#340 | October Q&A: Pushing "Wrong," Laboring Down, Birthing the Placenta, Fistulas, Lip Ties, PP Rage, Pelvic Floors, Explaining Conception to Kids

I'm Cynthia Overgard, birth educator, advocate for informed consent, 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 Show. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Welcome to the October Q&A episode, all right! Well, today we're going to begin with sharing a few confessions and maybe a few questions from our community. You know how we periodically do a question or a confession on Instagram, and we let people write in with their questions and what's on their mind? Sometimes we get great confessions, yeah, sometimes we get we get a great confession followed by like, 110 questions. And then we get another great confession followed by another 110 questions. Yes, a lot of questions. So it's amazing how many questions people have. Is endless questions. There's always a question. So I have a little confession to start with, no so the other day, I was doing something on social media, getting ready to post a reel on our on our page, which often, you know, contains pretty graphic videos of women giving birth, which is what we're all about. So, you know, always happy to post them on our page. But I was also in the middle of doing something for Camp billwood, which is, you know, a children's camp, and I was sending an invitation to the parents to join us for the end of the season events with a link to RSVP. And I don't know what happened. Oh, God, you sent them a full crowning photo, didn't you what happened? No, I accidentally included, somehow, I included the link to the video of this woman giving birth that was, you know, right front and center in the link. He said, The invitation link said, Please RSVP to our end of Season camp events. And you clicked on it, and it was just like a woman grunting and groaning with her legs spread, and I posted it on Facebook, and I didn't know, because it wasn't like the video posted. It just posted a link. And of course, I didn't check the link to click the link to check. And finally, a couple parents texted me, like, within like, five minutes, a couple of like, close parents texted they were like, um, I think that there might be some inappropriate content posted here. It was really embarrassing, but fortunately, it was caught early, and all I'm thinking is women are supposed to be good at multitasking. Sometimes the wires get crossed Exactly.

Well, I love that that happened. That's hilarious. Oh my God, I know, I know it was, it was a good moment. It was a good laugh. I mean, I think, you know people, most people know I'm a midwife, so it probably wasn't. It probably was fine, like the parents who saw it probably didn't really care that much. But okay, that's my confession. I know one other thing before we get into our our community confessions that we must share. Do you remember when I dropped Ruby off at college, and her dorm room was number 304, and when I left from dropping her off, and I just pulled over randomly at a hotel, you know had just said goodbye to her, dropping her off at college at the first time, I pulled over randomly roadside hotel, and my room number was room number 304, and I was like, Oh my gosh. You know, this is just like a such a crazy synchronicity, and such a to me, such a like validation that Ruby was going to be fine and she was in the right place, and all the stars were aligning, and then you tell me a few days later, because you dropped off Alex, a few days later, a few days later, I drove Alex to school, and I had a hotel booked for myself with many floors and many it was like three floors, multiple little wings. It's a beautiful place, and I dropped we brought him to his dorm, unpacked him room 107 I walked into the hotel, and when they were getting my room, I was actually thinking about what happened with you and Ruby, and I was thinking they're gonna put me in room 107 I just, I can feel this, they're gonna put me. And she starts, okay, you're on the first floor. And I was like, I do not believe this is happening. When are you ever on a first floor in a hotel? First of all, it was like, it was a very cool place. It had really like it was, but yep, room 107, how did the math happen to both of us? I did the math on it happening to both of us. Now, I'll tell you. Would have really been miraculous if it was all the same number, but it was incredibly.

Miraculous nonetheless. And the odds were, like one in 79 million, that you and your daughter would have the same room between her dorm and her hotel, and that my son and I would have the same between his dorm and his hotel. So and I showed you, I sent you a picture of my of my receipt thing and the dorm, and you, you couldn't believe it. You just flipped. And I was like, I I want to flip, but I had a feeling it was going to happen, so I it kind of took the shock out of it, because I just had a feeling that was going to happen, and it did well. It always brings me back to the episode that we did with kale blossom on fetal microchimerism, about how a you know, once a mother and child are together, they are Forever together, and the cells from them are always living in your body, and so therefore you always have sort of, like this telepathic connection with them. And I don't know, I think those are pretty cool examples of how that's true. It reminds me, I don't know if you if I should tell a story. Should I fit in a story here? Sure, it reminds me of something really remarkable that happened when I was in my mid 20s. GE hired me out of grad school, out of business school to work in Connecticut, and my first Christmas with the company, Jack Welch was still the CEO, and they threw this huge Christmas party. It was absolutely opulent. It was just amazing. It was so exciting. It was a dated function. It was just so wonderful. And at one point during the event, he goes up on this, basically, like the, I guess, the middle of the dance floor area, and he gave away these incredible door prizes. So everyone got, like, a raffle ticket when they walked in. And I was standing with a bunch of friends that I had made, guys and girls, and we were standing there, and everyone was like holding their raffle ticket. And he was he gave away the first thing, he gave away the second thing, and I suddenly got, like, my whole body, my whole body filled with, I wish I could explain this conviction that he was about to call my number on the next one, and I kind of froze in place. And eight or nine people heard me like they saw me get very still and look very nervous, because I was nervous. I was young. I was, you know, it's like my first big executive job, you know, and and I felt nervous at the thought of winning, but I knew I was he was about to call my number. And I stood there, and I was like, Oh my God. And they're like, Cynthia with, like, what's going on? And I said, he's about to call my number. He's about to call my number. And one of my best friends, Jalal, was like, Oh, really, he's about to call your number, you really think so? And I just was standing there, very frozen, very nervously. I was 100% where time didn't exist, because I had certainty it was about to happen. He called my number, and I was so nervous, and he called it, I had to walk out in front of everyone. He kissed me on the cheek and congratulated me. I won, like a ski trip, and it was fascinating, because so many people witnessed it. But that's not the incredible part of the story. That's the first part of the story, just like you and your daughter sharing the same room number. The following year, there was a joke where everyone was like, because, you know, most of us worked in like, a building with maybe 800 people, and I was the only person in my whole building who won one of the things. So the next year, at the same party, all these friends gather around me, they were like, oh, Cynthia is our good luck charm. Come on, let's stand you. Know they're making it, making a big thing about it, because it was such a big thing that I had won the previous year. And unbelievably, he started calling off the things again, and the exact same thing happened again. I froze, and I said, Oh my gosh, you guys, he's about to say my number again. And they just, they just didn't know what to make of me. They were like, what? And I there, I froze again. I got nervous again. Oh my gosh, he's about to say my number again. I won the door prize two years in a row, and I called it in front of all these people right before he, like, right before he announced mine. So the odds of me winning two years in a row were already so low to begin with, but the fact that I announced it out loud and I froze like everyone saw me get so nervous beforehand was the fun part, because they were witnesses to it. And then the next year, of course, it was an even bigger deal. All these people were crowding around me, and I was like, Guys, I'm not feeling anything this year, just you're wasting your time. But it's not incredible, that is. And either he had a thing for you, no, or Trisha, that's my work. I mean, Trisha, there were a couple 1000 people there. It was like 1500 probably, no, no, he didn't personally know me. No, I wasn't like that at all. Maybe you were connected to him in a past life, somewhere, somehow this. The amazing thing is how I knew it in advance and and that's happened to me. And I, you know, I want to ask that question to our listeners. It happened to me another time. I'll tell you that story quickly too. I went on a really wild and crazy vacation with a boyfriend. I had my German Boyfriend Back in my, like, late 20s, after grad school, and we used to travel a lot, and we went to Venezuela, like a really rugged, rustic, wild trip. Went to the jungle. It was just the most, by far, the most rugged thing I've ever done. It was incredible. And it was, it was like, brutal. It was like parts of her.

Just brutal. But anyway, we were basically being taken around the country in the back of this guy's, oh shoot. What kind of car was that Land Rover? And he was this guy, I'm telling you. This guy was driving us around the country. He was a professional who was driving with bare feet, and at one point he had his left foot out his driver's window with a cigarette in his left hand out the driver's window, beside his luck, it was just absolutely crazy. Anyway, I journaled like crazy, and I'm so glad I did, because that journal is such a treasure to me now, but it's a lot of work. So every day of that vacation, I was always trying to catch up on the day before and all the things we had experienced. So I was constantly, anytime we had downtime, I was journaling, journaling, writing everything down, and he had tied all of our luggage to the very top of the Land Rover, and it was tied on there with a rope. And he got us on some kind of highway, and we were in the back there with my boyfriend and then two other random nice German guys who were traveling everywhere I've ever gone. I've met Germans there was traveling, so I was in the back of the land rover with the three guys, and I was journaling, and we were hanging out. It was very pleasant. And all of a sudden, the three guys saw me look up, and I said, Oh, my God, the luggage is flying off the truck. And right then, out of nowhere, about five seconds later, all of our luggage while we were going down, I won't say speeding, but like he was going down the highway, all of our luggage was airbound, kind of came untied, and we looked out the back of the window and we saw all of our luggage in the air and it slammed down on the highway, of course. What did he do? He put the car in reverse and reversed on the highway, back to our luggage. Mine was torn up. A couple of things got messed up, but I sensed it like five seconds before it happened. So I want to put this out there, because this is definitely not only me. I know some people listening have had a similar experience, and we want to hear about it. So message us if you ever had an intuition of something right before it happened, not months before, not weeks before. Not like, oh, I met him, and I knew he'd be my husband. Like, if you could energetically feel something 10 to 30 seconds before there was any evidence of it happening. I bet we're going to get a bunch of those and we'll read them. I'm sure. I hope so. Yeah, okay, ready? Yep. What came in? So a few questions and confessions from our community. The first one is, I peed in the birthing tub. I didn't think about it in the moment, but is that bad? She probably was like, I need to pee and I don't feel like getting out, so I'm just gonna go, Okay, let's see. Next is, how can I afford a home birth? Money is so tight, and we already have quite a bit of debt, I would say it's worth going into debt for your birth. That's what I would say.

Everyone's noticing my silence right now.

As the finance person like I will not say that I have too many questions before. I would say that I've questions to know how you could get out of that debt before. I would say, Yeah, I just I there is nothing more important than your birth. However, you don't want to calamity on your you don't want to calamity on your hands because of it. So that I do have other questions first, but anyway, your yours was a very nice as long as it's not going to mean that you have to go back to work six weeks postpartum, go into a little debt for your birth. That's That's what I would say.

Okay, next confession, I think I pushed wrong. I used the muscles that I use when pushing out a period cup.

How much dexterity does she have with all of those muscles to be able to differentiate the same muscles? Yes, yes. But I mean, honestly, the you know, your uterus is actually pushing the baby out, and then there is the there are the muscles in the vagina that are also pushing the baby out, but not necessarily consciously. And then you are using muscles consciously, too when you're experiencing that sensation? Well, it's actually called the Ferguson reflex. There's a lot of confusion between the Ferguson reflex and the fetal ejection reflex, but the fergan Ferguson reflex is really like that feeling when there's something pressing down on the back vaginal wall that makes you feel like you have to take a poop, and then that's kind of like a conscious response. So I don't think she's pushing incorrectly. I think that there isn't really a wrong way to push unless you're being told what to do and it doesn't feel right. I am excited for baby number three, but terrified of another round of postpartum rage.

This one's for you. Yeah, I mean, well, first we've done a lot of work on rage, and we have a really outstanding Patreon Workshop. If you're not on Patreon, you can just get the workshop. Go to a patreon.com/downtobirthshow/shop, and you just watch it. There is so much good information there about identifying rage, what to do about it, because rage is the variation or manifestation of postpartum depression that actually has a cyclical and somewhat predictable pattern. So it's about identifying and breaking the pattern, and it's normal to be afraid of it happening again, but it is very largely preventable, and there's so many things on that topic to be aware of. It's so important not to go through that again, and primarily because, not only of the suffering that you go through with it and your family goes through with it, but the guilt that you suffer afterwards, and that's really the part that gets women. So please, please, we've done so much work on that, please don't miss out on it. Alright, one more quick confession. I told my OB I wanted my hubby to catch the baby so that my hubby can block an eye catch.

That's good strategy. They'll be, did they'll be get the joke, the reference, I don't know. Oh, I don't know. You know what? You teased me in a recent episode that I didn't get a football reference, and I just got one that was a football reference. Oh, you didn't get that. I mean, catch is just a no block that that's a football catch and block. I can't believe the table just turned. You should have known that long before I Okay, yeah, I wasn't thinking about it that way. Well, okay, it's a good strategy because your OB should just be there. Your OB should be sitting in the back corner, not the receiver, the receiver there's literally receiver. Your OB should be the tight end.

Okay, let's not talk football, because I don't know what I'm talking about anyway. Point is good strategy. We want the OBS to be out of the way, right? Like, find a way to keep them out of the way so you can receive your own baby, and if that means putting your husband between you and the OB, then, oh, well, that's what you got to do under the category of easier said than done. But I know, but it is a little easier to do that than to tell your OB to keep their hands off you when they're trying to put their hands on you. Hands on you. What a haphazard today that was needed. My time limit for Instagram for the day, and it's already only 12:45

All right, let's let's get into the first question then.

Hi ladies. Thank you so much for your show and all the support you give. I just had a quick question with my last pregnancy at about 30 weeks, I risked out of giving birth to my midwives because I was diagnosed with a seizure condition, and so I had to find a hospital to go through to Give birth. And really, overall, enjoyed my hospital experience. I asked him all the provider green flags and everything. My question was, when it came down to giving birth, I overall had a really good experience. They pretty much left me alone for the whole time. The only thing was that when I started to push my provider had me get onto my back. I had been on my hands and knees, and then she told me to flip over and push on my back. And I asked her if I could switch positions, and she had said no, even though, when I interviewed her, she had said that she'd let me give birth in any position that I wanted. In the end, I really only pushed for 10 minutes, and so I don't think it hindered me in any way, but it was by far the most uncomfortable part of my birth, and so looking forward to my next pregnancy, I'm just wondering what I should do moving forward. To give a little bit more context, she text me and told me I was seven centimeters, and then I had my baby on my chest 29 minutes later. And so it went really fast. And so I don't know if that was a condition to it, but yeah, just looking for any advice or guidance moving forward. Thanks, ladies. Bye.

Break up with her.

This is the most common thing in the world, and I talk to my clients about this all the time.

Yeah, yeah. I mean, don't go back to her. But let me just for women who are still expecting. When I talk about birthing positions in my class, I always finish it with saying, listen, talk to your providers about how you intend to birth and whatever position feels right to you, especially in a physiologic birth, because you can really trust what your body is telling you to do when you're feeling everything. And I said, be sure to say to them, especially when the baby is descending and coming out, because they tend to say, yeah, no, that's fine. You can move around, you know, I'm gonna need you on your back when the baby's coming out. That's the moment you're talking about most of all. And in my first birth with wonderful midwives, they stay asked me to get off my hands and knees in the tub and flip around.

Right? I didn't want to flip around. I regret that I did. They didn't have me on my back. I was in a tub, and I went into another good position, so I knew it was still another good position. It was the semi reclining so my sacrum could open, and my back was lean, you know, I was leaning back, but my whole sacrum was available and open to expand. But I didn't want to be in that position, and it was just better for them. So after my son was born, I really thought about that a lot, and I thought, you know, they really shouldn't have asked me to do that. So with my next pregnancy, I said to Amy, my midwife, Amy, are you going to be cool with me birthing in any position I want? I mean, when the baby is emerging, I can you just leave me? Because I still feel like I want to do that on my hands and knees, and I didn't get to and knees, and I didn't get to and she was like, yeah, yeah, absolutely. So ask them about it in advance and specify, especially including, and especially when the baby is descending and coming out, because they do have this little caveat, yes, they want to have you on your back at the end. Well, you're it's a it's a hard thing to find an OB that is going to comfortably receive a baby in any position other than the mother on her back. They just are not trained that way. They haven't seen it that way. They are very uncomfortable for the most part, that way. I mean, she did ask this OB if she could deliver in any position, or birth in any position, and the response was sure, and then whoop bait and switch at the end, which is, as you said, extremely common and a good reason to choose a midwife, because a midwife is going to understand how to receive a baby in alternative positions or any position that's comfortable to you.

Hi, Cynthia and Trisha, I recently came across a Tiktok of a doctor explaining why she thinks that laboring down is a trend and poorly understood by most providers who advise for it. She said that having extended amounts of time between being fully dilated and baby being born puts an extreme amount of pressure on your ureter, perineum, pelvic floor, that whole area and can cause lots of damage. She then brought up some very fear mongering worst case scenario facts about cyllus, and said that laboring down makes them much more likely. She was speaking specifically about laboring down, but also mentioned that long periods of pushing can cause similar damage, and that's why you should listen to your doctor when they rush that stage because they know better and are trying to prevent damage. It got me really curious to hear your take. I've always understood from more natural minded content that laboring down has a lot of benefits, and as long as baby and mother are doing well, pushing for hours and hours even can be normal and fine. So I was wondering what you thought, and if there is an amount of time that becomes too long for laboring down, or even for the pushing phase, if damage is more likely to occur after a certain number of hours or such love to hear what you have to say. Love the show.

So that's why you should listen to your doctor when they want to rush that stage. Okay, yeah, so this sounds like a provider who is in a hurry to hurry up and get your baby born, and if you rush that stage, you increase your risk of a severe laceration, a severe perennial tear, a third or fourth degree tear. So let's first start by explaining what a fistula is. A fistula is something that happens when there is prolonged pressure, particularly in one spot, so like when a baby maybe is kind of stuck in the vaginal canal for a long period of time, and putting an excessive amount of pressure on the vaginal wall, which then creates a thinning or stretching and sometimes a opening of the vaginal wall with the bladder or the rectum, which obviously is not a good thing. So the idea that laboring down is going to cause a fistula, I don't think that there is really good evidence to say that is true. The other thing about laboring down is that it's more of something that happens when you have an epidural, when you are in a physiologic birth, you are going to feel that spontaneous urge to push. So laboring down is just sort of passively letting your uterus do the work, and you're not feeling the sensations of your body like that Ferguson reflex that we were talking about earlier that might help you get the baby down and out faster. So it's not really something that happens so much in physiologic birth, although it can a little bit. If a mother is in a resting phase, she might let the baby labor down a little bit.

But I don't think the advice to hurry up and get your baby out to prevent a fistula is good at all like work with your body, follow your body's cues, and if your baby is in a prolonged pause somewhere in the in the vaginal canal, yes, that does increase the risk of pelvic issues after birth, that's that's true.

So that's not also, that's also not a reason to force a woman to push her baby out faster. I think it's always a bit of a good observation to make when they're using fear, which that was. And it's not that using fear is always wrong, necessarily, sometimes it's effective and necessary, but when they use fear and then downplay the risks of whatever it is that they're recommending. So if they say, Look, I'm not going to let you I mean, I think the whole thing is nonsense. Never mind that there are risks with every aspect of labor. There are but he but that's not how we go through our safest approach toward labor, our safest approach is to take on those risks, as opposed to the other risks when they're not called for. And he was saying, this is when and why I would intervene, and he didn't give any commentary to her on the risks of the intervention. And right there you have, you see the whole picture right there. If he's saying, look, it's a risk if I intervene, because this could happen. But I'm also concerned, if I don't intervene, that could happen. That's at least a sincere person having a sincere conversation with you, but when they don't mention the risks of whatever it is they're recommending, right off the bat, you know you're not dealing with a straight person here. You know they have a motive and an intention because they're downplaying what they're recommending, and there's always risk to intervention. I mean, it's crazy how they act so concerned about every little rare possibility. I've had one client that I'm aware of in these years out of a couple 1000 who had a fistula. It was a bummer. It was, you know, something she really had to deal with. But if the risk is that small, why aren't the doctors talking all the time about the risks of the things that they're doing when they intervene? Because the risks of the things that they do when they intervene help them get the baby out faster. And they would choose a baby coming out faster and stitching up a fourth degree tear. That would be their preference, sadly, so the the other option here is with an epidural and laboring down, you can turn the epidural down or off completely, and then kind of get some of that sensation back to help push your baby down. So if your baby is stuck and laboring down as a concern for whatever reason, see if you can turn the epidural off. I mean, look at how many stories we both know of women who labored for hours in the pushing stage, hours because the baby's head needed the time to mold. It needed time, and that was the safest way nature could get those babies out. And these were not fistula stories. There was there was nothing else into the story but the fact that the baby needed time. It is a function of time that safety. So when they just take a normal birth situation and come up with all these risks, I don't really trust the motive, because they don't seem remotely concerned about all the things they're doing all day long that are actually driving up maternal mortality in this nation to top the Western world. So come on. I mean, where's the rest of the story?

I don't know. You're always looking for the whole truth like this is like, tell me the truth. Nothing but the truth and the whole truth. This is the whole truth. Well, what we're really looking for is facts, not facts, not fear. Yeah, that's true too. We don't really even have good facts on fistula data in a physiologic birth, I think probably more so in medicated births. But let's, let's focus on facts informed consent, as it always comes back to.

Hi, ladies, love the podcast. Thanks for all the work that you do. My name is Blakely, and I am from Pennsylvania. I am currently 30 weeks pregnant, expecting my third baby. Very excited. I did have a question with my second I've been listening to your podcast, of course, trying to be as prepared as possible with each birth. But something did catch me off guard with my second although I felt prepared, his labor was very fast. Hospital birth actually very positive experience. However, after he was delivered, it was time for the placenta to be delivered, and it wasn't coming out quickly. They had told me I had 30 minutes to get the placenta out or they were going to take me back for a DNC procedure. But luckily, the resident that actually delivered him worked very hard and got it out just at the 30 minute mark. But it did kind of scare me, just something that came up unexpected. I did not know that was a thing. So I'm just kind of now thinking, going into my third if that were to happen again, what would be a better way to advocate for myself? Is it really true in a hospital that you have 30 minutes, or is there more of a wiggle time? Any insight to that or help would be greatly appreciated. Thanks for all you do. Bye.

Major red flag.

Anything with time, a D&C, I have a placenta. Yeah, oh yeah. We're gonna take you back for a D&C, if your placenta is not born in 30 minutes, I mean, okay, first it was, we're gonna manually extract it, like getting up there in the hand and pulling it out, which it sounds like she did say that. You know, her provider did a great job. What did she say, getting it out fast, aggressively, something like that. I mean, just, let's please leave these women alone. There's nothing related to birth where there's a risk as of a certain duration of time. There's nothing. It's not true, like we hear about it all the time. You have to get to 10 centimeters in 10 hours or less, which was the one I was told. There's so many women who are told you have to push the baby out in two hours or less. You have to get the placenta out in 30 minutes or less. It's all made up. You don't have to play by their rules. So if you're wondering what to do when that just relax, because that's going to get your baby out faster anyway. Your placenta out, but you don't. You're not playing by those rules. You know, it's arbitrary. There's not research associated with that. So you say, I'm not, I don't consent. I'm not doing that. Now, if you're hemorrhaging, if there's a medical indication, you'll deal with that if something comes up, but to look at the pressure on her to get there, like, phew, got it out in 30 minutes. This is not how this should be, absolutely not. I mean, there it is true that there's a correlation. There is some increased risk for postpartum hemorrhage with placentas that are not birthed quickly. Normally, the placenta does birth itself on the third contraction after birth. That is the physiologic kind of norm. Some placentas do take longer. 30 minutes does not mean you're going to have a postpartum hemorrhage, though, but yes, there is an increased risk, which is why there is all the rush to get the placenta out, and that's also, you know, so they can seal up the birth and be done and get the perineum stitched up and close the doors and move on to the next thing. So it is the number, you know the 30 minutes is arbitrary, but the aggressiveness that we are putting on mothers to get this placenta born is creating a stress response. Of course, if you're told after your baby's born, you have 30 minutes to get your placenta out, what do you think that's going to do to the oxytocin in your body? Yeah, and that was going to be my next point, if they knew a thing about this that could justify this 30 minutes, if they were really sincere about this and were really doing their best and really cared about preventing hemorrhage, they would never have an arbitrary amount applied to every woman. They would say, we'd like to see it come out. We'll see how you're doing it 30 minutes. And whatever they want to say around that, but they would say, and this is presuming your baby, you've had no epidural, and your baby goes right on to you, and that your skin to skin, and your baby is latching on, because that's what your body is expecting. And those are the conditions for getting the placenta out as safely as possible. And if they're ignoring all of those things, then it shows you everything. If they're ignoring all of that, then this is just a completely arbitrary thing. You can't say that to a woman who's having a physiologic birth and takes a little wet baby onto her skin to skin and is starting the breast crawl. And say the same exact thing to a woman who's had an epidural and she's fully clothed and they take the baby away, to wash the baby. Each body is going through something radically different. So if they're really coming from an informed place, or if there were any good research on this, that would be the top factor, not the time, right? So they're applying non physiologic management of the placenta to the physiologic birth. So in a non physiologic birth, when a woman has had oodles of Pitocin throughout her birth and an epidural, her risk of postpartum hemorrhage is going to be up and active management of the third stage of labor came about for this reason, and it showed that it decreased the risk of postpartum hemorrhage when used but when you're looking at a physiologic birth. It's a completely different ball game, and we can't apply the same rules to them. We are so mismanaging the third stage of birth. The things that we are doing to women immediately after birth are so incredibly disruptive. All the people coming in the room, all the lights going on, the birth space is completely gone from whatever it was, you know, maybe peaceful, maybe not, but to definitely not peaceful after the baby is born. And you know how I feel about the skin to skin, like you said, the probably the biggest harm we're doing to the third stage of labor is cutting the cord and separating moms and babies after birth. The second you take that baby off of mother, her oxytocin is going to drop, her adrenaline is going to increase. Her her stress hormones and her fear hormones are going to go up, and her placenta is going to be like, nope, staying right here.

Hi, Cynthia, Trisha, I was listening to your podcast number 25 and Tara said, Too much Pilates could cause hearing I do prenatal Pilates three times a week. Could that be a problem? Should I stop? I'm 22 weeks and I've been doing them since day one. I did Pilates prior to pregnancy, too. My other question is explaining childbirth to kids. What if they asked me how the baby got there, and they're young kids, like six years old. What should I say? I'm also not religious, so I don't know how to go about that.

Okay, let's start with part two of this question. First, did you ever have to explain to your young children how a baby got inside? Mommy? Yeah, well, I chose to tell them. It's not that they asked. I chose to tell them when they were young, because my mom told me when I was, like, five years old, and I remember very well. I was just like, Huh. But if you tell your kids, if I did the same exact thing, I started telling them when they were three, four or five years old, you know, you leave details out of it. They don't have to understand anything about the the logistics of how a baby gets inside of the mother, because it's easier to tell them when they're young anyway. Just be mature about it. Just use normal terminology, normal body part terminology. It is so much easier to tell them when they're 3456, than if you wait and they start getting curious and you're telling them at eight, 910, of course, they'll know something by then, but don't make a thing about it. Just talk normally, talk matter of factly about it. Just don't, don't make it hard. There are facts in the world. And just teach your children facts, anything else about it. They're not learning about orgasms. They're not learning about sexual position. You just tell them how it happens. The penis goes inside the mommy's vagina and, you know, you just explain it, that's it. And they're going to be like, cool, like, Can I have a peanut butter sandwich? Like they it's not that, if you don't make a thing about it, it means nothing. They grow up knowing it. I mean, I've understood, I've known it from the time I was very little it was. I just was sure that was the right way. So, and I don't know what religion has to do that or what her point was about religion, I would hope religion doesn't change the facts of the matter. But don't make a thing about it. Don't make it weird, don't, you know, just be normal. Be as normal as can be about it.

Yeah, I completely agree. I have zero recollection of my kids ever asking about it or really having the conversation about it, but it never seemed like a thing, like it was just understood. Yeah, you don't have to explain erections. You don't have to explain arousal. Dad plants the seed. Yeah, I'm kidding. When two people love each other very much.

Dad gives mom a seed, and the seed grows, and then a baby's born.

No, don't make a thing about it. I agree, yeah, don't make a thing about it. And you know what? Same goes for the Pilates. Don't make too much of a thing about it. I think her point maybe from that episode with Tara, Episode 25 was just that, you know, if you have a super tight, taut pelvic floor. Sometimes that can increase the risk of tearing, because it has a little bit harder time relaxing if it's really tense and tight. So don't increase your Pilates in the third trimester. Just kind of do what feels normal. You're probably going to naturally back off it anyway, because you're going to start to get a little bit more uncomfortable and maybe move toward, you know, more gentle exercises like yoga and a little less on the reformer. Yeah. And I just want to say about Tara Gibson, who is an outstanding women's health physical therapist who was the guest in that episode. Tara is a Pilates master. I mean, she's in like, she has the most perfect posture. She's She was really into Tai Chi and pilates and like anything else, like yoga, Pilates isn't the same for everyone. If I just go to a random Pilates class, I'm going to be focusing on my large muscle groups and moving my leg and holding my posture right. But people who really understand Pilates, like Tara Gibson, it's very deep, deep abdominal core work, and the abdominal core is tied to the pelvic floor. So from Tara's perspective, if you really master that deep muscular work in the core of your body, in your lower abdomen, that's what's going to lead to the tighter pelvic floor. But most of us in Pilates who are not complete masters of it, like Tara, I mean, she has a reformer right in her office. We're it's, I think it's great that you're doing Pilates. I really do. I think it's great. I think Tara really was coming from a place of someone who she herself could have been at risk of that if she didn't understand the pelvic floor so well because of how effectively she does Pilates. So that's probably the factor that she was referring to. So all right, that's a wrap on our questions. Trisha, so we've, let's get to our quickies. Quickie. Quickie time. Okay, okay, we're just going to start with this one, because I just am going to be very curious to understand. How many people do this, the first quickie. How often do you wash your walls? Don't lie.

Do you wash your walls? Well, not from top to bottom. I just repainted a couple months ago. So when I when I see anything on the walls, I wash what I see. If I see fingerprints, or if I see any smudge, I wash the wall. I don't like, I don't like, wash the wall.

Walls the way I you know, like the way you dust a house or vacuum a house. No, I kind of wait till I see something, and then I want, then I wash it.

What do you do? I do not wash my walls. Well, what about when you see stuff on your walls?

I mean, maybe that happens once or twice a year, or somebody like runs a grimy hand across the wall, and you have to wash it. But, no, I don't wash the walls. I can't think of the last time I washed the wall.

Yeah, in your house, I don't think that would be likely to happen. It's kind of more rustic, and you have that big wooden piece when you walk in. For mine, when you walk in, there's like, you know, matte finish on the walls everywhere. It's very easy for us to get a fingerprint or something on our walls, because it's like mostly wall in our entryway, we have, like a console, but in a mirror, but that's yours, has a large piece of furniture. You almost can't access the wall that easily. I think you would see a lot more if your house were laid out a little differently, but it's a quickie, and we're going to move on. That was okay, great. All right, yeah, let's go. Should an OB be able to tell if a baby is head down without an ultrasound. Yes, yes, yes, more, yes, yes, yes, they should. Can they should have you lost all your skills, right? Have we stopped? Did you ever have them, right? Did you ever have them? We've stopped touching women. Touch is care. Touch is love. Women should be touched by people that they feel safe with, and that those hands should be able to say, Oh, this is how your baby is, and this is where your baby is not hooking you up to wires and machines. And that definitely speaks to me of a an absolute loss of skill and a lack of ability. The answer is, yes.

Don't give me that look. Do not do you know how boring quickies would be if we just said yes or no? Sorry. Okay, you're ruthless.

Does a lip tie in a newborn need corrected? If their latch is great and they're gaining weight? Oh, this person's from Ohio or Western Pennsylvania. Why? Because she said, Does it need corrected?

It's a colloquial verbal thing. Instead of need corrected, I didn't even notice that. Yeah, does it need to be corrected? Okay, you best for you? Yeah, I don't think so. No, no, I'm not. I'm not super big on correcting the lip ties. I mean, especially if there's not a problem. It's a, it's a, definitely a more painful process for the baby.

Are there any supplements that actually increase milk supply, or all scams to scare breastfeeding moms? Yes, actually, yes. Supplements, or galacticogs, as they're known, are herbs and foods that help support prolactin so all they do is give your little prolactin hormone a nice little boost. But the real work is in removing more milk so you can elevate your prolactin levels through foods, teas, supplements, tinctures, whatever it is. But if you're not removing the extra milk, it's not going to do a whole lot for you.

There are many galactic dogs, and they do work. Yes, is estrogen cream a helpful tool postpartum? My midwife recommended it? Well, guess what? We have an episode coming up on this because there's something called genital urinary symptoms of lactation, and this is because estrogen levels are very low during lactation, and a lot of women can be prone to genital or urinary issues because of it, like UTIs, recurrent UTIs, or the incredibly dry, painful vagina that leads to painful sex.

So yes, estrogen creams can be helpful. They can also help with healing. If you only have the time or funds to pick one. Would you choose a PT or a chiropractor during pregnancy? So physical therapist or chiropractor during pregnancy, it completely depends on their skill. I would pick the person that is most skilled at working with pregnant women. I would meet them both, I would go to one of each, and I would see which one felt more effective, and then pick one I agree. Just depends. And there are other modalities. I hate to leave out pelvic floor PT is probably one of the most valuable things you can do. But why leave out acupuncture? And they're not all created the same. Is it an outstanding chiropractor, acupuncturist? PT or not? So we can't leave that out of the equation. All right, a couple more. We've got a lot of personal ones today. What are you currently reading for fun?

I'm actually currently reading Joe Dispenza is breaking the habit of being yourself, and it's amazing. It's absolutely amazing. Good one. I need to read that.

I don't read for fun very much. I need to read for fun more. So I'm going to ask for some book recommendations, I could use some more light from My Brilliant Friend. You have to read My Brilliant Friend. My Brilliant Friend. Yes, it's a four series book. I'm waiting to start it because I know I'm going to become obsessed, like the whole world is obsessed, and my mother and my niece and everyone's like, Oh my this. It's apparently magnificent, and I know that when I read it, I'm going to need a lot of time in my schedule, so I'm waiting to.

Begin My Brilliant Friend, and it's sitting on my sitting on my table. Well, let's read it together, and maybe we'll add it into book club. Okay, so I'm currently reading unshakable by Tony Robbins. Oh, okay, great, great book preparing for the great stock market crash that's coming.

Which leads into the next question, Do either of you believe any conspiracy theories? Well, the thing is, when you believe them, you know, they're not a conspiracy theory. I believe many things that are totally factual that other people right say no, but like, you know, landing on the moon and stuff. Now, we landed on the moon. I'm not, I'm not going to be prone to just all sorts of random things that come up. Yeah, I really tried to that stuff, the production that would have been involved in faking that and that, thou, the 1000 people that would have been involved in that who never spoke in two generations about it. No, but there are many things that are factual and are chock off as conspiracy theory. I think that's the most harmful thing, because it shuts down discussion.

And sometimes things that be that are started as conspiracy theories become factual later on when we find out, yeah, and they always were factual, like, during how many, how many things were there during covid, right, right? And all the research is out, all the research is out now, but I try to stay away from that stuff, because it just, I don't know it's, it's, it's not worth the mental effort to me.

So Okay, what else does Trisha have an easy birthday cake recipe to bake during early labor? Gluten Free, preferred? Well, shoot, I do, but not gluten free. So I'm gonna have to come up with a gluten free one. I've never baked anything gluten free in my life. I don't even know how to do that. I'll work on it. All right? One more. One more. What is your current guilty pleasure as far as like a show or something that you're watching? Oh, I actually have an answer to this. Good I haven't watched a show in the longest time, but I saw a clip on Instagram of a show, so I made a note of it, and I started watching it over the weekend, it's on Apple TV, and it's called platonic, and it has really great actress. Her name's Rose Byrne. She's the beautiful one in bridesmaids, and she had a role in the movie Annie. Anyway, she's a great actress. And in the show, she's happily married to like a handsome, nice, nice, nice man, and she's best friends with Seth Rogen, and it's funny. There's some improv in it. It's entertaining. It's an entertaining show. It's been amusing me. I played it while I was cooking the other night, and it was, I was really getting a kick out of it. I sent a scene to a friend of mine, yeah. Are you watching anything? Yeah? So no, I'm, as you know, I'm very serious about my sleep these days and going to bed very early, because I've been getting up very, very early. So there isn't a lot of time for show watching lately. But as soon as land man Season Two comes out, I will be watching. Did you ever hear of it or see it? No, never have it. Okay. So it's with Billy Bob Thornton, who is not someone I have ever thought was even remotely appealing or attractive, but in this show, don't you dare tell them all he is, don't. Man, no, no, I would not. I would still not say attractive. But there is a slight like, oh, I Okay, I kind of can see it now, slight, ever so slight. He's so good in the show, and it's such a great show. I love it, all right.

Well, that's a wrap. Have a happy end of October, everyone, and we'll see you at the end of November for that next Q and A and next week for our next episode. Thanks guys for that. All right. And Adios, bye, bye.

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