#373 | June Q&A: VBAC Labeling, Big Baby Ultrasounds, In-Law Matters & Labor Questions

I'm Cynthia Overgard, birth educator, advocate for informed consent, and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Show. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Welcome to the June Q&A. Hello everybody, and thank you for being here. Hello Trisha, hello Cynthia. It's wonderful to see you as always, as always. All right, so what's going on? Anything new in your life?

Oh man, I got a lot going on right now. Camp stuff. Camp is just kicking off right now. Yeah, yeah, just busy with getting that stuff. This month is every day, many, many tasks. We have 150 kids coming from around the world and have to make sure we know exactly how everybody's getting there by airplane, bus, train, boat, whatever it takes.

Amazing.

That's a lot of details.

Amazing. All right, so we got a voicemail that I just heard, and I've got to play this for you. It was really very interesting, and I thought it was worth playing for everyone. So let's pull that up.

Hey, so I am not a first-time caller. I have called in before and have sung your praises. I absolutely cherish this show for the information you put out. I'm at the start of pregnancy. We just found out, so I am keeping up with everything that is being talked about on the show.

I have a comment, and I want to know what your take on this is. I listened to the episode recently with Nancy Wehner talking about VBAC, and I am a VBAC that I found myself really kind of hating the term, and I almost think the term perpetuates the problem.

Hear me out. In my opinion, based on what I've heard, at least it seems like there is the same chance for uterine rupture for someone having a VBAC as a first-time mom, but basically it's very, very small. So why does there even need to be a term to begin with?

It seems like providers then put you into this bucket of high risk, even though I've hired a midwife, and they believe in physiologic birth. But there's something about having this title of VBAC that makes it tie in your C-section no matter what. Does that make sense? We're always referencing the first birth, which was a C-section, even though it was unnecessary, and it's tied into your second and third and any other birth unnecessarily, it seems, in my opinion.

So I kind of want to just do away with the term. I don't like them labeling me as VBAC, and so I'm not labeling myself as that. I kind of want your take on that. All right. Thank you ladies so much.

I love how she said, Hear me out, like we're not already with her on this. We didn't even need to be convinced of this. We already both have talked about it on the podcast and agree. First of all, trial of labor after cesarean is a term that we really don't agree with. But also we relabeled VBAC a long time ago. It hasn't really caught on yet, so maybe now it will catch on.

What do we call it again?

HVBAC.

I think. Okay. I don't think she would like HVBAC any more than VBAC. Vaginal birth. She wants the cesarean out of that.

Yeah. I think she makes a very interesting point about being labeled and about having every birth of hers consistently referencing the first. I think that's a really good point.

It's not that uterine rupture is the same risk as it is for a first-time mom. They are both very low, but the relative risk is a little higher for women who've already had a C-section. So they're not the same, but they're both extremely low. Not worth haunting a woman about if she's pursuing her first vaginal birth after having had a cesarean section.

But I like the idea of rejecting any label. I think that's a great point. It's empowering.

Yes. This is just what happens in the medical community because we're always looking at your medical history. That's part of your medical history, that you have had a cesarean, and it is actually important information.

You can't just not take it into your next birth at all, because if you have had a cesarean, you don't want to be induced if you're having your next labor because that does increase the risk. So it is an important consideration. You can't just wipe it off the medical record or put the memory behind you.

But it is really important that we don't let it be the predominant factor in thinking about your next birth. It's just an important piece of information.

The risk of uterine rupture either becomes an issue of highly fear-mongering people, that your risk is so much greater because you've had a C-section, your risk of rupture is much higher. But it can also go the other way and be completely disregarded.

As you said, it is not the same risk if you have not ever had a cut into your uterus. Your uterus almost never ruptures. Not never, because it has happened, of course, but it's highly unlikely. If you have had a surgery or a cut in your uterus, your risk of rupture does go up, but it is still a small risk overall.

It comes out to be about one in 100 or one in 200. That's the estimate of uterine rupture for a VBAC, but that's not separating out women who were not induced, didn't have Cytotec, didn't have Pitocin, were giving birth at home. The rate of vaginal birth after cesarean at home, the success rate, is extremely high compared to the success rate in the hospital.

That's not talking about rupture. That's just talking about how the birth environment can dramatically influence the birth.

Well, yeah, and she has every right to just reject the label. Even if you consider many birth centers, if you've had a cesarean for your first birth and then you're planning that VBAC, they will say, Oh, you can't have your second baby here. You basically need clearance. You have to have your second baby in a hospital.

I don't agree with that because I know home birth is statistically an excellent place for a woman's first vaginal birth after cesarean section. But then those birth centers say once you have your second baby vaginally, then you have full clearance like any other woman to have your third baby in the birth center.

Even that is basically conceding to this point that you make. Why should this woman bear this label? It's such a good point. Everything is always referencing the first birth. She heals, she's recovered.

As I always say, every cell in your body is always preparing for and anticipating a vaginal birth. So this is something the hospital has to be aware of, especially so they don't increase risk and compound the risk. But good for her for rejecting that. She shall never use that term to describe herself. Perfect. Why should she? Someone else's term.

Right. Just, I had a baby.

Had a baby.

Had a vaginal birth.

Had a baby and then I had another baby and then I had another baby. That's it.

I gave birth.

That's right. I don't know what else to call it. We don't need a name.

I like her thinking. She's definitely got her mind in the right place to have a vaginal birth.

All right. Well, that was great. I love it. Love the contribution. We always say, call us for any reason. Share anything. Call us. We love it.

Yeah, exactly. It doesn't have to be a perfectly written-out question for a Q&A. Just call in and share your thoughts and we'd love to chat about them.

But speaking of perfectly written-out questions, I believe the next question is a perfectly written-out question.

I don't love those.

Yeah, we do. I think it was the next question. I can't remember, but you can tell because you can tell they're reading it. It doesn't ever feel stiff, but it just flows so nicely, and it's so succinct, and we don't have to chop out long pauses or babies crying in the background or ums. It's just lovely. It's pleasant and easy to listen to.

So no pressure, everyone. Call us no matter what if you want to call us. But it really goes to the top of the list when it's a good-quality recording, for sure.

So here's our next question. I don't even remember what it's about, but I remember thinking it was very, very easy to work with.

Hello Cynthia and Trisha. Just wanted to first thank you because I gave birth at a birth center a couple weeks ago, and I had both of your voices in my head at multiple points during my labor, and I don't think I would have been able to do it without your guidance. So thank you.

My question is about in-laws. During my pregnancy and in the weeks since having my baby, several people in my husband's family have expressed that they are excited and seemingly a little desperate to babysit my son soon.

I plan to exclusively breastfeed and basically forego bottles altogether, and I'm a little worried that they won't understand my decision to do this and will be confused as to why they can't babysit like they had imagined.

Do you guys have any suggestions about how to approach this subject, specifically with people who don't really understand the attachment parenting style? Thank you so much.

I mean, I feel like this is pretty easy. Just say, Hey, when you're with the baby and the baby's hungry, I feed the baby, so let me know when the baby's hungry.

They don't need to babysit for eight hours. We're talking about a newborn baby. When the baby is older and she wants to leave for longer stretches of time, or they want to go out on a couple's night or something, a baby can easily go four hours without eating when they're six months old, even if they're breastfeeding. They would probably prefer to breastfeed at the two-hour mark, but they're perfectly fine to go longer stretches.

A three-week-old baby, a six-week-old baby, can't tolerate that. They need to feed every one to three hours. So great, come be with the baby for an hour so she can take a nice shower and maybe a nap. Then when the baby's hungry, she feeds the baby.

She didn't indicate one way or another if she wants her in-laws to babysit her baby. She didn't indicate. She didn't say, Well, it would be great and I'd love for my in-laws to babysit, but I don't know what to do because I want to only breastfeed.

She might be masking another emotion, and I don't think it's conscious. I think we all do this all the time. She might be masking another emotion, which might be, I don't really want to turn my baby over to them, at least not for a long time.

And if that's how she's feeling, then we're having a false conversation about this whole thing. Because we're like, Yeah, go out for a couple of hours, enjoy your time. But if you feel more like you don't want to turn your baby over, and I completely understand that, especially postpartum women with any amount of anxiety, it's a very uncomfortable thing to do.

I found it uncomfortable, for sure. I did feel the pressure. I didn't want to let my in-laws down. I did feel it was a healthier thing for me to force myself to do, but it was extremely uncomfortable.

And if that's how she's really feeling, then I just want to respond to that. You don't have to let anyone babysit your baby for a long while. A newborn? Heck no. You have every reason in the world not to have anyone babysit a newborn for a few months.

But then have them babysit the baby while you're in the house. Say, I'd love you to come. Go take a nap. Go have a long phone call with a friend. Just play around with your comfort level around the babysitting if you are open to it.

Yeah. I don't think babysitting a newborn is even a thing in the first six weeks. There's really no such thing as babysitting a baby under six weeks of age.

By the time they're maybe three months old, then you're thinking about leaving for one to two, maybe up to three hours at a time. And if you feel comfortable with your in-laws or your own parents being with the baby for that period of time, then again, it's easy. They don't need to worry about feeding the baby. Nobody else has to feed the baby. You're just not going to be away that long that early.

But as you said, if the underlying fear is really, I need a good excuse for my in-laws not to babysit the baby, then just make sure you recognize that and take a firm stance on that. It's totally okay.

They're going to be able to spend time with the baby and bond with the baby and get to know the baby over a long period of time. Nobody has to know the baby that well in the first few months of life. It's okay.

Yeah. And if my presumption was completely off base and you really would love for your in-laws to babysit, just say when the time comes, a few months out, Yeah, it'd be great if you come over. The best time would be 9:30 in the morning, or whatever. Then just say, I'll be back in an hour and a half because he or she will need to feed again. That's it. You just control your return time.

And you control the feeding. Nobody else feeds the baby. That's easy.

So was that a breastfeeding question or an in-law question?

I think so too.

I categorize that under family boundaries.

Yeah, because it wouldn't have been complicated if it were simply a breastfeeding question. It would have been, Well, when my husband has the baby and I'm running errands... It's not that kind of question. It's, My in-laws keep saying how they can't wait to babysit the baby. Okay, that's a whole other thing.

I just want to say one more time, bonding with a child does not need to happen early on. Whether it's the dad, the dad doesn't need to feed the baby to bond in the first six or eight or twelve weeks, or even six months or a year.

If you're breastfeeding, the father might never feed the baby. That is not a requirement of having a healthy relationship with your child. Nor is it a requirement for the in-laws or your own parents to have a bonding experience with the child. Feeding does not equate to bonding, especially long term.

Hi, Cynthia and Trisha. My name is Faith. I'm originally from Vermont, but I moved to California, so I loved dialing the 802 number.

My question is, as someone who's never been pregnant or given birth, what is the best way that you can describe what contractions feel like? Thank you. Bye.

Oh, what a fun question.

What a creative question. I know, I was giddy when I heard that. Everyone's thinking it. Everyone who hasn't conceived yet or hasn't given birth yet is wondering.

Well, they're already labeling it as pain, so we're always focused on the pain conversation and trying to explain away the difference in childbirth pain versus the pain of an injury. But nobody's ever really asked, What does it feel like?

I have some thoughts. You start.

Okay. I was about to say, What a great question, and then say I'm not going to tell you what they feel like. I'm just joking. But I also think it's presumptuous. I don't think it would be right for me to do that.

I've only given birth to two babies, and the feelings were completely different in my two instances.

I think it's rational to tell women that possibly the most normal or common experience is that of lower abdomen or uterine cramps. For some women it's so mild that they say, Oh, it's like having period cramps, but they come and go.

But for me, I didn't have any of those cramps in my first birth at all. I had them in my second, and when I experienced it in my second birth, I looked calm on the outside, you were there, Trisha, but inside I felt like escaping my body.

It didn't just feel like period cramps. It was exactly the feeling of period cramps, but I felt like escaping my body. I had a wave of... I don't know if the word is jealousy. Like, why of all the people in the room right now, my husband and you and Amy, why do I have to be me? Why do I have to be the one in labor?

There were moments where it was incredibly intense.

So that's still how I would describe the sensation.

One more thing I'll add. With my son's birth, I felt only back labor, which I don't think was more difficult than my second birth despite what everyone says about back labor.

But they needed me to lean back for a moment to check how dilated I was when I arrived at the birth center. I transformed into a different woman when I leaned back.

I leaned back. I wasn't even having a contraction at that moment. When I leaned back, I started begging them, Please hurry. I completely changed. Please, please hurry. Hurry, hurry.

I was panicking because I thought if one comes right now, I don't even know what I'm going to do.

I mean, being on my back was completely intolerable even between contractions. So I know the sensations would have been far worse and more intense if I had been in that position.

One more anecdote. I have a wonderful friend from Minneapolis who was having her second baby at home. It was going so smoothly, and it must have been four or five in the morning.

Out of nowhere, after a couple of hours, her older child woke up and ran to her calling for her, and she was overcome with feeling torn and guilt. She said her contractions immediately became painful. She immediately doubled over. She immediately had to change her coping techniques.

It took them a little while to calm down her daughter and put her back to bed. She said she got right back into that calm state and was comfortable again.

That reminds me of what happens when you have, say, a headache. A headache can wax and wane, and it can get a lot worse really quickly when you get stressed, panicked, or tense. Then it can go away when you take deep breaths, close your eyes, put a cold washcloth over your forehead, and do things to relax. It can completely change the experience of what you're feeling in your body.

So what you just described with this mother reminds me a lot of how you can experience that kind of discomfort.

For me, all of my labors felt pretty similar, except that the faster ones, which were the second two, versus the longer one, which was the first one. The intensity of each individual contraction was much higher in the short labors than it was in the long labor. But the long labor contractions were also still very intense and just wore me down a lot more over time.

It was more of a feeling of, I don't know how many more of these I can take, whereas in the short labor it was just like, Oh my God, I just have to get through this one, and I'm almost there.

So which was easier and which was harder? That kind of describes my two experiences too. Even though both of my births were so short, which one would you say is harder? Shorter and more intense? They do say this, that the shorter the labor, the more intense, and the longer and slower, the more exhausting and mentally demoralizing. Which was harder, would you say?

I would not describe it at all as demoralizing, but I would definitely say, hands down, without even a fraction of consideration for anything else, the first birth. Way harder. Way harder.

Which was the longer, slower one?

Longer, slower one. Yes. About 36 hours, whereas my second and third were three hours and 90 minutes. But the inside of each single contraction was completely overwhelming, just gripping to get through. I don't know how to describe it other than it felt like beyond a menstrual cramp.

My first labor felt like really, really intense menstrual cramps, the most intense menstrual cramp you've ever had. Then the second and third were a step above that.

Now, can you understand how if women have really long labors, especially in a hospital, that it can be demoralizing? We've met with enough women in birth story processing sessions where they start to question, Why is this still going on? Why is this taking so long? There's pressure that they're facing. It does seem to present a new set of challenges.

Yeah, I think it has a lot to do with how the people on the outside are relaying your experience to you. In my case, a 36-hour labor just felt completely normal. Everybody around me thought it was normal. I expected it to be long.

That is...

Yeah. I don't know that I was even thinking that it was that long. I wasn't in the moment thinking that.

You weren't analyzing it, and no one was pressuring you. No one was saying, Look, you've been this many centimeters for this many hours.

Nobody ever said anything like that to me, nor did I have a clock. I wasn't even looking at a clock.

Didn't have one.

I didn't know. I only knew that I had started labor the day before in the afternoon and that we were approaching nighttime. That had to be kind of like, Wow, this is going on a long time. But at the same time, I knew it was always progressing. I knew it was progressing not because I was getting cervical exams, but because I felt things changing in the course of labor.

The only thing I want to add to this question is something that, before I gave birth and I was taking my childbirth class, I remember saying, How long does a contraction last? Which is like this very silly question, and women do wonder this sort of thing.

I fully expected my instructor to say five to ten seconds, and instead she tilted her head and said, Forty-five to sixty seconds.

I think I white-knuckled the arms of the chair and said, What? Because I thought, How am I going to endure anything difficult for that long?

What she didn't explain, and what is so important to explain, is that if I didn't hear anything or know anything and you asked me how long they last, I think I would still say five to ten seconds.

Not just because of time distortion. I think what we forget is that they start very mild. You feel it arriving. You feel the sensation arriving. You feel it mounting. You might be finishing your sentence if you were talking. You might be finishing your sip of water if you were drinking.

Then you just relax into it, do your thing, whatever you're doing. Focus. Relax. Check out.

It's that peak. You feel it mounting, mounting, mounting. You feel it reaching some kind of crescendo. You know you're reaching the peak. Then it starts to wane.

I remember the whole peak and the left and right side of the peak being difficult. Even after I reached the peak, it was still difficult for a few more seconds. Then it gets easier again and slowly goes out.

So all we really have to concern ourselves with is being at our calmest and breathing our most comfortably and being deepest in that peak. In the most difficult moment, be your calmest, with the maximum comfortable amount of oxygen in your system. That's it. You kind of don't worry about the rest.

Yes. And that peak sensation is different for a lot of people.

If it is all uterine, I think it is most commonly described as a super, super intense menstrual cramp. It can sometimes feel like a maximal stretching of your tissue, like stretching almost to the point where you know it shouldn't stretch anymore.

What you said is so important. Nearly every woman will experience her uterine contraction in that wave-like fashion. How long the peak lasts is different for different women. The buildup time is different. The coming-down time is different.

They do range from 30 seconds all the way up to two minutes per contraction. That's generally the range. But that peak is usually only about 15 to 20 seconds.

As long as you know that it's coming, coming, coming, coming, you're going to hit that peak, and then it comes down the other side. It always comes down the other side.

I think what's really difficult is when women experience sensations outside the uterus because these are harder to navigate. Some women will feel a lot of sensation, or what they describe as pain, down their legs, in their thighs, in their back.

If there is something going on in your body that's pulling and you need to change positions, or your baby needs to move positions, you're going to feel a sensation that feels different from that wave. That can be a little bit harder to cope with because it doesn't have that same pattern.

Yeah, that's an interesting point. In my first labor I only felt back labor. Again, if I could redo either, I think I would redo my first one with the back labor because someone can apply counterpressure, as my husband did. Rubbing the back is such a reprieve.

I truly remember feeling absolutely nothing in the uterus at all. So the back labor with that support was really manageable.

But it's interesting. I forgot we can feel other things. When you said outside the uterus, I couldn't even imagine what you meant.

In my second labor, my sacrum lifted very quickly as the baby was descending, and my husband witnessed it. He was like, Oh my gosh, Amy, come and look at this. She was like, Isn't that so cool?

While my sacrum lifted right before his eyes, I felt this very intense ache go down my femurs because the femurs penetrate the pelvis, I guess.

And also it's hard because all of a sudden we've gotten used to coping with a certain rhythm of sensation in the body, and then your body throws this other sensation at you, and you're like, Wait, that's not supposed to happen. What is that? How do I manage that?

But without a doubt, whenever any of these sensations come up and you feel you're at your limit of what you can tolerate, one, that's a good sign that your labor is progressing well. So remember that.

And two, use water. If you can get in a tub, get in a tub. If you can't get in the tub, get in a shower. Water just has an unbelievable way of softening things. Not taking it away. It is not like an epidural. But it softens. It tempers things.

That was a great question. If we have any more preconception women or women who are expecting their first, it would be fun to hear the things on their mind and the questions they have because you and I wouldn't have thought to address that if we hadn't been asked. It's a tough one to answer, isn't it? We're all over the board. I don't know what she got out of that. Hopefully she has some sense.

Well, you know what? We should ask the question of our community. Let's have other people describe what it feels like to them.

That's a good idea.

One thing that I've said for years in teaching childbirth education classes is that I want you to focus. It's okay to ask and be curious, but when you're pregnant and expecting, focus less on what you anticipate feeling and focus entirely on how you will respond to whatever you feel.

I think there's no better preparation for that than a yoga class where you're intentionally putting your body into safe but purposefully uncomfortable positions just with the weight of your own body, for the sole purpose of a deep breath, a calm physiology, and a relaxed face.

That is powerful, and you take that into every aspect of your life. So I think that's the perfect way to prepare for birth.

Okay, let's go on to our next one.

Hi there. My name is Audrey. I am 38 weeks pregnant. I am planning a home birth with a midwife and planning to do a water birth.

My midwife, at my last appointment, recommended that I do an ultrasound to do BPP testing on the baby. I was hesitant to do it because I wasn't planning to do another ultrasound, and it surprised me.

But she said, Just as a baseline, in case you go way over and we need to do another ultrasound, we can have something to compare it to, just to show that you're still doing well.

So I agreed. They had me go to a place called High Risk Pregnancy of Arizona, which I was hesitant to go to. I just did an ultrasound with a tech, but the doctor afterward contacted my midwife and said that he had a concern about the size of my baby because his abdomen was measuring big.

They estimated that he might weigh about 8.7 pounds at this point.

So my question is, how accurate are those tests? How much of this is just an overly cautious doctor who sees a lot of high-risk patients?

They're suggesting that I do glucose testing and a finger prick four times a day to see what my glucose levels are.

I have no concerns that my baby's too big. My husband had three kids before this baby, and he has kind of a history of big babies, but nothing crazy, and all three of his were delivered at home.

I feel very confident that my baby is the size he should be for my body, so how seriously do I take this? How much of it is just doctors being doctors?

Should I have just gone with my gut and not done an ultrasound at this stage of pregnancy at all? Because I feel like that's an intervention, and now they want to do more interventions.

So I'm kicking myself a little bit and would love your advice on it. Thank you.

She opened that can of worms at the advice of her midwife. That's what happens.

She just explained exactly the problem with routine ultrasounds in the third trimester.

So yes, she should have trusted her gut and declined. There was no evidence that she needed an ultrasound. She feels good. She trusts that her baby is the right size for her. She's not worried. There were no indications in her pregnancy that would require an ultrasound.

Now there is unnecessary intervention and unnecessary worry.

This big abdomen thing makes me laugh. What if they think they have a little sumo wrestler in there or something? That she has this disproportion?

This is so ridiculous. Ultrasound is so faulty to begin with as far as guessing fetal weight, especially late in pregnancy.

But the abdomen? What baby is getting stuck at the abdomen? They're soft. They compress because they're soft.

It's not that they're worried about a large abdomen. They think the abdomen is an indication of the baby's overall weight and size.

But these ultrasounds are off by easily a pound or more.

Well, they already measured the weight, and it isn't a good correlation to shoulder dystocia.

Look at what they want to do. They now want to have her test her glucose all day long. For what? Only so they can say, Oh good, now we have a reason to induce you.

They've done meta-analyses on this. We've talked about this. A care provider's suspicion of a big baby is far more dangerous, with significantly worse outcomes, than actually giving birth to a big baby.

That is a very important takeaway.

Again, that's meta-analysis. This is putting together all the studies from different continents. That is a very clear finding.

I think the adverse outcome rate was quadrupled in the case where a care provider suspected a big baby. Cesarean rates were far higher. Induction rates were far higher.

So you need to really protect yourself from unnecessary checking and unnecessary interventions.

Now, that's not to say she did the wrong thing. She did what a lot of us would do. She trusts her midwife. Her midwife said, Let's just make sure everything's okay.

But again, she marched her into the hands of a high-risk doctor who is going to find either low fluid or a big baby or something.

Well, this is the classic trap in the end of pregnancy. Let's just get a baseline. Let's just make sure everything is okay.

If there's no indication, if there's no true indication for an ultrasound, you don't need one.

I can't remember how many weeks she said she was.

Thirty-eight.

Right. We're not even talking about post-dates or anything at this point. She's just 38 weeks pregnant, feeling fine, and having a healthy pregnancy. There's no need for an ultrasound.

What I liked hearing is she herself isn't worried about a big baby, as I never was.

It's very good not to be afraid of a big baby. It's a great thing. She's comfortable with it.

The only thing to hope and pray for and work for and try to influence is a well-positioned baby because that's actually what's going to determine how smoothly any birth goes more than the baby's weight.

Yes. Your baby's head position is the most important thing.

All right, Trisha, we turn it over to you now because it's quickie time.

Oh, my favorite time, as we know.

Okay, so these all started coming in this morning, and as per usual, we've got a lot of them. So let's just start at the top, and here we go.

Oh, okay, that's a personal one right off the bat, and it's a big one, so we're not actually going to start with that one. We're going to hold that one.

I'm nervous now.

All right. I love how we always get a personal one and we always put it at the end, but it's so reliable.

It's become reliable. It wasn't at first. It took a little while.

Yeah.

But now people... There are actually several personal ones in here.

Okay.

What do you do for a cervical lip, if anything?

Nothing. You don't have to do anything. A cervical lip is a normal part of labor progress.

We just had a birth story processing session, you and I, and in that story she shared with us, her midwife reached in. It was very uncomfortable and moved the lip out of the way.

What happens if it's not moved out of the way?

It just works its way... The baby just pushes through it eventually.

Yes. I had one in my first labor that lasted probably an hour before it finally went away.

I have heard of midwives using ice to try to get it to retreat.

It's just cervical tissue. It's basically being nine and a half instead of ten. You just have this one last little bit of cervix that's hanging on. Usually it has to do with the baby putting slightly asymmetrical pressure on the cervix.

Anyway, now here we go. Not being very quickie right off the bat.

We're not being quick, but you don't have to do anything, is the point.

Why do I have high lipase milk? My baby won't take it frozen.

I can't tell you exactly why you have it, but many women have it, and many babies don't take it frozen because it does actually change the flavor of the milk.

There is a technique to scald the milk before you freeze it that deactivates the enzyme. You can look it up online if you want to do this.

But nature didn't design us to be storing and freezing a lot of milk and feeding it to our babies later.

My baby prefers a binky to sleep instead of nursing. Should I worry?

No. That's a habit that babies can develop. As long as your milk supply is keeping up and your baby's gaining weight, then no.

It's not a great habit, but a lot of babies have it. I prefer a thumb to a binky.

That might be a much harder habit to break later, a thumb.

But they can break it on their own. You have to take away the binky.

I know. That's exactly why I thought the thumb would be a harder habit to break. I don't know. I never had a child who did either, so I have no experience and no understanding of it. Okay, go.

I think children will break the thumb-sucking easier than you taking something away from them. That's just my personal opinion and experience.

Can you drink coffee while pregnant, yes or no?

I would assume organic decaf is probably fine in moderation.

I think even small amounts of caffeine are okay, one cup a day. But if you can give it up, give it up. It's better not to.

Yeah, but...

A lot of women don't even crave it in pregnancy. It just doesn't even taste good. They can't drink it.

Yep, I've heard of that.

But don't beat yourself up if you have a little coffee.

The Fresh Test or Glucola?

Neither, but definitely not Glucola.

What's a milk bleb? I'm not currently nursing, but do I need to worry about it with my new baby?

No, you don't need to worry about it.

A milk bleb is an inflammatory process in the nipple where you get a block in the nipple pore from inflammation in the nipple duct.

Bleb? You and your make-believe words.

That is the real word.

Did you have to look it up?

No.

I would have to. I didn't know that word.

Bleb.

I didn't look it up, but I would. I didn't know what it was. Is that used in other contexts outside of breasts?

I don't know, but it's definitely...

I mean, I know blurb. I know blob. I don't know bleb.

Bleb.

Yeah, no. I've never heard of bleb. It's never come up in all my conversations.

All right, all right, all right. Let's look it up.

Really?

Yeah, let's find out what the actual definition is.

It's a medical term. A bleb is a small blister-like protrusion or vesicle filled with fluid that forms on the surface of a tissue.

Except that's interesting because a bleb is not actually a vesicle filled with fluid. That sounds more like a blister. That's not what a bleb is.

A bleb versus a blister?

They're actually different things, but used seemingly interchangeably when people are calling it a milk bleb. It's actually not fluid-filled.

Okay, moving on.

Is it bad to stay on antidepressants for many years?

You're asking the wrong people.

There are better things.

Yeah. If you want to learn about this, listen to episode 235, and you'll probably want to get yourself off of them if you listen to that episode, which is outstanding.

Dr. Roger McFillin, I think. He's doing the research and sharing what the pharmaceutical companies know but suppress from the public.

Yeah, I don't think we can give you a yes or no on that, but we can say there are alternatives.

And you might be much happier off of them. That's what I think women are afraid of. They're afraid to come off of them because they think they're going to hit a low.

If someone supports you and you're responsibly weaning off of those, you might actually be much, much happier, ironically.

So listen to episode 235 and then take your research from there.

Definitely not a quickie.

That's why I said listen to the episode. Turn it over to an episode.

Thoughts on swaddling and wake windows?

Oh no.

No. Very judicious use of swaddling, I think, is okay. But wake windows are something I think we need to just not worry about or think about really ever.

It's a new thing that didn't exist before to give moms anxiety over.

Trying to create and follow wake windows precisely is something to feel anxious about. Children naturally have wake windows. Babies naturally have wakeful periods in a day.

But trying to analyze them and track them and control them is a recipe for tremendous anxiety.

Yes, and breastfeeding disruption.

And it'll change how you relate to your baby, which we don't want.

Dates or sex to dilate your cervix?

I thought she meant dinner dates. I was like, Well, first one, then the other. Come on.

Which one first? Sex and then the date, or date and then the sex?

That means eating dates. They're all good. Eat dates. They're great for dilating the cervix.

She left evening primrose oil off the list, which she should definitely add to the list.

And if your membranes haven't released and you have sex, that's a cervical ripener.

They both help soften and prepare the cervix. They don't actually necessarily lead to dilation, but they soften and ripen it, which is important.

Oh, here we go. Follow-up: Is sex at 37 weeks really going to put me into labor?

No. It's not going to put you into labor. It's going to prep your cervix for labor, which will help you progress faster in labor when labor kicks in.

Now maybe a good orgasm can tip you over the edge. It has to be a good one.

Has to be a good one.

Was there such a thing as good, better, best? I don't think there's such a thing as a bad orgasm.

So we're talking duration and intensity equals better?

Yeah. They're different sometimes.

So to answer your first question, yes, definitely start with the dinner date.

I mean, I prefer the sex and then the date.

Really?

Kidding.

No, I think it's a good thing.

Okay.

Can you avoid a retained placenta?

Well, there's no guarantee. No.

But you can do some things to reduce the chances of having a retained placenta, like not cutting the cord and separating your baby from you after birth.

Like not letting them tug on the cord.

Like not letting them put their hand inside of you and scoop it out unnecessarily.

Or excessively palpating on the uterus, which they dare to call uterine massage.

You can best avoid it by leaving it alone.

Leave it alone. Keep the cord intact. Breastfeed your baby and allow it time.

When do you think induction is necessary?

Nice quickie.

When there's a medical indication that's greater than the risk of induction.

In your conversations with providers, they're seldom going to talk about the risks of induction.

Previously, about ten percent of the time that it's actually done. That'd be my guess.

They actually found in a study, I believe it was in 2007, that 97% of the time Pitocin was administered in the United States, it was administered off-label, which means to speed up or augment labor or for non-medical induction.

So I think you're being generous. I think it's even less.

But you'll know if you have a serious condition. You would know. By default, you don't go near inducing unless you're thinking, Oh my gosh, I need to get this baby out.

Like preeclampsia, something like that.

Again, we can't name everything because autoimmune disorders and other conditions can predispose women to very risky situations. We can't cover all of that.

We actually did a Patreon on this.

Did we do a Patreon on this?

Yeah, we have an event on this. We walked through the reasons for an induction and why you would get induced.

Moving on.

Creatine while breastfeeding?

Yeah. It's just an amino acid.

Just...

Of course it's fine. It's food. It's an amino acid that you get from food, just in a more consolidated, simplified version. So yes, totally fine.

Okay. We actually got several personal ones this time, so maybe we'll do a couple.

Let's see.

That's good in case one of them stumps me.

Okay. And there's a whole bunch more quickies in here that we'll have to save for another time.

Well, last time we took them over to Patreon and did a whole Patreon event on quickies only. If anyone wants to join Patreon, they can watch our last quickies event where we did a whole hour-long quickies.

Yes, and we'll do that again with some of these. We'll get to it again soon. You can't get enough of quickies with Cynthia and Trisha.

We love our quickies.

We got you covered.

Okay, so moving on to personal.

What's your favorite on-the-go coffee? Dunkin', Starbucks, etc.?

I've never had a coffee from Dunkin' Donuts. I don't drink coffee from Starbucks. But the best one on the go from whatever café of choice I'm going to would be an iced latte.

And yours is a hot coffee anywhere.

Yours is a hot coffee.

Well, it has to be good coffee.

Good. It has to be good.

I don't go to Starbucks because I think they're... I haven't had their coffee in 20 years. But that's my treat, a nice latte.

You have a hot coffee.

What if you're on the road and you don't have a good local Westport café to get a nice latte? Where are you going?

I wouldn't drink a coffee. I can go a long time without coffee. I drink coffee as a treat.

But when we're on vacation or something, if we're in a city, that would be my daily thing. Find a nice little café and get a nice latte.

There are like two weeks of the year in the Northeast that are too cold for me to get an iced latte, and I will convert it to hot. Then two or three weeks later I'm back to iced. I love my iced latte.

You. It's always... We were out the other day. It was freaking hot, and you got a hot coffee.

Eighty-seven degrees.

I got a hot coffee.

We were in open air.

I just like the flavor of coffee hot.

Yeah.

Oh, my favorite on-the-go coffee is definitely, hands down, Tim Hortons.

Okay. Never heard of him. Never heard of him.

You've never heard of Tim Hortons?

No. He sounds like a country musician you would listen to.

No. That's like not having heard of McDonald's, Ronald McDonald.

No, it's not like not having heard of McDonald's because when I was a kid there were McDonald's commercials on TV all the time, not Tim Hortons commercials. You can't say that.

Tim Hortons is the Dunkin' Donuts of Canada.

Oh.

And many other parts of the world.

You're giving me your old...

You've never heard of it. It's only the biggest coffee chain in Canada.

I mean, it's clear they do exist.

Okay, but I think most people have heard of Tim Hortons.

Now that we have to find out, we will find out.

But yeah, their coffee is decent, actually. It's pretty tasty.

All that shaming of me over a brand that you only describe as decent. Unbelievable.

This is on-the-go coffee.

The best on-the-go coffee is my own coffee in my ceramic white mug, open in the car. Always the best coffee.

Next personal question.

Okay. Are you ready?

Yeah.

Last one.

Sure.

Yeah.

Okay.

Hope so.

Do you regret not having more kids?

No. Not at all. I had exactly the number that I wanted to have.

I can't say what I would have said at age 28. I think I would have said three. But starting as soon as Alex was born, I did exactly what felt right to me, and it has felt right ever since.

You have a different answer. You always...

Not regret. Before, not a regret.

Now?

I always kind of wanted five.

Okay.

But I was very happy when I was finished with three. I felt very finished.

But had I had four... I always crave a baby.

Okay.

I wouldn't say I seriously considered it, but I always crave a baby.

Yeah, I could see that in you.

Not a three-year-old.

Really? I found the age of three easier than infant, probably.

Oh, I just love infants.

Well...

We can talk to them. It's just so awesome.

I love toddlers too. I love them at all ages. But I could just have a baby in my life, I think, at all times.

Okay. That wasn't as hard as I thought.

No, that's it then.

That's a wrap for the June Q&A.

If you're interested in that induction conversation about when you really need to be induced, you can find it in the show notes and go check it out wherever it is. We'll find it.

Thank you for the questions, everyone. Have a good one. We'll see you next Wednesday.

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.