#365 | April Q&A: Best Age to Have Children, Precipitous Labor, Pushing and Tearing, Pregnancy Weight Gain, Water Birth Myths

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.

Let's begin today by me asking a question of you.

Oh, let's hear it.

In response to a conversation that we have been having on, or I've been having on Instagram with some of our followers, I want to ask you how you feel about the best age to start having children. Do you think it's better to have children younger? Do you think it's better to have children older? Do you think somewhere in the middle? What are your thoughts on this?

Honestly, I don't. I don't have thoughts on it. I don't have opinions on it. There's an obvious advantage to having children younger because, you know, then you're younger as a grandparent, and you're around longer in that sense. You're potentially more energetic. But I love how I've done it. I mean, I love how I spent my 20s. I met my husband when I was 30, and we got married two years later, and I would not change a thing about my 20s. So I can't say personally. And I got to go have my MBA. I did tons of traveling. I had an exciting career. And I don't personally wish I started any differently. So I really don't have an opinion on it. I just think every woman needs to feel fulfilled in every stage of her life, whatever that looks like. Honest to God, I really believe that. I mean, one of my favorite couples from many years ago, they were married 13 years, madly in love, never even planned on having kids. You were at the birth of their second boy.

I was, yes. Talking about a cute baby. It was Mindy.

Oh yeah. Florida, yeah.

They met and they got married in their 20s.

Great couple.

They didn't have their first till she was like, I don't remember, 40-ish, 38, 40-ish. They have two boys now. But who's to say that they should have started earlier? They had a very happy marriage for 13 years, and I think everything's gone so... I honestly have never had opinions on this.

What do you think? I mean, it was kind of a fun conversation because it is not something... most of the time we're talking about informed consent, and we're presenting the evidence on both sides, and we're helping you make the most correct decision. And we kind of have opinions. And this is just something where there is no strong opinion on this. There are so many factors to take into consideration: when you meet the right person, where you are financially, where you are mentally, emotionally, physically. I mean, I do think you could argue that from a physical perspective, purely from the perspective of our body, we start ovulating and get our periods around 12 or 13. Biologically, our bodies want to have children earlier.

But that's that early.

Not that early, no. But I mean, way back in time, yes. You know, our body just evolutionarily hasn't really... our lives way back in time, yes. Why do you think we got our periods at 13? We didn't have a very long lifespan. Obviously, we don't live in those times anymore, and that's never how we would recommend doing it. But the conversation came up because I was asking our community why there's so much pressure on women to have their kids so close together. It seems like many women feel this need to have pregnancies back to back, like barely nine months, maybe 12 months in between pregnancies. And physically, on your body, it's pretty demanding to do that. I do think that there are some downsides to doing that. And the reason that came up was that in the millennial generation, let's just say the pressure has been to get your career going, have a lengthy period of time with your career, building financial stability, spending time with your spouse without children so that you can enjoy your time together as husband and wife without children. And then women are starting to have children later in their 30s, and then they feel this pressure to have children by 35 because we're told that we're AMA at 35 and that our fertility is going to fall off a cliff. So then they're trying to pack in three or four kids between 30 and 36. That's tough. So that's how the conversation got started. You had children later. I had children younger. For me, it was just literally a drive that I couldn't resist. Like there was no way I was going to make it to my 30s, 35, to have children. No way. I couldn't wait another day, really.

Yeah, I was 33 when I conceived Alex and 34 when I had him, and no one could have convinced me even to get married in my 20s. I was just nowhere near ready. I just knew I wasn't ready. And then when I was ready, I was ready. I was just, like I said, that's the thing. I don't like when women hear your fertility is going to get... I don't like any of that. I mean, I did not worry in the least about fertility. And after Alex was born, we took our time. I had no desire to rush. And four years later, well, three and a half years later, I was like, okay, I'm ready. And I was just turning 38. I felt great. I did. Everything was perfect. And I just don't want women to feel pressured. I really believe, I say this too often and I know women like more specific instructions, I really believe you just have to trust more and trust what you're doing with your life. Trust what feels right. Don't rush things if rushing doesn't feel right. If you feel compelled to have another baby and you can't wait and you're ready to do it again, then trust that too. But I just think that there are times in life things become irrefutable. You know you need to move forward with something because it feels so right to you. And I believe in living your life exactly that way. I'm very happy with how I spent my 20s because I feel so fulfilled in so many things that I knew I was going to need to experience in my life. And boy, am I glad I did those things when I did them, because I just feel very at peace with how I've lived my life. So anyway, don't worry about advice from us on that. Do what feels right to you, and just be happy and enjoy your life one stage at a time.

That was the conclusion of the conversation, that this is a situation where you need to really do a lot less thinking and a lot more feeling into what just feels right for you. And lean into the spiritual side of it, like just trust that you're going to be guided to the right person at the right time, and that you're going to know when you're ready to bring these little souls into the world. Because maybe there's more to it than us just deciding when we want to have a baby. Maybe there's more of a connection, a communication, with our little soul babies of when it's the right time. And if you're too caught up in thinking and planning and the logistics of it, or the pressure from whomever, you might not hear that message. So trust yourself. There are advantages and disadvantages to both, right? Like I started young, and my kids are grown, and I still feel very young, and I still feel like I could live my younger years now. Or you start later, and you lived and traveled and did those things in your 20s and 30s that I was busy having children and feeling tired during those years. So there are advantages and disadvantages to both, and I think what we definitely don't want to do is question how we did it or regret how we did it, because there just really is no perfect way to do it.

Agree. All right, so let's get on to our questions.

Hello, ladies. I want to start by saying thank you so much for all that you guys do. I have been a longtime listener, and I have had my opinions completely changed by the advice given on your show, and I am just so grateful for you ladies. I am pregnant with my fifth child. This will be my third home birth, hopefully. I am 24 weeks pregnant, and I actually have a question about precipitous labor. I had a precipitous labor with my fourth child, and it was about an hour and a half from first contraction to delivery, and I had a very, very tough time getting into the correct mental space to properly prepare myself to give birth. I went from having nothing happening to complete active labor and then pushing very quickly, and it just completely threw my mind for a loop. And I was wondering if you guys have any tips or tricks or anything that can help with preventing a precipitous labor, if there are any, or even just how to manage a precipitous labor mentally. I would really, really appreciate your ladies' advice, and thank you so much.

Well, that sounds very much like my third birth, so I can relate to this very, very well.

And my first. Your first was only an hour and a half?

Well, my first was precipitous. It was three hours exactly from the minute I said, "I don't think I'm in labor," until I was holding him. It was exactly three hours. So that's the definition of precipitous still, yes.

That is the definition. The hour and a half labor is what I experienced with my third, and it was very overwhelming. So I can relate very much to what she is saying. There is no way to prevent this. This is just what your body is going to do. You can't really slow it down. And I think there isn't a lot that you can do mentally to really get yourself prepared for it either, other than to know that you have already been through it and you will get through it again just fine if it happens again. All you can do is know that when it starts, you're in it, and be as present as you can in it, and try not to think about what's coming with the next contraction, or how fast it's going to be, or how you felt the first time. You'll probably trust it a lot more the next time because you have already been through it once, and you know that you can do it.

I feel like everything in childbirth has its way of saying something went wrong, women thinking they did something wrong or something didn't work optimally. The reason you had a precipitous birth, we don't even need to give it a name. The reason everything... I had my first birth and I never heard the term precipitous birth for years. I don't like giving labels to things. I think it just freaks us all out and makes everything seem like a thing. She had a short labor, and the reason for that is that her body had very efficient physiology. That's a positive, no matter how you look at it. The baby was well positioned, and her body had very efficient physiology. And many women do for subsequent births, and it can happen for a first birth, but it's a positive thing. Yes, women can feel a little bit like they're on a wild horse, like things are just happening quickly. There is no way to prevent it, as Trisha already said. The only thing to do is, first of all, recognize that the opposite of this, let's say a very long, slow labor lasting 30, 40 hours, is incredibly challenging, and it's potentially demoralizing and it's exhausting. So first of all, view it as a positive and don't fear it again. But if you should experience a fast or precipitous labor again, all you have is to breathe and to do something very present and grounding. For example, there are many options, but for example, vocal toning, like making a low, deep sound with every single surge. Just take a nice, relaxed, deep breath in between surges, and then make a low sound. And some women like to make vowel sounds, so they'll make ah sounds or E sounds or ooh sounds, but that's going to help you to focus and to stay very present. And that's, as Trisha said, all you have. It's to stay present and to ride along with your very efficient physiology.

I mean, the challenge is that with a precipitous birth that fast, 90 minutes or an hour, sometimes you really don't get a break in between contractions. It feels like they're just one after the other after the other. And I do think that is really intense. It's really hard to stay present. But know that it's going to be fast, it's going to be over soon, and get in the water. The water is so helpful in those situations. It's helpful in all labor, but when it's really just piling on you like that, and you submerge yourself in water, or if you don't have time, which you probably don't have time, to fill a tub, but try, or get in the shower, it can just tone it down enough to get through.

Yeah, that's a great tip. And then I almost did address the fact that so many women say they did not get a break, or they came one on top of another. And I almost addressed that, so I guess I will share some thoughts on that, which hopefully will be helpful. I mean, there are some women who might have experienced a precipitous birth and they won't agree consciously with what I'm saying, but I'm trying to be helpful for your next birth so you don't take negative beliefs into it. Your labor is not, if you're having a physiologic birth, it's not a constant. It is, by definition, happening in waves. There is a biofeedback system happening. There is a buildup and there is a coming back down. There is an ebb and a flow to it. So even if it feels like they're coming one on top of another, it's really important for you to sense that flow, sense that wave, so that you can at least feel like, I'm coming down from that last one, time to just relax the shoulders again, relax the hands and take a breath, and then prepare for the next one coming. There really usually is a nice little moment of break. But if you don't feel you get it, you have to sense that wave, and as it's coming down, that's your chance to just relax again and take a deep breath again and prepare to make, for example, vocal tone sounds with the next surge. So just find that rhythm because it is happening within your body. It does exist, so just tap into that. Easier said than done, but it's all a positive. And again, first-time moms, when you're preparing for your second birth, the big challenge for women is the fact that they keep anticipating they're going to relive their first birth, and it really, really messes with them. You have to let go of how your first birth went and just prepare for your next baby.

Yeah, I'm trying to picture myself pregnant right now, thinking about going into labor, imagining my third birth and how shocking and overwhelming it was, and thinking, how would I be anticipating this next labor? And I think the most important thing to remember is just that nothing, no matter how overwhelming it is, nothing bad is going to happen to you. It can feel like your body is just... I don't even want to say it, but it's...

Really, it can feel relentless.

Relentless and just insanely intense. Just nothing bad is going to happen. Your body will work through it. Your baby is just moving through you quickly. It's happening.

With or without your participation. That's a really important thing for women to recognize because we can relax a little. It's happening with or without your participation. So the question is, if you participate, how will you participate? And anything where you can ensure you're getting oxygen, ensure you're keeping your physiology relaxed, and grounding yourself into the present second, the present moment, is going to really serve you so that you're not thinking ahead and thinking backwards. So that's why I gave that one tip for making vocal tones. But that's really all you have. Otherwise, it's just your job to stay out of the way and let your baby come through you. I mean, it's incredible how birth can take any form and shape.

It's wild, and how women experience it so differently.

Hi Cynthia and Trisha, I'm so grateful for your show. I first started binge listening with my first pregnancy in 2023, and I've continued with each of my pregnancies. And I can truly say I've become so knowledgeable about birth, and you've truly taught me to trust my body. I'm now pregnant with my third. I've been in hospital settings with midwives. My second birth was really great overall, but I did have some issues during the pushing stage. I labored at home for about four hours. Once I got to the hospital, contractions were strong. It was kind of a blur at that point, but I do remember them telling me that I was eight centimeters dilated around that time. Some more time passed, and I started to feel the urge to push, but I really needed the guidance on what to do, so I remember asking my midwife if I could start pushing, and soon after that, I did start. I'm not sure what I could have possibly done wrong while pushing because I ended up with ruptured blood vessels in both of my eyes, to the extent that the sclera in both eyes were completely red for over four months. I also developed an anal fissure that took 16 months to heal. I felt like I was breathing very well and managing the pain. I'm just not sure what I could have done wrong during pushing. My son was normal size, eight pounds, nine ounces. I believe I spent some time pushing on hands and knees, but then I did move to my back. I listened to your October episode about pushing, but my question is really just what I could have done wrong during pushing and what I can change so that my next birth can be even better. Thank you so much.

Well, first of all, I don't know if anyone else caught this, but she said, "so my next birth can be even better." That is nice to hear. This is someone who thinks in a positive, constructive way. She didn't see this... I mean, she had a lot of reasons to complain. She had anal fissures, for crying out loud. That's a big deal. That's a terrible thing to endure. But she's saying, "so that my next birth can go even better." And I just want to show people how some people speak. We usually speak unconsciously, and the words we choose are indicators of how we think. And the fact that this woman said, "so that my next birth can go even better," I just think says a lot about her, and it's a very positive... it's just a really inherently positive attitude, because a lot of women with the exact same experience would have the right to just complain through and through. She has been through a lot. I insist on this first point I want to make: she did nothing wrong. I don't know who convinced her she did anything wrong. She did nothing wrong. The only little window into what she might do differently next time still isn't about her doing anything wrong, but she was taken out of a hands-and-knees position, and it does sound like she gave birth on her back, which is exactly what we would want to make sure she doesn't do the next time. But the tearing is an indicator not of pushing wrong but of fetal positioning, tissue stretch, the speed of her birth, and tearing can always occur. Anal fissures, Trisha, you can talk more about this, but this has more to do with pressure, swelling. That's a whole other thing. So before we talk about what she might do differently next time, can you say whatever you can add to that?

I think that that could potentially be reduced by getting off her back. I think that's probably the biggest contributor to that.

Yeah, I mean, she said that so casually and kept emphasizing, what did I do wrong, what did I do wrong? And then she said it like an aside, but that's probably the biggest indicator of what might have resulted in a potentially different outcome if she had not been on her back.

Yeah, I agree with you completely that she definitely needs to not be thinking about what I did wrong. Even if you are pushing spontaneously with your body, not under somebody else's direction or the classic purple pushing, what she experienced can happen. You still can pop blood vessels. You still can tear. You still can get an anal fissure. You still can have prolapse of your vagina or something afterwards. These things still can happen, even if you're completely following your body's cues. They certainly are higher risk if you are doing forced pushing, and we really do want to try to avoid that. But I really think the only thing that she can know and take into her next birth is that she didn't do anything wrong. It isn't necessarily going to happen again. And really try to stay off your back. If anything, if you need to be in bed and resting, get on your side.

We did just do recently a really thorough event, a video event on Patreon that's still out there for anyone to see, on reducing the likelihood of tearing. But I just want to give her one quick takeaway, that it's not so much about how to push and pushing wrong. It's about what not to do, and often providers are there complicating what women are doing in this stage of labor. So what we do want to make sure of is that she not push forcefully, that she not hold her breath. And then this last point is probably the hardest of all for women: it's to slow down. We can get really eager to push the baby out, like just get the baby out and everything is fine. But in those last few moments, slow down, because the baby and the body are going at the pace they're going because the tissue does need time to gently unfold. So we can't just rush the baby out without that risk of tearing.

And one thing that I don't think that we talked about in our episode on preventing tearing is avoiding your provider pulling the baby out after the head is born, so making sure that you allow the time between the baby's head being born and the body, the shoulders and the body, in the next contraction, not in the same contraction or in between contractions. It's very commonly done in the hospital, especially if you're on your back in bed. The head is out, and the provider has got their hands on the baby, and they're providing traction on the baby, and they're trying to get those shoulders out and the baby out before the next contraction even happens, because sometimes it's two or three minutes before that happens, and they get pretty uncomfortable with the baby sitting on the perineum. So make sure that that's not happening, because if your baby's being pulled out in between contractions or all in one step, you're going to increase the risk of tearing. Be conscientious not to hold your breath. Even if you find yourself naturally doing it sometimes, try to bring yourself back to just deeper, slower breathing.

Hi, my name is Shelby. I'm from North Central Arkansas, and I've been listening to Down to Birth for both of my two pregnancies and home births, and I'm asking today about pregnancy weight gain. I have a friend who is so stressed because of her pregnancy weight gain, and both of us have had midwives who have been discouraging, like too much weight gain, and some things that have stressed us out in our pregnancy, so much so that I actually declined being weighed my last pregnancy. But pregnancy weight seems so hard to control if you're already eating pretty healthfully, moving when you can. So I'm just wondering how important weight gain is during pregnancy and how big of a deal midwives should make out of it. Should pregnant women ever consider counting calories, or not eating immediately when they get hunger cues? Like, how much should we be controlling weight during pregnancy, and what's the evidence on that? I'd love to hear what you think. Thank you so much.

For heaven's sake, not eating when you have hunger cues, let's not do that. Listen to your body. Eat when you're hungry. Definitely don't torture yourself.

No, not healthy. I think it is easy for midwives and OBs to simply say you're gaining too much weight, that puts you at higher risk, without really looking carefully at what's going on within the woman. The risk in gaining too much weight is, sure, it does increase risk of high blood pressure in late pregnancy, but the real risk is, is it because there's something going on in your physiology, like gestational diabetes? And like she said, you can't really control it that much. So if you're just gaining weight and you're paying very careful attention to eating balanced, healthy foods, your body's going to gain the weight it's going to gain. And if you don't have an underlying issue like gestational diabetes, there is really nothing to be worried about. Now, if you're gaining weight because you are eating a pizza for dinner every night and ice cream at lunch and a Twix candy bar in between, drive-through fast food whenever you have the chance, that's a whole different story. It really comes down to what you are doing with your diet. So if your midwife is simply saying, "I'm concerned about your weight gain," and they're not talking to you about your diet, they're not doing their job. So we always, as a midwife, I always did a three-day diet recall with mothers.

Like they had to keep a food journal, yes. Yep, yeah.

And it's actually better to... well, the recall is helpful because they can't change it. But the going forward is like they don't always remember. With the recall, it's good to see what they were eating for the last three days. So that's a three-day diet recall. Let's look back and look at everything you're eating for the last three days. But it's really hard to remember that. If you do documenting what they are eating going forward, they tend to make changes. So it's not always what was really going on before, which is fine if you're going to stick with those changes. So either way, it's just really important to get a diet history or a plan for food so we can really see what's going on with what you're eating, because it's not how much weight you're gaining. It is what you are putting in your body that matters. And a simple thing that most people just aren't even aware of is how you eat foods. It's not always what you eat. It's how you eat them. So if you eat a plain bowl of pasta, you're going to have a very different response in your body as far as what your body does with that energy than if you eat a bowl of pasta with vegetables and protein in it. If you always combine your carbohydrates with fiber, fat, and protein, you're going to have a much steadier balance in your blood sugar, and your body is going to utilize that energy much more efficiently. So how you eat matters. What you eat matters. And if you are gaining weight beyond what your midwife or OB thinks is normal, and it's with a great, healthy, well-balanced diet, there's nothing to worry about. Anything else on that?

No, I mean, I just want to specifically say we definitely don't believe in calorie...

Counting in pregnancy.

No, I don't ever believe in calorie counting personally. And the top reason I never did at any point in my life, and it was a very big trend when I was growing up, I never did believe in it because I had the common sense to recognize that 100 calories of avocado is completely different in the body than 100 calories of soda. So I find calories to be pretty useless. We can all look at our food and know when we're eating a healthy food and when we're not. And it's not that every single bite of food has to be perfectly healthy. It's just have an awareness of how you eat. Don't stress yourself with calories. And people love to say, "A calorie is a calorie." I totally disagree. Your body has a completely different response based on what you're putting in your body, a completely different response if you eat a cracker versus an apple. The body handles these things entirely differently. So I'm not a fan of calorie counting, but I would also say don't distress yourself with it. And that's what we do. We also don't think BMI is a good measure of any of this. That also can drive women crazy, the whole BMI thing. So again, just... the thing is, she said she eats healthfully, and most of us believe we do. And some of us would reconsider that with different perspectives and debate what's healthful eating. But do obviously get nutritious food in your diet. Obviously eat, buy a lot of produce when you're going to the supermarket. Put living foods in your body, along with whatever you're eating. Whole foods in your body, along with whatever you're eating. At a minimum, those foods will detoxify from the other things that you are eating. So just maybe making one switch like that, adding a little more fiber, a little more produce, will make a change. But otherwise, if you're eating well and not overeating, and you're moving, then don't worry about it. She did say moving like when I can, or something like that, as much as I can, when I can. So maybe the movement is something where change... walking after a meal makes a huge change in blood sugar. There are a lot of little things you can do.

Yes, if you can just get walking 20 to 30 minutes a day, that could change everything. And I would definitely recommend writing down an honest assessment of everything you eat in three days. Don't skip anything.

Okay. Oh, I threw in one more just because I reached out to Barbara to send a response to this one, so I'm going to play it, and then I'll tell you what Barbara said. Gotta include Barbara wherever we can.

Wherever we can. We love Barbara.

We love Barbara. Okay, so here we go.

Hi, Cynthia, Trisha. This is Mary from Virginia. We had a question about waterbirth. I've had three water births at this point, but none of them have been in the hospital. And one of my friends was telling me recently that a reason that water births often don't happen in the hospital and aren't permitted is because a specific kind of bacteria will exist in the hospital but not in out-of-hospital environments. And I'm wondering what you think about that. That was something I never thought of. Okay, thank you. Love the show.

I'm going to save Barbara's response until we each say our piece.

Does she mean a specific type of bacteria that's of concern in the water?

That's exactly what she means, which on its face makes no sense because the hospital does have a lot of bacteria that makes it much less safe, causing staph infection and all sorts of things when there's open wounds. The water would block that.

Doesn't make any bacteria in the water in the hospital.

Of course not. It should be clean, and there should be no hospital-specific bacteria like staph. That would be...

It's actually the same water that you're getting at home. If you live in a city and your hospital's in the same city that you live in, the water is the same in the hospital as it is in your home.

I can't help but think she must mean something airborne in a hospital, because hospitals are rife...

Into the water. They are rife with airborne bacteria in hospitals.

Yeah, that's what I would think, but then the water would be protective. So just for fun, and everyone is going to love it...

Before you read Barbara's response, we just have to acknowledge that this is another one of the ridiculous ways that hospitals can start stories or rumors to avoid doing the thing that they don't want to incorporate. They don't want women giving birth in the water. They're going to come up with some ridiculous excuse for why it's not a good idea.

Well, the real problem is that if someone at the hospital told this to her friend, her friend believed it without questioning it, without researching it. And I'm not faulting her. I'm saying this is how the problem goes with everything in society, with all the lies and all the trickery and all the nonsense. This is what happens. Someone repeats a thing, and then the listener accepts the thing, and then they repeat the thing. And then for the second person, it's like, well, my friend told me this, and I trust my friend. This is how nonsense gets spread. Anyway, I was going to say everyone is going to love what I'm going to say next because, as we all know, and as many clients have teased me for, I basically never swear. If I swear, it's usually in humor, and on the podcast I virtually never swear. Once in a while, you delight us with little surprise language, and it's always entertaining and fun, but it just doesn't tend to happen with me. But Barbara is forcing me to swear because she gave a two-word response when I shared this message with her. She wrote back, and I quote, "total bullshit."

That's it. Barbara's language.

That is what the expert has to say. So there you go.

Ridiculous, yes.

Ridiculous, yeah. I wrote to her, "This is ridiculous, right?" She wrote back, "Total bullshit." I was like, thank you. Better said. I'm going to read your response. Yeah. So again, I think the bigger thing we can all gain from this is that this is how nonsense spreads. It's that easy. Just like the whole one about delayed cord clamping. Well, you really want to stop it after 45 or 60 seconds because that blood will flow right back into the placenta. I mean, just nonsensical theories right before our eyes. There's no method to do that, to suck the blood out of a baby's liver and bloodstream. I mean, it's just ridiculous. But people hear it enough, they repeat it, they believe it, it becomes "common knowledge," and it's...

Remember the one about you should get the hepatitis B vaccine in case the woman before you giving birth in the bed had it or something like that? I mean, these are just crazy things that get spread and make no sense. And if there's bacteria present in the hospital room, whether you're having a water birth or not, the bacteria is present in the hospital room.

Yes, we live amongst it. Yep. Water has nothing to do with it.

No, it's protected from the airborne stuff anyway, as far as the baby emerging. Okay, but it is time for quickies. So what do we have? I can't wait. We just... right. I really liked the all-quickies event we did on Patreon back in late March. I really enjoyed doing that, and I think it was good because we get so many of them, and that was a whole event of quickies. And then at the end, women came on screen with us and asked us personal questions, which you can all do as well on Patreon, which is good. Get face to face with us if you want, and we can talk it out. But that was fun. We have to do more of those.

Yes, I think it's nice because sometimes people have to wait eight weeks before they get a response to their quickies. So if we can be on Patreon a little bit more answering those, you have more opportunity to ask, more opportunity to get quick answers.

And one woman joined and asked like eight of her own. She threw eight more into the chat, so we answered all of those. Yeah. We just stay on and do that all.

Yeah, yeah. They're a great reason to join Patreon.

We know phenomenal value when we see it and when we put it out there.

And that's just the $6 tier.

So easy. We did that for everyone.

Yeah, yeah. Okay, yes, we will. Let's answer today's quickies. Okay, okay. First one: does the purple line from labor ever disappear?

Okay, explain what that is first.

Okay, so the purple line is a line that develops in labor, not in everyone but in the majority of women, basically in the buttocks crack, in your butt crack, and it's indicative of how far you are dilated in labor. It's a very interesting phenomenon, and it's totally...

Accurate.

Mystical.

Totally mystical.

The weirdest, wild, wild... It's on the sacrum, isn't it?

Yeah, it kind of...

It kind of starts with the tailbone, right?

Yeah, but the tailbone is way down by your anus.

Yeah, but then it basically travels up into the sacrum, doesn't it? Isn't it measurable, and you can just...

If you're looking at it, basically... I thought it was totally visible on a woman's back.

No, it's kind of like... but when you know when a woman's giving birth, that's pretty visible, okay, position she's in, okay. So it has to do with the pressure in the pelvis and the pelvic congestion of blood in the pelvis. And so yes, in theory it should go away after you give birth. It may not fade immediately, and it may take days, or I guess it could possibly take weeks. I'm not sure. Maybe I wouldn't think it would be permanent, but sometimes you get skin changes that take a really long time to fade away.

It should go away. Strange thing about it is it's a centimeter-per-centimeter reflection.

Of how dilated. It's wild.

It's wild. You'd think when the dilation goes down after the baby's out, you'd think the line would go back down. I never thought it could last. All right, this is a quickie, so I guess we've got to move on. Purple line questions. Fun.

We'll find out who still has a purple line.

So much mysticism, yeah.

It's a very cool thing. And just another reason you don't need a cervical exam in labor if you don't want one. Is nursing to sleep a bad thing?

100% no. It's a good thing. It's a great thing. You want to encourage it. It's helpful. It's helpful for breastfeeding. It's helpful for getting your baby to sleep. It's helpful for your milk supply. Do it.

I had a great first pregnancy and home birth, and I am torn about having a second child. I don't want to split time between the kids.

This is about having a second child?

Yeah.

You're never going to feel like that after you have a second child. You might feel like that now before you have a second child. You won't feel that way after you have the child. I think women can initially feel that. They feel a lot of guilt when they have a baby and they're not spending time with their toddler, but that will go away. It's not a reason to not do it. It'll go away. It only adds value to your life. If you only want one child for other reasons, that's fine, but don't let it be that reason. I had preeclampsia in my first pregnancy. How do I avoid it this time?

Talk to Sarah over at Functional Maternity, Sarah Thompson. Sarah Thompson is doing a lot of great research in this. We really don't... I mean, if we still don't totally understand the root cause of preeclampsia. Don't have a new partner. That's one way.

I mean, diet. Diet is a big part of it, no doubt about it.

Yes, you've got to go into pregnancy having your nutritional stores repleted. This is another reason that I'm kind of big on what I said about the child spacing. You have pregnancies too close together, these risks increase. So nutritional depletion is definitely a reason. New partners are definitely a reason. Imbalances in bad blood sugar management, high blood pressure prepregnancy, all these things. So that is not a quickie, really. Okay. Best... what are your best tips for morning sickness? I was down for the count all day in my first trimester.

Eat before you get out of bed if you can. It's a big trigger waking up. Don't brush your teeth before you find something to eat. That's a big trigger.

Wow, I didn't know that.

Oh my gosh, yes. Do not brush your teeth when you're pregnant in the first trimester before you eat something.

Really? Okay, interesting.

Eat frequently every two to three hours because when your stomach gets empty, that's when you start to feel more nauseous, which is also why you should keep something by your bed in the morning, have something right before you go to bed at night, maybe even a snack in the middle of the night if you wake up, which you probably will. Just the longer your stomach is empty, the more that hCG hormone builds up and makes you feel more nauseous. Is it okay to exclusively nurse and hand pump with a Medela Harmony hand pump? I love the Medela Harmony hand pump. I think it's fantastic. But you don't need to hand pump if you're exclusively breastfeeding unless you're trying to increase your supply. So I'm not totally sure how to answer that.

Does she maybe mean... okay, let's just think about this. Maybe she means if she's away from her baby and has to relieve the pressure in her breast.

Then yes, you don't need an electric pump to do that. You can exclusively nurse and use a hand pump when you're away from your baby to supply the milk while you're gone or relieve your breasts while you're gone. In fact, I think that's the best way to do it, so hopefully that's what she means. Okay, what are long, difficult births for first-time moms due to, and how can you prevent them?

This is very similar to our first question, isn't it? Oh no, this is the opposite of her first question.

First question was about purple line.

No, no, no, no. I mean the first question of the podcast was precipitous birth. This woman said long, slow, and I'm like, that's exactly like the first question. Oh, what can you do to prevent long, slow labors? Well, I don't know if there's anything you can do to necessarily prevent it, but let's talk about things that prolong labor. Being dehydrated or not sufficiently hydrated can result in a much longer labor. Being on your back can present in a longer labor. Having an epidural can also. Not being well rested, being depleted, or not having nutrition. So drinking something with minerals in it, like coconut water or some kind of natural expressed juice, is very energizing. I mean, there's a component of this that's out of your control because it could be related to fetal positioning. But as far as your energy level... and also Evening Primrose is shown to very impressively shorten labors. We shared the research on that in our August 2022 Q and A episode, so you can look that up and listen to it. There's many minutes' worth of research that we shared in that episode.

I would also add, stay safe, quiet, protected, undisturbed as long as possible. Interruptions in labor can really change the course of labor. So, I mean, good reason to have a home birth, but if you're not having a home birth, try to go to the hospital later because that is a big disruption. And fetal positioning is a huge reason for long, slow labors. So you really do need to become very conscientious about your body position in late pregnancy. So you want to avoid sitting for long periods of time. You want to avoid reclining. You want to keep your center of gravity forward, sitting on a birth ball sideline rather than sitting on a couch, not spending too many hours in a car. Get your abdomen forward. Get on your hands and knees and do cat-cow multiple times throughout the day. That will help your baby be in the best position, and if your baby's in the best position, your labor can go faster.

I'm glad you addressed the emotional because fear, stress, self-consciousness, all of those things do slow labor as well. So where is that woman emotionally? That's huge. She has to be in a state of trust for labor to go its smoothest and fastest. All right.

My eight-month-old baby sleeps only two-hour stretches at night, even co-sleeping. I'm dying. Help.

Two-hour stretches for eight months is very, very taxing. So first thing I would say is you've got to make sure your baby's doing well with breastfeeding and weight gain because you can't intervene with night weaning if they're not doing well with weight gain or if there's a concern about your milk supply. So make sure that that's all squared away. And then you work on trying to break the cycle of waking up, trying to get the baby to sleep through the first one or two night wakings, and it usually involves having your partner help you. You do need to break that cycle if it is causing you this level of exhaustion. Is it normal for milk supply to be lower in the evening?

Very common. Many mothers experience a dip in milk supply in the evening hours and higher amounts of milk in the early morning hours because for many, most of us, prolactin levels are actually highest from midnight to noon and lowest from noon to midnight. What matters is that you have enough milk in a 24-hour period. I had a shoulder dystocia resulting in a broken humerus. Is this common?

The humerus is the big arm bone from your shoulder to your elbow. No, that should not break in a shoulder dystocia. That is not common. A clavicle breaking, separating, is more common, but breaking that big bone, no. All right, a personal one. What is your favorite meal to cook for yourself?

My favorite meal to make and to eat is one of my really big salads with grilled salmon on it and one of my homemade salad dressings.

Which salad dressing?

Oh, all of them. I would always ask myself which salad dressing am I in the mood for with each one. But I have a ginger sesame one I love, a carrot ginger, a balsamic vinaigrette. I have a lime vinaigrette. I've got just all these different salad dressings that I love so much. So one of my favorite ones that I haven't given a name to yet because it's so basic is walnut oil with balsamic and honey. Oh my God, it's amazing. And salt. It's delicious. And that's the one that I use, that's the one that I pour over my salad if I don't have a salad dressing ready to go, because it takes 30 seconds to whip that up. I just drizzle the balsamic, drizzle the honey, toss it. Delicious. So I like all the dressings, but that's my favorite. That's my favorite meal because it just takes so long to eat, and it's so delicious, and I put so many different things in it. My favorite meal that you make me is pesto pasta with salmon on it, and we're due.

Yes, yes, yes. We haven't had pesto pasta in a long time.

I remember the last few times you were apologizing, and I was like, you can make this for me every time I come.

I do make it for you every time.

I just said, don't apologize. I just love it. I never get sick of that. It's so good.

I'm not a great vegetarian cook. I don't have a lot of vegetarian options.

Pescatarian, pescatarian. So what about you?

It's got to be chicken curry. That's got to be my favorite meal to cook because it's so aromatic and it's so comforting, and the whole house smells delicious, and it just feels cozy and it's so satisfying.

I divide my spice cabinet because we have at least 100 spices in the spice cabinet, and I divide them by cuisine. And the whole right-hand side, the whole right-hand third, is Indian, just all the different Indian spices. And a good curry is wonderful.

Yes, because in a curry I use a lot of different Indian spices.

It's not just curry. So you make, well, curry is a blend, but you don't buy it. You make your...

I buy a curry, and then I add additional spices to it.

Yes, yep. Garam masala, marjoram or whatever else, ginger, ginger, turmeric, yes, yes.

Sometimes salt, sometimes paprika.

Cumin, of course.

Oh yes, cumin. Thank you.

All right, that was an easy one, unlike the last one that I think was the most famous person we ever met, and then we got into a conversation about who we'd like to meet.

Yeah, I was listening to that episode today, actually.

All right, everyone, thanks for the questions, and we will see you next week slash next month for our first episode in May. We'll see you.

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.