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.
Yay, February, we’re almost there.
You’re not going to believe this. Okay, guess what? You know how my whole thing is, like, I believe in doing new things. A keyword for me the past year is play. It’s like, yes, I have done wonderful things in my life, and I’ve taken up a new hobby that I’m not ready to announce yet, because there are visuals that will have to be associated with it. So I’m not ready to announce it yet, but when I do, it is exciting. I’m very excited about it. And then you won’t be that excited about it, but it’ll be fun for you, okay?
But the other thing I’m doing — you’re going to be so… I can’t wait to get your reaction. Dare I say, I think you’re going to be jealous. Not that I would ever want you to be jealous, but I think you’re going to be jealous of this one. Okay, wait till you hear. Oh my gosh. I get such a kick out of this.
So I made a new friend this week. One of Vanessa’s really good friends has a really nice mother, and the two girls have been saying forever, “You mothers have to meet. Both of our moms are so nice.” So it’s true, we’re both very nice.
We met for tea the other morning. Facts, yes, yes. Anyway, she actually was so nice. And we met for tea for a couple of hours. We talked very comfortably — very unpretentious, down to earth, nice, sense of humor. Deep.
Have a question I have to just ask quick before you finish. Is it because you have a friend named Marnie? I do.
I do not have a friend named Marnie. I’ve never even met anyone named Marnie. Never heard of anyone named Marnie. But how do you establish that you’re meeting for tea and not coffee?
Oh, because we made plans to meet, and I think — I don’t remember which one of us said coffee. I think it might have actually started with coffee. And then she said, “Actually, I don’t drink coffee.” So then I thought, I’m not really a morning coffee drinker either. For me, coffee is a dessert, or I don’t even drink it at all. Opposite of you, we know — with you guys, we’re already fast friends with your intravenous black coffee IVs every morning before you brush your teeth.
Very opposite of me, who has to put like maple syrup and half and half in it, and then I’ll potentially drink it.
Coffee is like wine. It is meant to be fully embraced with all its magnificent, magnificent flavors.
I’m not that into wine. I’m more into chocolate. I have very strong opinions about chocolate. I’m really not that into wine. I just, I just… You don’t like milk chocolate, right?
No. Oh God no, that’s not even chocolate. Okay? That doesn’t even count as chocolate. I like chocolate milk. I’ll flip it around. I like chocolate milk.
Of course, that’s exactly how I feel about coffee. You put milk in it, it’s not coffee.
Like anything chocolateized, you know. Like, okay, you put milk in coffee, and it’s not coffee.
Oh, milk in chocolate. It’s not chocolate because you appreciate the flavor.
I deeply respect your position on it. I’m not joking. I’m sure you are a better judge of coffee than I am. I’m not proud to say I have to turn it into a dessert in order to enjoy it, but I’m just being honest. There are things I will actually put a stake in the ground on, like whether we talk about quality of chocolate or something. Then I’ll get impassioned. I know you are the coffee person between us. No doubt about it.
Okay. Anyway, that’s all beside the point. We met for tea, had a lovely time, and we got into this conversation about the concept of play and new things we’re doing.
And I have been so happily playing pickleball twice a week. It’s truly just so much fun. And all the people who started when I did last summer — we’re all getting better and better and better and better together. So the games, the volleys are long and it’s competitive and it’s just getting so much fun.
So anyway, she and I talked about that, and she got it. She wants to learn pickleball, and we talked about that for a while. She’s into other athletics, so you’re not going to believe this.
She sent me a text this morning. She reached out to her new friend — which I am already impressed with. I love that about anyone. And she said, “Cynthia, I’m signing up for — are you ready for this? Tell me. Wait to see your reaction. Come on, get out your cowboy boots — line dancing.”
Oh, nice. Yeah, that’s awesome.
Isn’t that amazing? And she said, “Would you want to take these classes with me? My friend did it. She loved it. She’s moving up from beginner into another level.” And I was like, “Heck yeah,” because first of all, I’m going to say yes to virtually anything a new friend invites me to. I would not at all be inclined to say no to anything, especially if it’s dancing.
But dancing is like my favorite thing in the entire world. Though the last time I took dancing lessons, it was swing dancing lessons. So this is very opposite.
But I did have a friend who grew up on a farm, and I did actually line dance with her a couple of times in a barn with all the neighbors, and it was like one of the most fun things I did in my life.
So I can’t believe this. I’m going to be taking line dancing lessons on Tuesday nights. I love it.
Anyway, so that’s that. And it’s very early in the new year, and I’m already taking on two new things to add to the list. I began last August with pickleball. Okay, look at me. I’m line dancing.
What was the other one?
Oh, that’s the secret one I haven’t announced yet. It’s not a big deal. I don’t want to create a huge buzz around it, but it’s a fine motor skills creative activity that I’ve always dreamed of. That’s all. I’ve always just marveled at it.
And now my son bought me, as one of his Christmas gifts, all the supplies I could possibly need. And I was looking at it like, all right, I better — because it was such a thoughtful gift.
Jewelry making?
No, that’s a good guess though. Very good guess. That’s a good guess. No. So I’ll announce it soon, I guess when I’m ready to share some pictures. I’m going to be announcing my new creative skill.
But the point of the conversation, I think, is to our listeners: how are you? How are you playing in your life?
And I’ve talked about this in my postpartum group a lot, and I know when I was postpartum, if anyone had said that to me, I’d be like, “Oh, right.” Like, you’re hilarious to suggest I should play when I’m trying to make sure I can even eat lunch every day.
But truly: how do you get laughter into your life? How do you get play into your life? How do you get movement into your life? Exercise doesn’t have to be exercise. You can just find an activity that just makes you so happy. And obviously it’s hard with a baby.
But do have the intention, I believe, of expanding yourself. Remember when we started this podcast, I kept saying that this is going to be so hard for me because I’m not technical. I think I’m really technical now. I think I hear other podcasts and I hear things all the time that I would have corrected or done differently or fixed, and little mistakes that are getting by. And I’m like, wow.
I mean, first of all, we should lighten up and not care so much. But second of all, I’m highly technical. And who would have thought at that point in my life, I would be able to see myself differently?
So for everyone listening, no matter what your age, you can see yourself differently. If there’s anywhere that you aspire to something different — but we all deserve play and laughter and connection. I guess that’s enough I can say about that, but I do feel this is one of the most important things in the world, and it usually takes the lowest priority.
And for too many years for me, I focused on getting to graduate school, my career — and my free time, I was teaching finance classes at UConn in my free time, and I thought that was awesome. But now I just have a much better sense of… I don’t know. The creativity, the creative space…
Yeah, that is something that I very much noticed in the years that I was raising children was missing in those years. You need to have that time and space for creativity in order to feel like you’re fulfilling yourself.
And for me, when I was raising children, I wanted that to be through baking bread and making muffins and creating home and drying baby diapers in the sun, but it just wasn’t the reality and it was hard.
I do think that when you don’t have that time and space for creativity in your life, you do feel like you’re missing out. But it is really tough when you have little kids.
And I feel that now at this stage in my life, too. You and I both have kids that — they don’t really need us anymore. My youngest is 14. Your youngest is 16. Kids off in college. There’s so much more time and space now to bring these things into our life. I really feel that at this stage in my life as well.
But I think you can find small ways with young children in the house to find that. But also you have something to look forward to, because when your kids are grown and out of the house, that is all going to come back. That space is going to expand and be there, and then you have to step into it and run with it.
Well, we have our book club, and I wasn’t even thinking about that, but that is a sense of connection. We’ve invited women to just join in our discussion, or they can watch the videos. But that is a sense of — women are saying it’s just really fun. They love listening to it, especially a book like this one that’s exploring this friendship.
And when Alex was really young, my husband and I did what we called date night every Friday night religiously. We would put Alex to bed, and we played games every single Friday night.
We went through a huge phase of chess where our games got three hours long, very intense — actually a little too intense after a while — and I was like, we needed a much lighter game. Then we went through a big Scrabble phase. We went through a big Rummikub phase. There was another game, but we just played games on Friday nights, and it was so much fun.
There’s some of my best memories — just sweet memories of when we had a little baby sleeping in the next room, when we just played hundreds of games. I still see all the scorecards in the boxes, and it’s just really nice.
Yeah. There’s always some way. Or do you have joyful friends? Do you have funny friends? Do you have people who lighten you? And that also should be a goal. We need people who lift us.
Levity. More levity.
Yes. It’s very easy to get bogged down in the seriousness of life and the stress of life, and you have to balance that play and levity.
Yep.
So I’ll let you all know maybe by the next Q&A how line dancing is going.
We want videos. We don’t want to just hear, we want videos.
I’d rather post pickleball videos at this point than line dancing.
Well, fine, share some pickleball videos.
I don’t think my teammates will appreciate being recorded.
I just encourage other people to try something. I don’t think that’d be right. I wouldn’t want someone recording, okay, so they can post it on social media. Like just you all right.
That’s more than enough about creative fun play. Yeah, we gotta get to business.
Yeah, we do get down to business. Down to Birth business. Let’s go.
Hi Cynthia and Trisha. I know I probably have a lot of competitors for this role, but I think I might be your number one fan. I love you guys. I consider you part of my birth team, and I’m just so grateful for the way that you’ve impacted my mindset about birth.
So I am now pregnant with my second baby, and as I prepare for my second birth, I’m reflecting back on my first birth and some things that I hope might go differently this time.
I had an amazing physiologic birth at a birth center, but I was not able to birth in water, is one thing. I also received Pitocin after the birth for postpartum bleeding. And so I have a question about each of those two things.
On the first point, I was asked by my midwife to get out of the tub towards the end of my labor when I was pushing because of a pretty major fetal heart rate deceleration. And I’m just wondering if that is standard practice in the case of a concerning fetal heart rate deceleration. We now know, in hindsight, that she shot through the birth canal at like record speed, and that’s what caused the heart rate issue, and she was born totally fine.
But then I did have a fair amount of bleeding afterward, and they kept me longer at the birth center to monitor that bleeding, and ended up I consented to a Pitocin shot before I was discharged.
My question about that is that my midwife for this birth — who is a different midwife, because I moved two states — said that they would just go ahead and give me Pitocin immediately after this birth as a result of my history of a borderline hemorrhage. And I’m wondering if that is standard practice, and if I should just consent to that.
I don’t feel as conflicted about Pitocin in that case, because that’s what it’s for. But I’m just wondering if there’s any reason why I should delay that and just wait and see what happens.
So thank you so much. I look forward to hearing your responses. Hope you have a great day.
Well, I have thoughts. What are your thoughts? You want to start?
She was so cute. This is — there’s a lot of competition to be your number one fan, but I think I am it.
I wish I could know all these women. It’s just so nice when you — it’s so hard to envision when you see like thousands of episodes are played every day. I try to picture the people around the world and just how neat it would be just to meet one of them and talk to them and get to know them. That’s the hardest part about podcasting. It’s like you want to be connected to people, and they feel connected to you, and you just want to know them back.
Like, well, that is why, Cynthia, we are eventually going to do a Down to Birth retreat. That is the solution to that.
Yeah, obviously.
Be able to meet everyone that way, but we’ll get to meet some, and it’s going to be a beautiful day when we get that organized.
Anyway, yes, if there are any retreat organizers out there who want to do that for us, we would be delighted.
Help us get the ball rolling. Cynthia’s too busy playing pickleball and, oh yeah, over here.
So, okay, well, it is normal for the baby’s heart rate to have a pretty steep deceleration if the baby is making a quick passage through the birth canal, and/or they get a little too much pressure on the head, and/or they maybe squeeze their cord, or the cord is getting compressed momentarily as they pass through the bony part of the pelvis. All of these things can cause short decelerations and steep decelerations in the heart rate.
The point is: do they recover? If they recover quickly, once the pressure is off, that’s fine. Babies can tolerate that. They’re built to tolerate that. So getting her out of the tub might have been extreme.
A change of position, definitely. You know, when we do notice a heart rate deceleration, the first thing we’re going to do is change the mother’s position, because that’s going to relieve some of that pressure. Or if the baby is a little bit stuck, that’s going to resolve that.
But I do think providers can get a little panicky and nervous when that happens, and getting her out of the tub and into a bed assumes more control over the situation. Makes you feel like you can get her in McRoberts position if you need to, if there’s going to be a shoulder dystocia. You can see where the baby is better. You can assess the situation better. You can see how close the baby is to being born. But probably getting her out of the tub resolved the situation, and also a position change would have likely have done the same thing still in the tub.
When I hear questions like this — and we hear questions like this all the time — and when I say “like this,” I mean a woman tells us about a very common action of her provider or response by her provider during her labor. Like, “Oh, we need to get you out of the tub for this reason,” or “We need to give you Pitocin for that reason.”
And then that woman is then told, “Oh, for your next birth, ooh, we better be careful about that thing that happened.”
And what always gets my attention is that it’s so common these days that women are told to get out of the tub for no reason. And what I mean is like, there are hospitals like Danbury Hospital has tubs, and they have had a policy for decades. Despite that, they are the plan B for the birthing center that’s right across the street that totally supports water birthing in the hospital, they say, nope, nope, nope. You have to get out before the baby comes out. When you’re 10 centimeters, you got to get out. That’s very, very common.
I can’t tell you how many clients I’ve had from all over the country who plan a water birth and they say, “Cynthia, what do you think about the fact that they have a tub, but they’re going to want me to get out before the baby comes out.”
So when this woman says that she was told to get out because of decels, I’m a little cautious slash suspicious of decels to begin with. And you know why? Because just a quick decel doesn’t really mean anything. It not only has to be a certain deceleration, it has to last a certain amount of time.
Yes, the whole key is if it bounces back.
You covered that exactly, but if it just goes blip and it’s low for two seconds, as you said, it bounces back, but it’s technically a decel. And I can’t imagine how many millions of women have C-sections, amniotomies, Pitocin because of a supposed decel. I think it’s one of the easiest things to say to a woman to get her to change her course of action. It’s a very scary thing to hear.
So when she was so close to birthing her baby — right around the time that so many providers tell women to get out of the tub because it’s a lot easier for the provider if she is out, and most of them are not trained in supporting water birthing, so they don’t even trust it — that they came up with this reason. I’m not saying it isn’t true. I’m saying I’m questioning.
I mean, think, Trisha, about I think it was our last Q&A in which a woman called in and said her own midwife said she can’t allow her to birth in the tub because she’s seen a lot of babies swallow water. And Barbara Harper came on to say absolutely false. That’s an impossibility.
So if you have a woman like that, a midwife like that, who then waits until that final moment and goes, “Ooh, decels, you need to get out,” I can’t help… I’ve grown a little cynical over these things over the years, because when you hear stories literally thousands of times that mirror each other, you grow a little cynical.
Meaning, it’s not that we blanketly can’t trust things, but if I were that mom in labor and had the lucidity I have sitting here comfortably talking about this, I would be questioning the decels. But that’s a very hard thing for a woman to question. What is she going to say? “Well, how low were they? Were they sustained? How long was the heart rate low? Did it bounce back?” No woman’s going to be doing that. She’s going to respond because you’re not going to take the risk.
So what concerns me is when that woman is then told, “Ooh, for your next baby… Oh, your first baby was big… Oh, we got to get that baby out sooner and induce you… Oh, you hemorrhaged the first time… We’re going to have to… Oh, you were group B strep the first time…” Like, all the time they’re doing this.
So I don’t know if there is a protocol — I haven’t heard of one — that if a woman hemorrhaged the first time she should have Pitocin the second time she’s giving birth. I don’t think that that would be evidence based.
But have you heard of such a protocol by rote? They just do it again for a second.
I just want to go back and finish on the deceleration comment. I hear where you’re coming from, but it’s not to say that under every situation, under every circumstance, with a deceleration, that midwife suggesting she get out of the tub would be wrong.
There — I’ve been at birth where a woman does need to assume a different position, and if she doesn’t feel confident to do it on her own, which is sometimes the case, the midwife is going to give some direction and instruction, because if there is a true problem with the baby’s heart rate, we’re going to need to get out of the tub anyway.
I agree.
Make a transfer. We’re going to need to get in the bed. We’re going to need to assess the situation.
So I think the point I was making is, how can we know which is which? And no one is going to take that risk. But then when they use it against her for her next birth, that now compounds — like that’s not justified.
So maybe, definitely not justified.
It makes me less trusting of birth scenarios.
Yes, but it’s also policy that she was in a birth center. She wasn’t at home. Even birth centers and hospitals, they have policies around these things. If there’s a deceleration, it’s probably in their protocol that they get out of the tub.
So this is just one other example of where being in a policy driven environment for birth can alter your birth versus being at home where those rules don’t exist.
And I guess if her birthing center does strongly support water birthing, then I would trust it. But it’s hard to know.
It’s kind of like if you get an episiotomy and the obstetrician is like, “Oh, believe me, you really needed it,” and they do them 80% of the time. You’ll never know if you did.
But I know midwives who have done them. Every midwife I know has done them at least once. I know many who’ve done them five times or fewer. I would trust that midwife. If that midwife who’s hardly ever done an episiotomy said to me, “Oh, believe me, you needed it,” I would not question it.
So that’s what I’m saying. I guess my key point is: I always feel for women when there’s nothing that they can prove. Just like hemorrhage is another one of those things.
But then when she’s told, “Oh, for your next birth, we’re just not going to let you…” Well, why not? It’s a new baby, it’s new conditions. And I think that’s not fair to that second baby or to that?
Yes, I agree. I agree with you regarding the Pitocin for the second birth. I don’t think you have to have a preventative, prophylactic Pitocin shot just because you needed it the first time.
No. I mean, it works quickly if you are in a situation where you’re hemorrhaging. That is why we have it. That is what it’s used for.
But of course, it’s routinely done. It’s standard practice to give Pitocin with the birth of the baby, so they’re going to use any reason they can to try to get a mother to agree to that, but she certainly doesn’t need to.
And just for the record, in my opinion — and I’m quite sure you’re going to agree with me — there is no comparison between a simple intramuscular shot of Pitocin postpartum and a woman who’s given Pitocin for, quote, labor augmentation. Pumping her with Pitocin while she’s still laboring.
There’s no comparison. You’d want to do the shot postpartum 100 times over getting Pitocin unnecessarily for induction or labor augmentation. So it’s not a huge deal to get a shot of Pitocin after the birth.
I’m just saying: here is a woman who clearly has a preference not to. She’s called and asked us. And I don’t think it’s justified.
But we so often see women are told, “Oh, for your next birth, I’m just going to tell you right now…” blah, blah, blah. We hear that all the time.
I can tell you that with my first birth, I had a shot of Pitocin because I was bleeding too much, and with my second and third, I didn’t.
I did for both. Yeah, I did for both. I did.
How did you know if you were bleeding too much? Did you just trust your midwives the first time? Could you see it? Did you believe it? Did you feel it? Because I felt comfortable—
I believed it. No, I was not paying enough attention at that moment in my first birth. No, I didn’t know. I trusted her.
Yes. And that’s what matters. Yes. Like we say, the most important thing is that you feel at peace with your birth. And when you trust your provider and they do something like that, you’re at peace. Bravo. That’s exactly what we’re looking for, not the women in anguish, who are calling in questioning things.
Because now she has the emotional suffering, so to speak, of wondering whether she needed something. And again, it’s not a huge deal, but it’s a deal. She’s here. She is still wondering about it. Now thinking about her next birth.
These — they matter to women.
There are plenty of scenarios where women get Pitocin with their first birth and do not need it in their subsequent births.
Cynthia and Trisha, I so appreciate your podcast, which I recently discovered this past year as I prepare for my second birth, which will be a home birth after birthing my son three and a half years ago in the hospital and having a very negative experience with my OB.
She did several things without my consent, such as sweeping my membranes at my 40 week appointment, not telling me, and then telling my doula after the birth that she had swept my membranes. She also gave me an episiotomy without telling me or asking me. I heard her do it. I heard the snip.
And then after the birth, she told me that she had snipped me because I was going to tear up into my clit, which were the exact words that she used.
And so my question for the both of you, as I prepare for my home birth — I’ve obviously, I’m going the complete opposite route this time. I’m, you know, as you know, under midwifery care, and I’m loving the model of care as compared to what I experienced with OB.
But my question is that I am more likely to tear because I’ve had that episiotomy. I’m not sure if with the scar tissue, it makes me more susceptible for tearing. Would love to just hear your thoughts on that.
Thank you so much for your show and all the work that you do, and I hope you have a great day.
It’s actually the perfect question after what we were just discussing, because this is exactly why you have the cynicism — or we have the cynicism that we do — around OBs.
I mean, that is abuse. That’s wrong. This is common. This is common in obstetrical care.
She swept her membranes without consent. Just keep your mouth shut. If you did something without somebody’s consent, that’s a violation. And she obviously feels that she has the — you know — she’s righteous enough to feel like it was okay, that she would talk about it afterwards.
And then secondly, the episiotomy. I mean, we have been talking a lot about episiotomies lately. It feels like that. There are just almost zero circumstances. The only situation in which I can ever think that an episiotomy might be warranted is not because you might tear into your clit, but because your baby is going to be cut out of your abdomen if you don’t do it in an emergency scenario. Then I’ll take it. But otherwise, no. Tear. It’s better, and you probably wouldn’t tear.
Yeah. I don’t appreciate the crassness any more than she did, right? She was like, those were her words. And I mean, use proper terminology. Anatomical structure.
It is — I would not want to be spoken to that way. That’s like calling somebody’s boob a tit.
Yes. That’s right. That’s how I feel about that. I personally would find that really distasteful, and I wouldn’t want this to be spoken about that way.
But also, it’s the most compelling thing you can tell a woman to justify an episiotomy. And here we go, where I’m thinking, yeah, well, that’ll get her attention, and then she’ll say, “Please cut an episiotomy,” because we don’t want that.
So thank God you did, because that would have been — oh my God, I can’t imagine.
Exactly.
So that again, it’s like: is that really the case? It can happen. We’ve spoken to women where that’s happened. It’s very, very rare.
But did the doctor foresee it? It was like headed that way, and she cut to prevent it, I guess? Why?
Yeah, the only reason that doctor could even make that observation is because she probably had this woman positioned on her back, with her legs up, or in some position that was going to make her more prone to tearing.
And if she just would have said, “Hey, the perineum is a little tight and stretching too much. I’m concerned you’re going to tear. Why don’t we get you on your hands and knees or on your side, or get you off your back,” an alternative position — or let the mother just assume a position from the beginning that felt right to her — then we wouldn’t even be thinking about worrying about where she was tearing and in which direction.
Yeah, and we didn’t even answer her question yet.
But again, the water — the membranes thing is incredibly upsetting that she did that without consent at a prenatal visit. How dare she? Honestly, how dare she?
That is the big decision to do a casual vaginal exam. You shouldn’t have to protect yourself this way. You shouldn’t have to think they might do a membrane sweep while you’re there, trusting them to do a vaginal exam.
But why are we doing vaginal exams late in pregnancy? We’re looking for information all the time. We’re looking for clues that we might be going into labor soon.
I did it. I was told I was two centimeters and the baby is probably coming soon. They threw me like an emergency shower at work. I was like, “Oh my gosh.” I told everybody. Went home and sat there for three weeks and didn’t have my baby until I was actually four centimeters two days before I went into labor. I mean, it wasn’t right anyway.
But for a midwife to go in there and do something like that without her consent is just outrageous.
Anyway, so back to her question, Trisha — and I want to turn this over to you. What do you say to her? Because now she has a concern about tearing because the doctor told her the big scary thing was about to happen to her, so she caused the damage she was purportedly trying to prevent by giving her an episiotomy. What should that woman think going into her next birth?
She should not think. There you go. She should not think about it.
She should give birth physiologically in the way that protects her perineum the most, which is to be in a position of your choice.
Possibly, if it feels good to her in the moment, a warm compress on the perineum can help with tissue stretching and relaxation.
She should have a midwife, not an OB, and she should have a good midwife who she talks to about this in advance.
Scar tissue can make the skin a little less stretchy, that would be the thing. But because the tissue has already gone through this one time, she is already naturally less likely to tear unless she’s using positions and force in a way that increases the risk of tearing.
So she can give birth in the water. She can give birth on her side. She can give birth on her hands and knees — anything but on her back, in a bed with somebody in there telling her how to push, when to push, and what’s happening with her perineum — will reduce her risk of tearing far more than worrying about the scar tissue.
That’s right, because in that position — I just want everyone to understand — the baby’s head is being pushed into the perineum, not the vaginal opening. So that’s what can cause that.
I do think of the first couple of women I ever taught who had third or fourth degree tears, and they had absolutely no tearing the second time around. I think they took measures to take care, but they had absolutely no tearing, and they must have had a ton of scar tissue internally and externally to suture up those tears.
The other point to remember is that the vaginal tissue heals really, really well. So we tend to think of scar tissue in the sense of if we get a cut on our arm or leg, and the scarring that we see can sometimes be really substantial and significant.
But in the mouth and the vagina, it’s a different tissue, and it actually heals differently and really, really well, and it maintains more elasticity. So I do not think we worry about this or even think about it.
I think her focus should be on preventing perineal tearing through all the natural approaches that we have talked about. We actually have a really extensive Patreon event on this where we talked about this for an hour. We talked about all the ways in which you can reduce your chances of tearing.
And additionally, we did an episode where we discussed this just a few weeks ago, in the first week of February, I think, number—
- Easy one.
All right, so lots of — there’s much more to consider than the scar tissue is the point.
Hi, I’m 13 weeks pregnant with my second baby. My first baby was a home birth, and it was such, such a good birth.
My water did break though on my actual due date with no contractions. So my midwife gave me like nine hours to make sure that if my body could go into it naturally, and then after that it didn’t. So I had to get a balloon catheter put in, and then I got a castor oil drink from my herbalist, which is also connected to my midwife, which was so yummy.
But I want to know why my water broke, and if that’s going to happen again with this birth, I don’t know how I could make sure that it doesn’t. So any tips and tricks to make sure that it doesn’t happen again would be great.
And then another thing is that I wanted to make sure that I don’t end up having to make sure my midwife knows to not send us to the ER for next time. My first baby had a heart murmur. We went to the Children’s Hospital in Phoenix. I’m traumatized from that, so I want to make sure that I can hopefully avoid going to the ER for next time if my baby has another heart murmur.
It went away when we went to the NICU, but they kept us because the doctor at Phoenix Children’s was making sure that I could know that I was going to kill my baby if I didn’t give her the antibiotics.
I feel like I’m not describing this well, but it was overwhelming. So if my baby has another heart murmur next time, will my midwife understand my first baby did as well? Like it’s the same midwife.
Thank you.
Okay, lots of problems in this story.
One, her midwife gave her nine hours after her water broke — not nearly enough. It’s not even justifiable at all. It’s nowhere. I mean, nobody does that.
No. The most aggressive OBs I usually do 24, and some of them try to dare—
At least 12. 12, I feel like that’s like the bare minimum.
They don’t need to do it at all. If you’re GBS negative, stay relaxed. Stay hydrated.
Yep. Don’t need to do it at all. Keep things out of the vagina. Let your water be broken. 85% of women will go into labor within 24 hours. 95 plus within 48 hours.
So it’s unlikely that you’re not going to naturally go into labor if you just give it time. And if, after 48 hours, you still haven’t, then maybe you can try some castor oil.
You don’t need a balloon catheter. That’s introducing infection risk by putting something in the vagina when you have already ruptured membranes.
And did she say, by the way, that she thought the castor oil was delicious, or was that—
It was very subtly having a dry sense of humor. It was very apparent to me. This is where having a dry sense of humor — I like — she was like, “Which was so yummy.” No, that was, yeah.
Okay. Yes. Yeah. So sweet. Trisha. Sweet, Trisha. It’s so endearing. I just always believe everybody.
And then the heart murmur thing. So first of all, it’s probably not going to happen with her second baby. Second of all, that’s not an ER visit, in my opinion. That’s contact your pediatrician.
Make sure she has a pediatrician in advance, her pediatrician who she currently uses with her child now should know about this. And her pediatrician would be the first point of contact, not an ER.
Totally agree. That sounded like the midwife was covering her own bases. She wanted to be able to say later, “Well, I sent them to the ER.” It didn’t sound rational to me. The pediatrician would be far better equipped to determine if that’s a concern than someone in the ER.
And yeah, a murmur is generally not a life threatening scenario, even in a new baby.
And so to hear her say she was traumatized by having her baby in the children’s hospital — I guess in the NICU — we hear that all the time.
I know. Can you believe that? And then they did what, they didn’t let the baby go—
We hear the emergency room is the last place you want a newborn baby. That is one of the most unsafe places for a brand new baby. You don’t go there unless you are truly in an emergency scenario with your baby, and this was not that. So of course she’s traumatized. That’s horrible.
This is why, when we had our discussion about the birth plan 2.0 episode coming out next week, this is why we talk about the fact that it’s not just so simple as hiring a midwife versus an OB.
Because there are so many midwives where you and I are just sitting here shaking our heads and just saying, what — balloon after nine hours, go to the ER. And that’s something that we wouldn’t agree with, and many other midwives wouldn’t either.
But again, I just want to give a nod to all of the parents and all of the women who have babies in NICUs and how they can’t get them out, and how terrifying it is.
And she said she was traumatized, and I totally believe her. I don’t think we can even comprehend how terrifying it would be to have someone basically holding your baby captive. And when you think the baby can be released, they keep coming up with excuse after excuse before they quote “let” you get your baby back.
I think most of us would lose our minds, and I think these parents do, and this is why they’re traumatized from it. I feel so deeply for these parents. Of course they want to avoid that at every cost.
The NICU has truly become the money maker of the hospital, and they will keep your baby every single day that they can for the smallest possible reason. You have to fight tooth and nail to get your baby out of there.
And these are people who obviously then have no respect for babies, no understanding what babies need, or even have a sense of what is safest and healthiest for a baby, which is obviously to be with their parents. Obviously.
So it’s, again, it’s just another crime going on under our noses every day, where women are left to feel completely powerless against the big dreaded quote “policies” that they’re facing, which aren’t the law. Policies aren’t the law. You have to remember that you do have rights.
But parents should have to worry about that after giving birth?
Because women are pushing back on the labor ward. Now the NICU is picking up with the pressure, and if they’re not making money over there in the birthing room, they’re making money on the other side in the NICU. Because the hospital is a business and it has a bottom line, and it will find a way to justify.
And women are pushing back in the birth space, but they don’t push back in the NICU because now it’s not about them, it’s about their baby. It’s easier to hold a baby hostage. And they are keeping those babies in there for the most minor thing. I’m talking about what, one point on a glucose test. 46, it was 45. Your baby has to stay 24 more hours.
It’s outrage. It’s so much for these parents.
And of course the blood sugar’s a little low because the baby is stressed, because the baby is separated from their mother and not breastfeeding.
And then it’s guilt these mothers are left with — the guilt that they’re left with for the months that follow. It’s just terrible.
Okay, so great questions this week. Really, really great. And I do believe, Trisha, it’s quickie time.
Let me calm down. Get in the mood. Your blood pressure is up now. That’s a switch.
The NICU thing really gets me. It hurts to think about, it hurts to hear about.
Okay, here we go. Let’s get light and fun again. Aren’t you going to do your little sing song?
Oh, it’s quickie time. Yes, ma’am.
Okay, here we go. Here we go. Yep, I haven’t seen these at all, so just gonna run down the list.
Is it true that all babies are born with high palates and nursing lowers the palate?
We did such a good episode on this with Jeannie. Do you remember that with Jeannie?
Jeannie, yeah. She’s an occupational therapist. I thought that was an excellent episode. I loved it.
Actually, wait, way back — myofascial — not, yeah, two years maybe. Yeah. That was in July of 2024, it was episode 274, Myofunctional Therapy: How to Assess and Help Your Baby.
That is a surprisingly fascinating, interesting — I really, really remember enjoying that discussion and learning a ton and thinking, man, if I had a baby, I’d be all over this right now. So definitely recommend that episode.
And do you remember about the palate? I know that Jeannie talked about that in that episode recording.
I do not remember. I need to re-listen to that episode. But I do know that not all babies are born with a high palate, and I do know that breastfeeding helps shape the palate.
Yes. But no, they’re not all born with high palates. And bottle feeding and pacifier use can contribute to higher palates, and breastfeeding helps the palate flatten.
But most importantly, it’s your tongue posture that helps the palate shape, so a baby needs to be able to have their tongue resting on the roof of the mouth. Anyway, quickie — that’s where I’m ending. It got it.
Next. When does your period normalize when you’re breastfeeding? I’m still breastfeeding at 16 months and haven’t gotten it back.
Well, in the most common scenario, a woman will get her period back between six and 12 months, or when she starts to go longer than six hours overnight without breastfeeding. That’s the most common scenario.
But given the history of how irregular women’s periods are and how much infertility is out there, it seems like women getting their period back after breastfeeding is taking longer and longer and not happening as easily for women. And I think it’s probably related to that.
So that’s the quick answer.
Are there situations or conditions that automatically disqualify someone from a home birth in some states?
Yes, no. But also in any state under certain conditions, sure.
Well, there are certain medical conditions that could disqualify, like preeclampsia, right? Although some women actually have given birth at home with preeclampsia. But would I recommend that? No. That’s the quick answer.
Very few, though, really. Very few that would sound very risky to me.
They don’t even administer magnesium sulfate. Or can they do that at a home birth? They just wouldn’t do it.
I mean, women have done it, yeah.
I wouldn’t. I’m sure they have. They would risk it, yeah. Well, not advisable.
Is perineal massage necessary to reduce tearing? Or are there better methods?
Actually, perineal massage isn’t evidence based to reduce tearing. The evidence is actually pretty mixed on it.
Perineal support with a warm compress is where hands off is best. Again, we have a whole episode on this first week of February, episode 353, and a deep dive on Patreon.
For anyone who missed it.
Can hand expressing to relieve engorgement cause oversupply?
If you’re talking about the initial phase of engorgement, the physiologic phase of engorgement when the milk comes in, no. That’s not going to cause oversupply if you do a little hand expressing for comfort.
But if you are chronically engorged and chronically hand expressing to relieve engorgement, you have an oversupply, and you are perpetuating the oversupply through removing the extra milk. Try peppermint tea instead.
Good.
How about this one? I need a word of affirmation for going from one to two children. I’m nervous.
Well, in economics, we have something called the law of diminishing returns. I think it’s kind of the same thing. It’s like, you know, your first — I’ll say cup of coffee — is the most satisfying, and then the second one is nice, but less satisfying.
With babies, you love them just as much. No, no, no, don’t misunderstand. You love them just as much. It comes from out of nowhere. You instantly love them as much, and there’s no issue there.
But in my mind, in my experience, and in the experience of so many women, the massive, radical change is happening from zero to one. And with two, yes, having two is harder than having one, but it is a significantly lesser adjustment than going from zero to one.
So that’s what I’m talking about, diminishing returns. In this case, is diminishing of the stress — the stress and the adjustment.
Yeah, because you know what to anticipate as far as having a baby. Remember when you’re pregnant the first time and you really think you’re going to be sitting around looking lovely, holding a peaceful, sleeping baby who’s just cooing at you all day?
Well, now you know that that’s not how it is 24 hours a day, and you’re prepared, and it’s wonderful, and it’s going to be great — just an adjustment.
Women are built for this, right? We wouldn’t have multiple children if we didn’t adjust and adapt really easily. We do.
Like, no one regrets having that next baby. You know, even if it’s an adjustment, you’re still gonna be like, “Oh, thank God I had you. Thank God we have you now.”
So that is what you can look forward to. But she asked for one word.
So okay, if we had to pick one word, what would it be? Capable?
I was just gonna say the word capable.
No, I swear I was just gonna say the word capable. I swear. I just hesitated because I thought it sounds, I don’t know. I hesitated.
No, it sounds—
Yeah, or like pep talky, or like “you’re capable, you can do this.” I don’t like when people say things like “you’ve got this.” I don’t like that.
But I was actually sincerely thinking the word capable. Like, actually, you are capable. That’s true. That’s why the word came to me, because that’s how I reflected upon it. I was capable anyway, and you will be too.
Your favorite timeless beauty tips.
Oh, all right, my favorite beauty tip. No one’s gonna love this because it’s laughable — like you make fun of me for not using creams or anything on my skin or anything like that. I don’t.
In fact, a friend recently told me how soft my hands were, and I was like, yeah, I don’t put anything on me at all. So that’s kind of the joke that I don’t.
But my honest to God belief is: do as little as possible to alter your looks. I really believe that.
I mean, I’m aging naturally. I don’t do anything to alter my looks other than, you know, the light makeup I enjoy. And I think that when women start criticizing themselves, not liking the first few wrinkles, looking to get rid of them, looking to change themselves — God forbid start doing injections and altering themselves — I think you fast forward 10 years and you might wish you could go back a little bit.
And I just think we’re supposed to change. And let your goal be to feel well and to feel healthy. Because if you look healthy, that’s a beauty tip. Looking healthy is attractive. Period.
You don’t need eyebrows that go a certain way, lips that look a certain way. You don’t need anything to be different about yourself. You just need to feel well and feel healthy, and you’ll look healthy.
That’s my sincere belief. I didn’t make this up. This was always my belief. People used to joke with me in my 20s, “Oh, wait till you get older, you’re gonna dye your hair again,” to change. I was like, “Oh, maybe,” but I don’t believe I will.
And now I feel stronger about it than ever. So do I see myself changing? Of course. But I try not to suffer with it and to expect change, because that is the one fact of life. It’s change.
What do you want to say?
Sleep. I mean, honestly, this is what—
Trisha says. It was a quickie, Cynthia.
Sleep, right? Sleep, yeah.
You, you when you can, are amazing at sleep. I think of you every night.
When I go to bed too late, you do?
Oh my God, every night. Well, I do, yes, yes, yes, yes, be flattered.
And I do because I feel a wave of admiration, a little shame, because I’m like, oh, Trisha has been sleeping for two and a half hours, and here I am. That’s what I think of every night. When I go to bed, I’m like, oh, she’s been sleeping since 9:30. So good for her. Maybe 10 o’clock on a late night.
So that is a fabulous—
It’s my number one priority in life, good sleep.
Yes, you take very, very good care.
Now, again, I did not sleep well when I had young children, and that’s also why I prioritize it so much now, because I feel like I’m making up for so many years of sleep deprivation. So I understand women are not — they’re going to be like, ah, sleep, who gets that? You will. You will.
And when you can make it a top priority, it’s the key to your health. Good sleep.
And if this brings us full circle, because we started the episode saying, okay, maybe right now, starting something new, reinventing yourself a little bit, finding more play in your life is a little difficult right now, but I said, make it a goal in your life, because there’s a lot of life to think about.
And as you just said, make it a priority. You had severe insomnia after having North, and you suffered and struggled a lot, and you really cared about fixing and changing that.
And now I think you can’t wait to go to bed every night. I really believe that. Am I right?
I absolutely — I go to bed at night, and I am like in heaven every night when I lay my head on the pillow and I close my eyes, and the next thing I know, I wake up on my own, without an alarm, naturally, and I’m never tired.
Yeah. I wake up without an alarm too. I’ve never had an alarm my whole life.
That feels around work and time, yeah, yeah.
I feel rested every day.
Well, with that — now that we’ve come full circle — and hate to have to throw this in, but we have another recording starting in five minutes with a guest.
Okay, let me just make sure we didn’t miss any. Let’s just make sure we don’t have any last quickie that must be answered.
Okay, we do have to answer this one.
Let’s just say the answer is yes. Is it yes? No question yes, and the answer is yes. Okay, good. They don’t even need to hear the question, how or what.
Okay, what was the question? I need to know. What did I say yes to?
Nah, never mind. We’re good.
I need to know. You have to say that.
Oh no. Okay, fine. Can you show up to the hospital and labor and deny the C-section even though it’s highly recommended?
Yes.
Okay. Thank you everyone. These were awesome questions. Fabulous questions.
Call 802-438-3696, that’s 802. Get Down bonus points if you know the area code of 802. Vermont. I know you know it.
So thank you for the questions. And what else.
Don’t forget that our episodes are all now on video, on Spotify. So go watch us. You can watch us on YouTube, or you can watch us on Spotify.
So many opportunities to watch us. That’s it, over and out. 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.
