#245 | December Q&A: Your Holiday Traditions; Postpartum Hemorrhage; Failure to Progress; RSV; Precipitous Birth; Osteoporosis

December 27, 2023

Welcome to the December Q&A episode with Cynthia and Trisha! Today, we begin with revealing your holiday traditions and difficult family challenges of the season. Additionally, we share our long-standing holiday traditions. Next, we dive into your questions beginning with:

  • What are the signs of postpartum hemorrhage?
  • Is failure to progress dangerous and what can you do to prevent it?
  • Is it safe to use breastmilk to treat pink eye in a baby?
  • Considering the danger of RSV, should I ask family members not to kiss the baby and if so, what should I say?

In the extended version of today's episode, we discuss whether or not vaginal birth is possible when a woman has osteoporosis; whether or not a mother who has a history of precipitous birth should plan to be induced to avoid giving birth en route to the hospital; and is intentionally rupturing the bag of water a good idea to prevent having a precipitous birth at home?

As always, we close with a round of quickies on topics such as weight gain in pregnancy, cervical lips, prenatal vitamins, must-have baby items, and more!

Thank you as always for your fabulous questions and keep them coming by calling into our hotline at 802-438-3696.

Down to Birth is sponsored by:
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Please remember we don’t provide medical advice. Speak to your licensed medical provider for all your healthcare matters.

View Episode Transcript

Avoiding something like forceps where you're forcing or doing any type of forceful procedure because, you know, birth is more of a soft tissue process is a bony process pregnant -

...with my first due in January and right now I'm hearing a lot about how a visitor's anybody besides me and my husband should not be kissing the baby. Hi, Cindy and Trisha, big fan of your podcast. Thank you for all that you do. I had a question regarding using breast milk topically to try to heal things...

It's one of the ones women fear the least. Because Pitocin is so scary because there's so many risks with other things. But I think it appears more harmless than it is. Why would you take on risk just to have a quicker labor?

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.

Hello, hello welcome to the December que in a in this lovely holiday season of magical white lights and a little too much Christmas music if you ask me. Kind of what started before Halloween this year, I actually saw somebody's house fully decorated top to bottom. Blow up Santos and reindeer and Christmas lights in the yard. before Halloween this year.

People have obsessions. And babies don't stop until after Valentine's Day.

I don't understand.

I just don't get the dilutes the Christmas spirit in my opinions that I know. Right? Yeah, I really like to hear it when we're decorating or like doing our cooking but a few months worth is just never okay.

Don't start selling the eggnog until December 15. Please. All right. Too much.

We put on Instagram. We asked everyone regarding the holidays. Tell us something funny. challenging, difficult, unusual or special about your family or your partner's family? A story, a tradition or a situation. I haven't read these yet. And you haven't seen them yet. So I just have like I would have an open to them on. So I thought we should go through them together and share them and make fun of them.

If they're worthy of being made fun of I really didn't think of it that way. Let's see what we got. Alright, honestly, I'm just always on the lookout for new special traditions because I think those are really nice. That's one wonderful thing about the season. Okay, so first one. My birthday is December 31. Okay, Happy Birthday Mackenzie. Mother in law takes me shopping the day after Christmas. Just us to relax. That's sweet.

Nothing to make fun of. They're beautiful. Not you cynic. Okay. All right. Now it says everyone gets sick. Every holiday we get together because of one specific aunt denying she's sick. I guess this aunt is always carrying some virus or something. Oh, no, no, it's no no, I'm not sick. I'm just just getting over it. It's allergies. I just want to know why allergies.

Oh, those people who call things allergies when they're sick. Who do they think they're fooling? But it's funny. Why is this aunt always sick is what I want to know. We don't allow our 10 month old TV. Okay, understandable. But in laws always have the TV on. So I have to play with him in the other room. Just that's annoying teaching the TV off. Doesn't anyone notice? Or mute it?

It's probably like, they're still have their eyes on it. It's probably like toxic politics too. You know?

That's definitely muted them. Like it's not like one happy Christmas movie after another. I bet. All right. We no longer speak to my husband's parents starting with our own traditions, starting our own traditions with our girls. That's difficult. I've known plenty of women in that situation. I don't know if I'd call that a tradition. No, it's not. No, they're not speaking to the husbands. And the tradition. Trisha This is the part where she said we're starting our own traditions with our girls is the tradition part of the not speaking to her horse not knowing a lot of traditions. We're gonna start a new tradition, everyone, we're no longer speaking to you. They had that's that's not a tradition. That's a declaration. My sister in law literally cannot function unless she's causing drama is the center of attention. Some people live in that state, she literally can't function. Every year my husband and I sleep by the tree, we'll see they have a newborn. That is sweet. I love that. That's so precious if they can do that with a newborn. Let's see. gift giving is not my language. Oh, she referring to that book that I don't like that everyone else likes the love languages. Yes, I'm the one person or I was just having a conversation in my girlfriend's last weekend and they were talking. They were talking about their husbands and love languages. And well, maybe it's just not their love language and like I don't, I don't really buy that me a break.

I don't really believe in it. My love language is gifts. Therefore I don't like attention and affection. What's your love language? Mine is Oh, nice acts been done for me. Well, who'd like it all that of course, we'd like it all.

Okay, anyway, maybe then I want you to know exactly what I need in the moment when I need it.

I want you to anticipate my every meet and exceed my expectation.

Don't categorize yourself into a love language category.

I feel that book was so immature and the guy just got extraordinary six. I feel the same way about him. Men are from Mars. Women are from Venus. I never read that. I never read it either. But I saw him. What's his name? John Gray. I saw him do a talk on television. And I was shocked. I was borderline offended. He was like, when your wife is angry. Number one. Apologize. Number two say I'm sorry, honey. I'll never do it again. I mean, it was so ridiculous. And then number three, buy her flowers.

Just for the record. Yeah. I don't ever want to be called Honey.

No at that though. It was it was just more of that, like patronizing.

It seems so insincere to me. It is

insincere. It's a script. Say you're sorry, say you'll never do it again. It was I'm sorry, honey. I won't do that honey. Bottom line, are you honey and then buy flowers? I mean, please. Can you imagine this whole notion of women seeing flowers and like buckling at the knees? I mean, we're all about getting flowers. But then time to get flowers is not in the apology. Just show up with them whenever that might, but we can't we're not just like we see flowers and we're like swooning now. They're just flowers.

They're just a little they're just a little act of joy. But that's why don't don't bring them when you need to apologize. Like that's the the flower is not going to resolve the problem.

I think we have a whole episode in here. Look at us going on about that. We got a lot to say, okay. All right. So gift giving is not my language seen. This is where it gets us not her language. Now she won't give gifts. I actually really liked this woman. I recognize the name. She's really great. It's a waste. And I hate that we have to reciprocate gifts given Yeah, that's awkward. You can't just go receive. But maybe you can do a gesture like we'll cater all the food for everyone this year, because I think that would be a very nice gift to give. So there are the pressure to give a gift when you don't really want to give a gift and it just feels like you're doing it for the show. Like I don't like that. Well, if I don't have a simple gift to give someone I don't really want to give the gift I want if I want to give the gift I want it to be because I really care about giving this meaningful gift to them. Just for the record. You're an excellent gift giver. I put a little thought into it. You do you have a wonderful gift giver. My husband is a very very creative, thoughtful gift giver. Okay, new baby arriving late January we live four hours away from the in laws and we are still worried they'll show up well you didn't have to tell them right when labor begins folks. That's the whole secret. Totally start pushing the baby out and get that okay, we think we're in labor now send them the photo when the baby is born. Okay after the placenta is out next for woman similar difficult difficult colon in laws don't know how to gather without alcohol and getting drunk. Wow. And I don't drink Okay, that's not that's challenging on a good mix. Okay, married a year ago in laws do so much opposite from how I grew up fun yet difficult. I do think that is the blessing of a marriage that you're fit you're in love family is almost definitely going to be very different from your own. And I think it's for me, it's been one of the best things because I don't know it just gives you another perspective on things so that little slightly like if you have the same core values. I think it's really neat to have a family that's just a little bit different. You know, I think that sense that's that can be good fun yet difficult that I think that sums that up very well. are nice. Our thumbnails are nice was stillborn on Christmas day 2021 If I go 42 weeks that puts us on December 23 I feel like the family is only pretending to be happy for holiday baby while still grieving the previous loss. Of course, that's very difficult. Of course there's nothing nothing to be done about that. Right. Both things coexist. My husband is the quote black sheep of the family. Those are usually the awesome people if there's a black sheep and a family Oh him I'm you Usually friends with those people.

The right one, yeah.

My husband is the black sheep of the family read established healthy boundaries and we've never in 12 years of being together been invited to any Christmas gathering makes me sad for our daughter, but also relieved we don't have to deal with them. Now everyone knows how many other women are going through really tough family things.

That is very sad for the children that shouldn't affect them.

There was one year before we were married they were they left their house when my husband was visiting to go see the other siblings and didn't invite him to come with. Good lord. definitely in need of new traditions in that couples household. Definitely. You guys can do better. The bar is very low. Husband is a cop WORKING CHRISTMAS for the third year in a row so hard for me and the kiddos. Definitely hard. Okay, I make a little I make a trifle every year. Little alcohol cuz pregnant breastfeeding, but it's still epic for her. A trifle. I make a trifle too. Yeah, you don't a checklist. What's a trifle? You're kidding. Oh my gosh, it's amazing. First of all, you need a trifle dish. So have a trough usually? No, no, it's like a stemmed glass dishware and it's cylindrical and it doesn't taper. So it's like a big wide cylindrical. I'll show you. I'll send it to you.

I'm expecting a trifle at your Christmas party.

I already decided to making one. So there you think you're challenging me but you're just actually giving me the support I need. And the cheering squad. No, it's a it's beautiful. So you make custard. You make a delicious custard with egg yolk and sugar and cream and all that. Then you make homemade fresh whipped cream, tons of it. And then you have just tons of fruit and berries and you do a layer of this like spongy delicious cake. And then you put the berries and then you put the custard and then you put a big layer of whipped cream and so on and so forth up this clear dish and it's a beautiful presentation and when people serve themselves, they kind of just scoop deep into it and get a nice spoonful of the whipped cream and the custard. You'll try it at my house. My mom's recipe but it doesn't have alcohol in it. I didn't even know some people do that. It sounds fabulous. And I don't believe I've ever seen or had one. Well,

you will by the time this episode airs because of Christmas eat. We're doing this right before Christmas, though. Yes, you will. It's amazing. It's a treat. You love it. Okay. My five year old sister in law loves to watch me breastfeed her niece. She calls it the baby's snack. Cute. We went bowling on Christmas night last year and I think it might be a new tradition. That's great fun. Yeah, because Christmas. That's a great one. The second half of Christmas Day is usually incredibly quiet Christmas Eve is the big day in my family. Your Yes. Morning is like intimate and the day is very peaceful and quiet. Okay, next, only the women exchange gifts on my husband's side. Poor guys.

That sounds fine are like can we just go golfing for the day please?

They're happy. They're fine. All right. difficult trying to hide early pregnancy while the family asks when we are going to have babies. People really need to mind their business a little secret,

fun little secret. The next one says in laws think it's appropriate to share utensils and take food out of their mouth and give it to her kid I'll click on gross. She can't mean that nobody should do that. Of course not right? Nobody should do that. Thank you for that. Although

in the world mothers do do that for their babies. Maybe she means like, like they bite piece of a piece of fruit and like bite a heart offer the other half don't like treat chewing the food for the baby and taking out of their mouth right mothers do that for their children in parts of the world. But that's okay. I'm losing my appetite. She added it makes me dread going there. They have very few boundaries like Good lord. My husband's family used Santa sacks. I had no clue what it was until my mother in law lost her mind over the excitement. She had to make my babies for a Santa sack. Interesting. She worked so hard song at that she got tendinitis in both wrists.

Oh my gosh, sweet dedication.

Yes. All right, next one when my pappy was alive. What's up happy grandfather grandfather. Oh, it's that you're that certain? What do you call them? What do you call the mother the wife then the grandma happy? What? The nappy? nappy? nappy is it now? Are you messing that up? Check out Trisha everyone cracking a joke. See, we need comes out like once a year. We need you to do way more of that spontaneous joke cracking. When my pappy was alive, he would make each of the grandkids that's another Midwestern term. Grandkids is not a Midwestern term, not like it is that is a English term.

I feel like it's a Midwestern thing. I was thought it was all right when my pappy was alive, he would make each of the grandkids a Christmas scavenger hunt to find their gifts. They lived in a big old three floor historic home in Pittsburgh so special that sounds amazing. And now everyone can know that I've done a scavenger hunt for years with my kids where I wrote I write poems, of course, and I say, of course, because I've done it since I was like six, but I write poems. And each clue was a little one stanza four line poem. And they would have to figure out together where in the house I hid the next clue. So it might be in the piano bench. It might be in the, in the washing machine, and then the last one would reveal a gift for both of them. Very fun. Yeah, very fun. Um, next, the tradition where my sister in law's passive aggression turns into straight up aggression. That's Christmas. For her. It's the truth. That's the tradition of aggression. My husband and I's family. Okay. I can't. My husband's and my family. Both gift gift ornaments that represent your year. Oh, that's awesome. That's cute. That's so nice. So our tree is filled with deck different ornaments and memories through that. I love that. Well, I do that with my kids. I give them an ornament for every year in their stocking. So they have an ornament that how does it remember the years that a photo of them or does it have the hero like, last year my son got a pickle because he was super into pickles. That stage of his life.

That's so great. What else have you done? That's so cute.

I don't know how to lose and surf Ruby got a surfboard? Because surfing was her thing. You should you should have done one that year when we started our podcast and you were with me and you weren't home in North was getting home and he was like, eight. And he couldn't get into the house and he broke in and you were really proud of him. He lives in a window. You were you were super proud of him. That was a good one. We should have a ladder, something perfect. fond memories of my dad writing riddles and scavenger hunts of where to find presents he had for us. That's exactly what it's a good one. That's great. I get that quality from my dad too. And little poems and all that. We don't. I don't know if you know this story. But there was a year this is pretty amazing. My dad always wrote great poems, and was very clever with words. And there was a year where I was about I think my brothers were in college. So I was probably like 14, and they were probably 18 and 20. And it was Mother's Day morning. And my mom Of course, we all went into it. We were all having breakfast together. And I had a gift and a card. I was so excited to give my mom and my brothers were at that age, they were just at that age, where they were just like, oh, sorry, Mom, I don't have your cardiac, but I'll give it to you later today. And maybe they meant it. But they weren't ready, right? And my dad just quietly walked out of the room after breakfast. And about 20 minutes later, he went to my brother's where they were where their rooms were and he handed them a sheet of paper that we still have. He wrote a whole poem from top to bottom. It was brilliant. And the first two lines of it were who took the M from Mother's Day and made it just an other day. That's sweet. And that was how he spoke to them about it. Just this whole clever, witty, he didn't sound angry. But it was very poignant. I always remember that. You know, he's very clever. All right. Next, we don't see family usually for holidays since we are military and live far from home. That's tough. This one says my mother in law sucks. She asked for advice on what to get my kids she ignored the links I sent her. Then when she called asking questions about what she did get for them. And I mentioned they aren't into that stuff. She said I don't care. This is what they're getting. Okay. Also, I'm pregnant with number four and she asked if it was an accident. She's a peach. This woman is from Germany instead of Elf on a Shelf. We have Klaus in the house because we live in Germany. House in the endof house. Alright, that's the last one. House being of course capital H au s of course. Of course even I knew that lest you think I'm speaking the opposite language again. See, but I wasn't the only one. I wasn't the only one who thought it was German. You weren't the only one What did I say like closing gate panic. And you in the other room? Thought I was actually speaking German when that word is horseless panic. That was funny.

Oh, what's your Christmas tradition?

Oh, goodness. We I feel like we have a lot my Christmas Eve brunch. Yes, that's a great one. Yeah. So after the brunch, which goes usually till like five or 530. Then we all all the family migrates over to my brother's house in the evening where we do our gift exchanges. And then we always sing the 12 days of Christmas. We all got a different part. Usually there's a few of us in each part. And that is definitely a family tradition. We've been doing that since I was a little kid. Had we always seen that told us a Christmas? Very nice love that? What are yours? I think the the main one is just that. Gosh, how many years now? 15 years, maybe more. My entire family descends upon my home. They do. And they bring all their dogs. Yep. And they move in. And your mom sometimes stays till March. My mother stays a very long time. And they take over my home.

They do the tradition. And then when when when it's wonderful, and we fight, and we laugh, and we fight. And when we hang out with your mom, she tells us what she thinks we should do with the podcast. Yes, of course. Remember, remember years ago when the day I met her? She was like no, Trisha, you should always wear a hat. Like Cynthia, you're gonna be the this one. And Trisha, you're gonna be the that one. And I was just like, whoa, I'm not sure about any of this.

But you do have thing kind of stuck. You don't always wear one. But yeah, you do look really good. And hats, and you have an impressive collection. Thank you. Anyway, so that was fun. I'm gonna get serious now. But I just realized this is a very long intro. And if anyone just can't get enough of hearing you and me sit around talking about our luck, anything between our lives and deep, meaningful things. That's what the book club is all about. So join us on Patreon. Join our book club, we do video podcast episodes where we talk just like this chapter by chapter book by book. Now, time to get on to our questions. Shall we? Almost forgot about those serious now. All right, let's get down to business.

I thought you were gonna say let's get down to birth. Hi, good evening, ladies. My name is Laura. I live in Boston. I am currently 16 weeks pregnant with my first baby. It's a baby boy, I feel very lucky. I'm getting two very lucky for having found your resources. I'm feeling like I'll be able to have the births that I want. My question is, in wanting to have a undisturbed, third stage first thing to placenta, I worry that providers may at times imply that to prevent hemorrhage, they'll need to get me Pitocin. So I would like to know what are the indicators of postpartum hemorrhage? Is it blood pressure changes, gushing amount of blood that continuously comes out? And if that's the case, how do you gauge how much blood is actually coming out? My hopes is, in the absence of true postpartum hemorrhage, I'll be able to birth the placenta, and wait perhaps 30 minutes more, and then cord cut the cord. Thank you very much. Bye, bye. Thanks.

So she wants to know the indicators of postpartum hemorrhage. But unfortunately, this is not what a mom is supposed to be thinking about or worrying about after she has her baby, she should not have to feel like she is the one who needs to determine whether or not she needs Pitocin. The point the sad reality is that almost every woman gets Pitocin in third stage or shortly after the birth, because it's done routinely.

What's odd to me is that they do it both before and after the placenta comes out. You would think that there's a right or a wrong time to do it even when it's necessary. Are you referring to throw as the woman is pushing the baby out? Remember, we had an obstetrics nurse on our podcast. And she said I was instructed to give women two bags without even telling them if they were hooked up to an IV for any reason, what I was instructed to give them two bags when they were pushing their baby out without even telling them. So just like even if it was what are the best practices for it, even if you do want it, I always would figure it was after the placenta is out. Now, active management of the third stage of labor involves giving Pitocin with the birth of the anterior shoulder. So that was meant to help the placenta release quickly and then it could be given again after the placenta separates to prevent bleeding. We know from some of the research that's out there and discussing this with Dr. Rachel read is that if you have had a physiologic labor, meaning unmedicated then giving Pitocin in the absence of true excessive bleeding can increase the risk of bleeding. If you have not had a physiologic labor, if you've been induced even if you've had an epidural or other medications then actually giving Pitocin does seem to reduce the risk.

Yep. Right. But she says once you're on that medical path, it's actually safer to stay on it until birth your placenta. But if you're not on that path, it's a higher risk to suddenly intervene and introduce Pitocin after the birth and Barbara Harper did I think one of the most valuable episodes on the topic with us episode 200. She taught all about third stage. I know even we both learned a lot from her in that Episodes of really recommend that one. But I just I, just for everyone to just hear what Trisha said, the argument goes, the first round of Pitocin is to get the placenta out quickly, that's always the red flag. That's not an indication just trying to get something done quickly is is always a red flag.

The idea there is that the sooner you get the placenta out, the less likely the chance of the woman having a postpartum hemorrhage that I think the opposite is true. Now, I mean, physiologic labor, yes. I mean, the capillaries, so most women aren't having physiologic bursts. That's why all of this is in place.

But either way, you need the capillaries behind the placenta to seal off in order for the placenta to detach. So to just kind of make it come out. I wonder what the process is underlying that? Does it make the bleeding stop in order to make it come out? Or does it just get the placenta out? Because it's like activating the uterus, which is what Pitocin does do? Yes. I don't know if
that's what it's that's what it's meant to do that her question about? What are the indicators of postpartum hemorrhage? Is it blood pressure? Is it bleeding? Is it maternal symptoms? Yes, all of the above. I mean, their technical definition is over 500 milliliters of blood loss. But that's very hard to gauge. Depending on if there's fluid coming out to then the blood is diluted, if it's going into pads, or sheets, or clothes or whatever, it's hard to gauge blood loss. So blood pressure changes, dramatic blood pressure changes, symptoms, and the mom of feeling faint. turning pale, that kind of thing. Those are indicators that your clinician should look at. But again, I hate to have this mom be worried about whether or not she has to determine if she's having a postpartum hemorrhage. That's not her job. That's the job of her provider. And can we wait is always an appropriate question.

I think when women have these questions, and we want to respond with this really shouldn't have to be your job, which is correct. It should be assigned to that woman that if she's even wondering and worrying about how to manage such a thing, it does point to a lack of absolute trust between her and her provider, or else she would not have a care in the world, she would trust them so much. We've also heard of many moms, though, who trust their midwives and who end up getting routine, postpartum Oh, yeah, there
was someone who trust their providers, and the providers can let them down later that that absolutely can happen. But if she's going into it with this mindset, that she has to learn everything humanly possible, that already points to the fact that she doesn't totally trust her provider. All right, let's move on.

Hello, my name is Jade. And I was just listening to one of your podcasts. And you mentioned that the number one cause of women going from a home birth to a hospital birth is failure to progress. So just curious, is that dangerous, that they are failing to progress? Or what is the real reason why a woman would need to transfer to the hospital for failure to progress? And what does that actually mean, to fail to progress? And is there any thing that a woman can do to help progress the labor at home? Thank you so much. I love your podcast. I just found it and have been binging listening to it. Thank you so much.

That's a very good question.

I agree. And we haven't gotten there before. Yeah. Okay.

So the transfer rate from home to hospital is typically around 10%. That's pretty standard across all home birth, and that is for non emergency non urgent transfers, which failure to progress, which we hate that term would fall under. So it's typically more for maternal exhaustion or labor that is not no longer progressing and the mom may need some epidural or pain relief, or sleep to have the labor continue. Is it dangerous now?

That's what's interesting about it. I mean, to to even say the mom may need some help is so questionable, because some women's Labor's last days and days and no one is here to say you should endure this. If you're not sleeping, if you're in discomfort, if you're exhausted, she has a right to change her birth plan. I always get concerned if the provider says it's been too long because if the fetal heart rate is fine, and you know her blood pressure is fine, and all the usual things you're looking for. There. Like Trisha just said there, there really isn't a concern. It's a matter of whether everyone gets I think emotionally demoralized, and the mother gets physically tired. You mentioned an epidural. Trisha, I've learned that you know when the cervix gets swollen sometimes from being Days and labor, the epidural is a useful tool at making labor relax and letting the swelling go down. So that's a tool that the epidural comes in for. Right? Yes, the other.

Yeah. The other thing, though, is that it can allow a mother who is exhausted and hasn't maybe eaten well are hydrated well, and is just depleted, it can allow her to rest and recover, and then her body can kick back in and take over. So that epidural gives her the time and the space to sleep. Exactly.

It's like it's literally used as a tool, which I think is an important distinction from like, you know, this isn't happening. So let's start throwing all the interventions at you.

Or give you some support so that your body can recover and finish the job. But homebirth transfer for failure to progress, as she described, it is, is pretty much always the mother's choice. It should be like you said, if it's the midwife saying, you know, is it taking too long I think we need to go, then that's not happening here. That's great. But if the mom decides that she wants to go and get some additional support, or if it's it, because the labor isn't progressing, and the baby's not looking good, but that's not failure to progress. Now we're talking about fetal distress, right? So failure to progress is not a dangerous situation. And it should be, again, based on the mom's choice to change course of action course of plan with her, her planned home birth. Yeah,

and I just want to add that failure to progress is the top reason for cesarean section in the United States. And I think that's the good news, because since it's not really a medical indication, because again, it's presuming everything is fine and normal, it's just a function of how long labor has lasted. That's good news, because that means we can eradicate the top reason women are getting Cesarean sections if we start handling a prolonged labor differently. Guidelines have changed on it, which is good news. That's true, too. They have changed favorably on it favorably,

they also changed the terminology, it's no longer called failure to progress. It's called I believe, a rest of labor. I don't think that's an improvement. I don't like failure to progress or a rest of labor. I don't like that one at all. I would never mean it's not great either. But it is not.

I like not having failure in there.

I like not having a rest in there. Because you know, when you when you think medically of the word, arrest, it's impossible not to consider cardiac arrest. I have to just also mention, I'm a HypnoBirthing. Instructor. And I have to represent making manga and founder of HypnoBirthing. She has her niche, firm opinion on failure to progress herself. And I'm going to put it there. She says its failure to weight. Its various failure to love its failure to give space and privacy and intimacy. She says it is as often in the mother's brain, not her mind, not in her mind, in her thinking in her brain as anywhere else, because she needs to feel that much safer, and better. So I do think it's beyond her position. It's the water and the hydration and everything else we talked about. But there is something very great to be said about how often women are in hospitals and not feeling safe. And of course, that tension is preventing the secretion of oxytocin making her cervix tighter, thereby increasing those odds of failure to progress. Failure to be patient. Right. So what we renamed it. That's why, and that is why you said it's the leading cause of C section because women have been expected to give birth based on the Freedman curve, which is so outdated and so incorrect. And finally ACOG gave up on that. But they still have parameters and expectations for labor progress.

Especially in a hospital where time is money for us right now.

Hey, Cynthia and Trisha, I love your show so much. And as a first time pregnant mom, you guys have been such an amazing resource of information and helping me ask questions and research things. I'm just so appreciative for both of you. The question for you today is about RSV. And I'm pregnant with my first due in January and right now I'm hearing a lot about how a visitor's anybody besides me and my husband should not be kissing the baby. And I was wondering if in your opinion, if that is warranted, that amount of precaution is necessary based on the research should I really not let my mother come to kiss the baby you know when she comes to visit. And I was also wondering if you do agree with that. I would love to hear how each of you would phrase that or set that boundary because both of you are so good with respectfully and kindly setting up boundaries with family and I would love to hear how each of you with Days, please don't kiss my baby. So thank you so much.

I don't think she's gonna love my response to this because I think women are divided on this and I'm really squarely on one side. I just I'm not a germaphobe I have a I have a reasonable fear of germs. I think I mean, I'm not someone who ever said to anyone who came into my home, can you please go wash your hands before you hold my baby. It didn't bother me if a loved one who came into the home held the baby kissed the baby. And I know statistically that's safer and better for the baby. But I wasn't even coming from my place. I just didn't fear it. I did not like being around other sick babies runny noses, coughing, sneezing when I had social gatherings with other moms and babies, I really didn't appreciate that. But I think we know when people basically look well and feel well, they are well. So I just I don't think it has to come down to how to delicately have this conversation. That said, I know that there are women who have incredible outrage, resentment, anxiety around even a grandmother walking into the home and kissing the baby. So I'm not here to tell anyone how to feel and think I'm just not a great person to answer because I don't understand those feelings. I just don't have that kind of fear of Well, looking people on the verge of spreading a disease.

Yep, I am pretty much in the same boat as you I never felt concerned or worried about people being around my baby holding the baby. We're work isn't a baby. I mean, I don't know that it needs to be like, standard that because all babies -

Yeah, I don't remember a lot of people kissing my babies. But it didn't. I didn't have any thoughts or worry around it whatsoever.

I think if you are the type of person who is a little bit uncomfortable with germs, and that is going to make you uncomfortable, then it's totally fine and appropriate to simply say, Can you please wash your hands before you hold the baby. And in this house, we're not. We're asking that you don't kiss the baby right now. To this woman, know your Self. No one is going to make you feel comfortable and not comfortable. And feel free to speak your piece. I think it's okay.

But also check your anxiety because it's a hell of a way to go through postpartum being terrified that every germ which is completely unavoidable that every germ is about to come and harm your baby.

Yeah, don't don't be like that. That's that's nerve racking. For Yes, the fear is far worse than anything else. But also remember that if you're breastfeeding your baby, you are literally passing on your immune system to them every day, and they are very well protected, doesn't mean they're never gonna get sick. Just like as adults, we can get sick and have a healthy immune system that fights it off. So a healthy full term, baby, who's breastfeeding is very well protected against environmental germs.

Hi, Cynthia. And Trisha, big fan of your podcast. Thank you for all that you do. I had a question regarding using breast milk topically to try to heal things. My son who's four months old, just develop pinkeye courtesy of his older sisters. And I would like to try to treat it naturally. And I know I've heard of putting breast milk in the eye. When I look it up online, the main like the main websites say not to do that. But I don't always trust those sources. So I was just wondering if you had any information on the safety of using breast milk to treat feet guy thinks they.

So breast milk is definitely antibacterial and anti viral. So it's not unreasonable to think about using breast milk. However, it may not be effective enough. And if you have if it's not easily resolving, or it's getting worse, I would say you need to pursue a diagnosis when your baby has conjunctivitis or some type of eye infection. I'm not opposed at all to putting breast milk and I'm just saying it may not but it can't hurt fresh breast milk. So the big concern is that you could introduce further bacteria into the eye.

Right? It can that happen with all those white blood cells. I mean, I remember when you leave breast milk out, it keeps getting cleaner and cleaner cleaner as the hours go by, because it's inherently anti microbial. And if there's bacteria landing in it, it kind of addresses it and takes care of and gets rid of it.

That's true. It I mean it is anti bacterial it does at some point change. The thing is is about the bacterial load so the breast milk can kind of keep everything in check for long periods of time and it does keep self cleaning. But if you have an unusual amount of bacteria, it can't keep up something like that, but this is pretty unlikely and we recommend using breast milk For a lot of remedies to heal things in newborns, cuts, infections, whatever. I'm just saying, I infections can be serious. So if it's, I wouldn't necessarily rely on that solely, especially if it's getting worse.

All right, well, that's a wrap for the condensed version of this month's q&a. But if you're with us on Apple subscriptions, or on Patreon, then let's move on to the extended version. Otherwise, what time is it Trisha, our favorite time?

I'm very quickies. Let's have it. Here we go.

Quickie number one. All right. I am five months postpartum. Should I tell my midwife? I'm five months postpartum? Should I tell my midwife now that she overmanaged My third and fourth stage of labor? It's never

it's never too late to tell your midwife that she overmanaged.

Exactly. I would say yes. You should tell her. There's no statute of limitations on feedback.

Right. Agree. Perfect. Next one. What is the longest pregnancy can go without intervention? Is it 43 weeks? 44 weeks, 45 weeks?

That is highly unlikely. But it can go as long as it needs as long as the mother and baby are doing okay, can go as long as it takes. There isn't a there isn't a cut off. Next? Do I need a RhoGAM shot for pregnancy loss? My doctor is pushing it on me. So she must be RH negative. So we have a really excellent episode on this. It's episode number 211. And it will give you all the nitty gritty information on this. But the short answer is that the chances of sensitization under 12 weeks is very, very low. So she may be pushing it but it is not likely necessary. Next, I would like to decline weighing myself at prenatal visits. Are there any risks to doing so? weighing myself? Right, you know how they will usually weigh you right when you get to them such as I would I would love to ask her why I like that. I like the question. But why do you think she's leaning that way? Just because she doesn't know I've gotten all the nonsense of yeah, she's climbing right around. Definitely had women decline to weigh themselves that their prenatal visits they just it's too anxiety too much. Yeah, too much anxiety to look at the scale. Or, you know, people just have a fear of gaining weight. And even though it's a natural process and pregnancy, it feels uncomfortable.

They have a fear also Trisha of not gaining weight. I had just a couple months ago, a client who died that can happen. That happened to me at one point in one pregnancy I didn't gain at all for three weeks, and then all of a sudden they jumped up a few pounds. But yeah, that's also another either way it can be anxiety provoking. So I think if she's willing to periodically just check in with herself on her home scale, that's not a bad idea. You can absolutely loot Lee go through pregnancy never knowing your weight. As long as your baby's growing well, and you're feeling good and you're eating well. You can do that. But you know weight gain is one of the variables. This is not quick, sorry, quickies. Weight Gain is one of the variables that we look at to to determine progress and growth and pregnancy. So you don't have to, but it is helpful. is pushing with a cervical lip really a big deal, though? Is it really a problem? Not necessarily. No, it is actually a normal part of labor. Progress.

Isn't that interesting? So it also supports not having a vaginal exam because one reason you always think well, maybe I need to have one is just to make sure there's not a cervical lip. It's like well, but even that should still work out just fine. Very good to know.

The answer is that it's more likely a normal part of the process of the cervix finally doing its final opening than anything else. Do you need to take prenatal vitamins while breastfeeding?

You don't ever need to take prenatal vitamins. What you do need is good nutrition always.

Which is not always so easy to do. So sometimes, high quality prenatal vitamin can be helpful, and it is important to know that you have more caloric and nutritional requirements in breastfeeding than pregnancy. Probably it's not a bad idea to take one a little bit. What are your options for breech baby to avoid a C section. Vaginal breech birth?

Find a provider who's skilled in attending a vaginal breech birth after? Yeah.

Second option is external cephalic version. Right turning the baby.

And for the women who do want a C section for a breech baby. You can wait until you're in labor. You don't have to ever schedule it. You can wait until you're in labor when your baby is really ready. There's a small chance the baby can go head down and labor but at least you can have that confirmation if the baby didn't have at least the peace of knowing the baby is seeking to come out and it's you know, you can imagine a gentler C section if the baby is seeking to come out. I'll stop there to quickie. It is another option I think women aren't presented with.

I am a first time mom and a minimalist. I have only the wildbird sling. Are there any other must have items, she must join our book club and go through our simplicity parenting videos from our November book club book on Patreon.

If she is to have one item that is the item of baby sling,

I absolutely agree. Okay, last one. Okay. This is a funny one. Okay.

I forgot this is the personal one, right? Yeah. If you could only wear one outfit every day for the rest of your life. What would it be?

bootcut yoga pants. Good choice. What else? What else? What on top? Yeah, I get to wear it up. You could probably wear it. No. I'm not as choosy about the top. What's your favorite thing to wear with bootcut? Yoga pants
I mean, everything. I don't have a good answer for the top. I'm flexible. Sports Bra. Literally just a sports bra with pants the rest of my life. That's ridiculous. Go comfortable. I would. I would look so silly.

I don't like to be in my sports bra a second longer than I need to be.

What about you?

Definitely jeans. I do love jeans. bootcut jeans and a white t shirt and some good and some gold hoops?

Well, that's an interesting question. All right. Well, this is now this is the last episode. Trisha the last episode of season four we launched Exactly. Four years ago, we begin Season Five with our next episode. Look at that. That's amazing. I know the exciting. Anyway. Thank you all. Thank you all who have been with us through the years or who are new to us. We wish you all a happy wonderful, fulfilling, joyful, playful. Did I say healthy yet healthy? Inspiring. Gratitude filled. Sexy, prosperous, sexy. Yeah.

Oh. Oh my god. That's so perfect for the episode coming out next week. I can't believe it. Oh, yeah. Are we are we is that how we're starting the new year?

Yes, if you guys blush easily, before warrants, and and we'll play this one with children in the car. And we have that one on full video with visuals and all and they will make you blush too. And we're putting that on Patreon. We're gonna give that to all patrons. Even the tier one patrons are gonna get that full video of next week's episode on Patreon. You will not want to miss it and do watch it with your partner. It'll change your life. And
while you're there, check out our new year's book on atomic habits. How tiny changes make remarkable results. Thank you everyone for being part of this ever growing beautiful community. We are so grateful and we wish you all an incredible start to 2024 and then we'll let you in on a little Downes verse secrets, shall we Cynthia?

We have very exciting things coming for 2024

...something you've all been waiting for.

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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