyone else is legitimate.

The reality is that a mother is going to know her child best always says this always.

Hi, I'm wondering if non stress test If, at the end of your pregnancy are necessary, or not, especially if you've had a normal pregnancy with no issues. Thank you.

Well, let's just start by explaining what an NST is. Yeah. So a non stress test, or an S T is a fetal evaluation of the baby's heart rate. It can be part of a biophysical profile, or it can just be the fetal heart rate monitoring on its own. So they're looking at the baby's heart rate, especially in response to baby's movement. And then it's evaluated as either reactive, or non reactive. So this is pretty routinely done in late pregnancy if you're in a hospital based midwifery practice or an obstetrical practice. But the thing is that there is no real solid evidence that NST screening actually lowers long term adverse outcomes for babies. So, yes, might it actually pick up a baby who is in a potentially dangerous situation? Yes, but does it have a very high false positive rate? Also, yes. So these tests can create a lot of stress for mothers unnecessarily.

I always find that ironic, they're called the non stress test, to do the stress tests, to better name they are. So there are certain conditions in pregnancy where an NST is going to be more like legitimate, any any high risk pregnancy, or if a mom is actually coming in noticing that she has decreased fetal movement than a non stress test is going to be really important, and it's going to have a higher predictive value. But just again, as we always talk about on this podcast, the use of routine intervention, in healthy, normal, physiologic pregnancy, can often lead to unnecessary stress and false positives and interventions that probably are not really necessary.

Hi, ladies, this is Amy calling in from Texas. And I had a question about rubber rupturing membranes. So my first question was, is there ever a medical indication for artificial rupture of membranes, and then also, if you could talk about any potential benefits, risks and alternatives? So women can make informed decisions in their labor? Thank you.

I personally am not seeing the evidence for having artificial rupture of membranes take place, certainly not routinely during birth. This is when doctors and even some midwives say, Alright, time to break your water. And the implication is that it's going to help things along, which is always a red flag, because we're not in a hurry. And the baby in a normal birth does not need any help. ACOG has even gotten much more vocal about this in recent years, I believe, as of 2017, they started getting louder about this. And their most recent statement, I believe, says that more than 15 Studies have now shown it does not speed up labor. But up until they said that for years before that a decade before they said that. I said, even if it does speed up labor, which we knew wasn't in the research, even if it does, how does that make your births safer? Why are we always in a hurry? Years ago, I had a home birthing couple. Because usually in every class, I teach that one to two couples are having a home birth, and this couple called me from the hospital. And they said they were originally transferred and I said what what caused it and they said the midwife broke her water to speed up labor and I thought homebirth midwife did this to you. Now what also can happen is that dental exams, we sometimes see that midwives are giving or doctors are giving women vaginal exams, and they're without the woman's knowledge, rupturing membranes, and then sometimes the woman feels very sick, she sometimes vomit, sometimes her contractions or her surge is very, very intense. The whole labor changes course. Trisha, I would love you to answer this part of the question, what are the benefits? I always feel like if it's like the step before a C section, maybe give it that one last effort, I would say there are really very few benefits, there might be a very specific scenario where it could be beneficial and that might be a bulging bag of water, that's putting pressure on the cervix, but not enough to maybe help the cervix, get that last bit of dilation or maybe the baby's not coming down. So sometimes if there's that space between the baby's head and the cervix, and there's just that water in between, it's not really applying quite enough per pressure on the cervix to get that last bit of dilation. And I have seen this happen sometimes in maltose. And if you break the bag of water, sometimes that baby just comes down in the cervix opens and birth happens like is in a matter of minutes. That is the only scenario. But even then I would only consider doing that if the mother one really wanted it, she just wanted something or two if the baby was in distress, and you really needed to get that baby born more quickly. Otherwise, there's really zero benefit. And there's more risk you the main risk and breaking a bag of water prematurely is cord prolapse. You can create space for that court, they'll come out with the gush of water come down before the baby's head and now you're in a really dangerous situation. And then early rupture of membranes, like as part of an induction protocol, which is often how it's used, like, Oh, we're gonna start the Pitocin we're gonna, you know, break your leg water.

So bad is not effective. No, and it's so dangerous, it potentially makes labor more uncomfortable. It can also impede baby's ability to get their head in the proper position, you break that bag of water, you take away that cushion, there's not as much ability for the baby to move. Yes, it does potentially increase contractions, but that's not necessarily what we need at that moment in time. So very few benefits, and definite risks and a practice that really should be reserved for very specific situations.

Okay, let's do the next one. Hi, my name is Christina. I'm from San Diego. And I want to say thank you for your podcast. I just started listening my second pregnancy and absolutely obsessed. But I had a C section of my first and so this time around, I'm going to have a VBAC, and I'm currently interviewing midwives and birthing centers. And one of the centers, one of the midwife mentioned that with a VBAC, that labor sensations are going to be different because of the scar that I'm going to be feeling, you know, different things than a traditional labor. And I was trying to research and find any information on that. And I could not find anything that the sensations would be different or that I have to look out for different things. With laboring with a VBAC, versus just the traditional labor. So I'm curious if you guys had ever heard of that or had any clients that experienced that? Thank you so much for all you do. Right.

All right. Well, Trisha, guess who I reached out to for this one?

I bet I can guess you can guess. Queen of VBACs

queen of VBAT si Wainer. Yep. Because we you know, what, if this is you know, I always have to think like, I thought this was nonsense, but who am I to say that let me go to her. She's attended almost 3000 births. And she's attracted VBAC women over the past. What is it four decades? And there's no one who knows more about VBAC. So she gave me permission to read her response. And let me just warn you all she's a lot more outspoken than either of us. So this is her response. This is basically garbage. And her midwife sounds like more of a midwife is telling her this I wonder what other garbage she's telling her? I would like to know more how the midwife has described what the contraction feels like, whether she herself has had babies, what's her experience with giving birth with what VBAC is, and how she quote knows that the contractions will feel differently? I thought that was a really good point, right? Like, is this woman talking from experience? And is she just right? I mean, trying to get would be the only justification for saying something like that is that she has actually been through this and that is simply her experience. And that could be completely unrelated to having had having it be a VBAC birth. This is not something that is true. This is not something that's known. This is not something that people say this is not something people report. This is not something that's been studied. This is her opinion, this midwife, that's all.

Yep. And I just thought it was such a good point. It didn't even occur to me. That's so true. How do we just like I suspected it was wrong, but I never thought the way Nancy did like, how did she even come up with this? Was it a personal experience? Or did she just hear this from someone else? And now she's spreading the rhetoric. Let me continue with Nancy wrote, Mickey manga, and that's the founder of HypnoBirthing. Mickey Monken used to say prepare them, don't scare them. And I want to know what else this midwife is doing to, quote prepare this woman. How a woman perceives or experiences labor is based on so many things. Certainly a woman who has had a VBAC will have memories of her previous experience, quote, embedded into her bones, so to speak. And as we all know, tension produces more discomfort and pain. I want to know if this midwife is giving her some help with healing from the last experience on an emotional level, talking to her about diet and nutrition, because that makes a difference also, and is giving her some good techniques for helping the woman stay relaxed and calm this time around. Pain is generally a signal that something is wrong, but the sensations of labor is a sign that something's right. Many of the women whose VBACs I've attended and there have been so many of them, have said that this labor was easier than any of the ones for which they were sectioned. This time the baby's in position or this time, they're getting more support, or this time, they're in their own environment, which is supportive and comforting. This time they didn't eat dairy Mansi is very opposed to eating dairy and pregnancy. This time, they didn't eat dairy and this time they took long walks, and this time they connected in a different way with the baby. And this time, they are more determined than ever to birth calmly and vaginally. This time, they're not going to let discouraging or uneducated or an experience or uncaring or line professionals dictate to them. Other Labor's will feel like dropped.

Okay. But now of course, we're all going to want to know why she says we can't eat dairy in pregnancy. Oh, I know all about that. She said that for years. I heard her saying that in 2007 on stage and I was pretty impressed. Because I know dairy is acidic. And I know that it's been can be very cleansing and healthy to give it up for a while if not very long term. But she says and she has studied all the women with their food journals and their birth. She has really studied this and a lot of this has gone into her books. But to Nancy, this is basically the explanation about the dairy. Whereas birds have essentially hollow bones. They're very porous, they can fly. cows have incredibly dense bone. So the minute a cow is born or within an hour of a cow being born, they've bones are so dense, they stand up, and they strengthen out those little legs and they walk away from their mothers and humans have semi porous bones. So we can neither fly nor can we stand up within an hour of birth. We take approximately a year to stand up and walk away from our mothers. Nancy is convinced from her own experience that when a woman consumes an inordinate amount of dairy, I'm not just saying some dairy, some women are told to have more dairy in pregnancy, so they have so much more than they even want to have. And Nancy has seen that when women have an inordinate amount of dairy in pregnancy, she is convinced by hurt by what she has witnessed those babies are just having a little bit harder time coming out because of those bones. Well, bones are supposed to be malleable in birth. Right? Of course, well,
they need to be able to move. That's right.

And Nancy says that when she when she has seen that difficulty, and she's she got herself to the point where she could anticipate it. If a woman had come to her let's say in her eighth month and said I'm doing a good job. I'm having extra dairy Mansi would say Okay, start you know, cut back on the dairy now get your calcium from another source or interest. Now, if women don't want to hear that forget you heard it here, everyone listened to yourself. But for the women who are curious and receptive. That's her explanation.

Very interesting. I would just add to that dairy isn't the best source of calcium. So if it is you are consuming excess dairy for calcium purposes, that's not actually going to help that much.

And it that and the reason it doesn't help. And you can read the China study or the pH miracle by Dr. Robert Young, there are two outstanding books is that because it's acidic, and those are for our blood pH and we have to restore it to 7.365 we have to actually deplete minerals including calcium out of our body in order to digest it and restore our pH. So that is exactly right. And when you have calcium from a non acidic source like nuts, it doesn't throw off the pH and you don't have to use calcium to digest it. Eat more spinach and kale. Absolutely. Salads all the way wake up and eat a salad. You know, oh, and my second pregnancy. I was craving shop salads in the morning. It was so funny.

I could not touch greens in my first pregnancy. I couldn't touch them. Oh, okay. Well eat more broccoli.

All right. Let's go on. Then. Thank you to Nancy and her website is birthday midwifery.com. She, she's in Braintree, Massachusetts.

All right, next.

Hi, there. Thank you both for all the work that you do. I just love your podcasts and all of the resources you provide. And I just had a question. I'm going into my third birth. My first was three years ago, gave birth to the baby girl where I got an epidural Eiken hours into labor. For my second, I went natural. And it was all good until the transition pushing phase which felt a little bit overwhelming. And I didn't feel entirely prepared just for that the mindset required for that portion of birth. So this time, I'm thinking of taking a HypnoBirthing class and just sort of trying to prepare more mentally for the transition and pushing phases. And I'm particularly interested in the fetal ejection reflex. So I was wondering if you could tell me any more about how to access that reflex. I know that it happens more at home birth in hospitals, they'll be birthing in a birth center. However, the birth center does not allow waterbirth only water labor. And so I feel like with my last First, when I saw, they saw me start pushing in the tub, I had to get out, or they told me to get out, I could have refused. But legally, I was supposed to get out. And I feel like that sort of ruin the mindset that transition out of the tub and into, you know, the bed. So, anyway, I'm curious if you've any advice on leaning into that reflex and allowing my body to do more of that work for me, and to hopefully avoid the overwhelming feelings I had during the pushing phase? Well, anything you know, I would love to learn from you. Thank you so much. Bye, bye.

Well, my first comment here would be that the, the place that you give birth, while important, it's really about how you feel during your birth. So the fetal ejection reflex can happen just as often in the hospital or in a birth center or at home, so long as you are in a birth mental space that allows for the physiology of birth to take over and be the dominant force. And you feel that you're feeling safe and relaxed enough that the cascade of hormones that elicits the fetal ejection reflex can happen, right? So she said she was worried about being at a birth center. Could the fetal ejection reflex happens still? And of course, it can happen anywhere.

Right? No, but but your birth space and how you feel in your birth, and whether you're feeling safe and relaxed and supported. And whether you have had an interruption in the physiology of birth, if you have had medication, then sometimes that fetal ejection reflex can be halted, because it requires that whole necessary cascade of hormones to kind of go through their their little dance that they do. Not that it can't happen with women who have medication, it can, but it's less frequent. So I think what she said about, you know, being told to get out of the water probably was the thing that disrupted it for her. Right? For sure. So, yes, it can happen anywhere. It is that last surge of adrenaline that happens right before the baby is born. It's nature's way of protecting that very critical moment. Before the baby is born. It is sort of the most potentially risky moment in birth is right as the baby is coming out of the vagina. And so that last surge of adrenaline is what gets the baby out quickly, and get your uterus to contract down. And that is basically what the fetal ejection reflex is. Okay.

Hi, ladies. I'm eight months pregnant with my second. I'm planning to homebirth within Certified Professional midwife, and she is requesting that I have coffee at the birth. At first I thought this was just in case, labor was going on through the night. And she needed a pick me up. But with further discussion, I realized that she uses this to help prevent tearing. Do you know anything about the effects of coffee on the perineum during labor? My gut is telling me to decline this, but we'd love to hear your thoughts. Thank you.

We're Where do people get this from? Whey have never heard of this. Well, neither has Barbara Harper neither has Nancy Waner. He quit where you asked around a little bit I asked around because I always try to learn you know, I always think what if this is a one in a million situation that I haven't learned about yet? Because it's one in a million? And they both said absolutely not. And they've never even heard of it. So it's like, what are we talking about? Like brewed coffee or coffee grounds a coffee compress on the perineum? That must be what it is. It's the only thing that I can think of is that there's something in the caffeine that maybe -

Trisha let's not finish creative plot. I appreciate your creativity there's not a thing and if you just say it once you know that one woman is going to tell the next one in her yoga class and we're going to be possible for huge the midwife just wants coffee at the burger was gonna be like, Oh my gosh, I don't have coffee in my birth bad yet. That's gonna be our fault. No, okay. If anybody out there has ever been told this or has ever heard a story about this, please write to us share, we must know where this comes from. Because never heard of it. Not buying it.

And to that woman I would really love if she would go to her midwife and say where did you hear that? Or where did you read that? And then send that to us because I don't think other women are going to have heard of this and I want to know where that midwife got it from. All right. That's it for For a regular episode, it's time to move on to the extended version for our Patreon subscribers and our apple subscribers if this is the regular version you're listening to it is time for quickies.

Okay, quickies. First one, what qualifies as a postpartum hemorrhage? Technically, what qualifies as a postpartum hemorrhage is the volume of blood loss, which is 500 milliliters, or 1000 milliliters counts as a severe, severe postpartum hemorrhage.

How did they measure it? eyeballing it, it's eyeballing it, isn't it that it is eyeballing it? There's no way to measure it. It's soaked into pads, it's soaked into blankets, it's soaked into, you know it's mixed with water. There's no way to measure it.

This is all estimation and why so many women are told they've hemorrhage when they haven't. And research shows between one and 6% of women do and the assumption is three. We talked about that in our famous Pitocin episode.

I mean, I think the only way that we can really qualify a postpartum hemorrhage is by looking at a mother's symptoms and bloodwork after the fact. Okay, next. Next, is it common for babies to prefer one breast over the other? Totally, totally. pretty much guarantee that's going to happen because we have different flow in different breasts we have different number of little outlets in the nipple, so that affects the flow at the breast. One breast usually produces more or less than the other. Sometimes it has to do with you know, babies have they prefer their head to be to one side, there's all kinds of things but yeah, 100% pretty much guaranteed. Next, how concerned should I be about a uterine rupture during the VBAC?

No, not very concerned. They're typically warnings letting you know that it might be an increasing risk. But the risk of uterine rupture for VBAC moms is only a little tiny bit higher than uterine rupture risk for first time moms and first time moms never hear about it. Never worry about it, never envisioned it and ever think about it. And VBAC moms at every turn, are led to fear it and envision it. So the safest thing you can do since it's unavoidable if and when it does happen is not think about it, and not envision it, and minimize the interventions that can increase the risks such as heavy doses of Pitocin. The Birth Center wants to perform a Hep C and drug tests in the third trimester. Is this necessary? A drum
test? This is one of those things sounds like the real game episode where the RH negative women say, Well, my husband is Rh negative. So it's not a concern. We don't need to get the shot. And when the provider is like, well, we don't know who the father is. Fired. I'm not here to assure you I'm here in the interest of my baby. So it's kind of the same thing.

It's kind of it's just another this is another example of Public Health Medicine dominating individualized care. So from a public health perspective, do we want to screen every woman in labor for drugs and hepatitis C because we don't know where they've been and what they do? Fine. But when we look at individualized care, know,
if a provider said to me, we need to do a drug test, I would say for whose sake because I already know I haven't done drugs. For his sake for your I need to assure her records in the interest of my baby's safety. I need to assure you, but I have not done drugs, that that's backwards. You're here to support me. I'm not here to make you feel better about this. Now, if you don't know if you have hepatitis or an STI or something like that, fine. Go for it. But the drug test, I can't believe that. I can't imagine one ever feeling willing to do that.

All right, next, I need protein snack ideas to get enough protein in the day. What do you recommend? Chickpeas? Snacks. Chickpeas. Yeah. Okay. roasted chickpeas. Don't
make fun of chickpeas in the snack. Oh, wellness thing. Come on us.

Yeah, great. I love almonds. In the middle of dates. Good and light and good and late pregnancy to nut butters are great. Deviled eggs, protein bars if you can find a good one if they exist. chomps if you're a meat eater, chomps meat sticks.

Is this another Midwestern thing?

No beef jerky? It's called the chomp. Chomp. It's like all the meat sticks. What? Okay, I never heard these are my go to snacks.

A chomp is the same thing or it's something else. As a meat stick, I can just see all the moms who want to chomp it's a meat stick but Is it beef jerky? Or is it just like a leg of lamb?

It's not like a lamb. It's like a stick of beef or turkey. That dried kind of dried. Well, if you'd like made it's good, Shawn. Okay. Can you wear underwear bras while nursing? So the risk with underwriters is that that that pressure extra pressure that the wire puts On your breast could restrict flow and potentially lead to plug ducts. So yes, you can wear an underwear if you feel more comfortable that way, but you don't want to wear it all the time. If you're prone to plug bucks, I would not wear it. If it creates any type of discomfort, I would not wear it. But you know, if you're going out, it depends on where you are in your nursing journey to when we're many, many months out, we can pretty much do anything. When we're in those very early weeks, we have to be a little bit more careful. So in the beginning, no wonder wires later. Yes, that's the what is the best time for a non pumper to pump if I want to make a small freezer stash. The best time to pump if you're just making a small freezer stash is usually after your first morning breastfeed whenever you're kind of like up and out of bed and feed the baby for the first time. So somewhere between like six and 9am, feed the baby pump for a few minutes after. As you guys probably know, I recommend only storing one to two ounces a day to not get into a oversupply situation, but usually in the morning because we usually have more milk at that time. Should fundal heights continue to match the number of weeks pregnant through 40 weeks? Well, in theory, that's the idea with fundal height. But that does not always happen. A variation of you know three centimeters can be completely normal and especially as the baby is moving down lower into the pelvis that can change how much sun is too much sun for a six month old baby. I would say it's the same as pretty much for any child. I mean, it has to do with how sensitive their skin is to the Sun and if they're getting burned. I mean if you have sunscreen on them, they can stay out longer. If you don't, they can't depends on how intense the sun is where you are, what time of day it is. So many variables but I think you just treat it like any person in the sun. So you know keep them covered, but let them get some sun. Why do you need to care about a baby's position in pregnancy and not just in labor? Well, one we need to make sure that the baby's head down the in pregnancy because then that's pretty much a guarantee of how they're going to start labor in late pregnancy and late pregnancy. Yes. And then how they are in late pregnancy is often how they start labor. So that's why it matters. So if your baby is posterior in late pregnancy, they may start labor posterior early. If they are breached, they're gonna probably start labor breech. If they're acing clinic and late pregnancy, they're probably going to start labor and that aids in clinic position. So they do start to especially in first time moms, they do start to kind of get fixed into position in late pregnancy and that's why it's important. Last one, what's your current favorite song on the radio?

No, I was just complaining about music the other day. I don't know I have if I ever had to pick. I had some probably a Taylor Swift song. Probably. She's so talented. I'm normally listening to like Matchbox 20 Rob Thomas, you know loopback stuff that was big in the 90s that's still my favorite music.

You know what mine is gonna be what? Country music

San Diego Bay this something's telling me this ain't over yet. Okay, I play it like 100 times a day and I've literally never heard it. I'll play it for you. I'm on my way to Westport.

I know. I'm so excited. I can't wait to see you and have dinner. Uh, thank you everyone for these great questions. As always, please support our good work on Patreon where we do two live classes with you every single month. See what the fun is all about? Go to patreon.com/down to birth show give it a try. Come hang out with us. It is such a good time. Such a great way to get education and support and community. And Trisha I will see you soon. Have a good one everyone we'll see you next week.

Interestingly, in and I don't know how we know this exactly, but it is also it is also believed that most postpartum hemorrhage is or the blood volume is actually under estimated.

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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