#391 | October Q&A: Postpartum Depression Recurrence, Anal Fistulas & Vaginal Birth, Pregnancy Dating Without Ultrasound, RSV & Newborns

All right, welcome to the October Q&A, Trisha.

Yes, we got off to a little bit of a late start today.

Yes, my fault. Sorry.

I was on the pickleball court for two hours this morning.

Good.

And in between games, I said, “Let me just see if Trisha texted me since we have recordings as soon as I get back.” And you said, “Running late, locked out of my car.” Yes. What happened? Where and why?

For the second time this week, actually, because old habits die hard, and my key fob is dying, and my brain hasn't caught up with the fact that if I leave my key fob in the car and lock the car, it will actually lock now. Because you know how if your key fob is in the car, it won't lock. It prevents your car from locking if your keys are in the car, and I typically leave my keys in the car. But the battery's, I guess, not good anymore. So if I inadvertently or forgetfully lock the car while my keys are in it, it's locking now.

So where were you twice this week?

I've locked my keys in the car. The first time was at Trader Joe's in the pouring rain with all my groceries in the grocery cart. I was locked out of my car, and the second time today was I was at the gym. Fortunately, so I had a nice place to wait.

So all anyone has to do is find your car, break in, and drive off with your car. You just leave your keys right in your car.

Well, yeah. With my car locked, it's a lot harder. With my car unlocked, which is usually the case, it's a little harder. But I don't know how many cars have been broken into. Interesting. Okay.

Yeah, I'm not a big locker of my car.

Yeah. Okay.

But if my computer is in my car, I will lock my car, and that's why I locked my car today, and that's why I locked my car the other day. But both times, my keys didn't do their job of preventing the lock.

But isn't your car worth much more than your computer?

No.

Okay, so my car is worth a lot.

So whoever breaks into your car, if they would please be kind enough to leave your laptop on the side of the road, Trisha would appreciate the gesture.

Don't take my laptop. You can take my car.

Just the car. Obviously, she's pretty indifferent to leaving the keys in it. Okay, yeah, it's a habit you'll need to break. I wonder if that's going to happen again. You went all those days of breaking glass water bottles, and I think that that hasn't happened in a while. But now this.

Yes, I did switch actually to a silicone-covered water bottle after I got terrified that I was going to break it in the steam room because I always take it into the steam room, and I would feel really bad about that. I don't mind if I've broken it in the grocery store, wherever, but if I broke it in the steam room, it would shut the whole place down.

Right.

So, yeah, I was a little disappointed in myself for not remembering that I just did this two days ago.

So, how'd you get into the car?

Well, both times I called AAA, and the first time the guy happened to be in the same parking lot I was in at Trader Joe's. It was so lucky because literally, I placed the service call, and three minutes later he was at my car.

Unbelievable.

He was like, “Oh yeah, I was just over here having some lunch.” So lucky, so blessed. And then today, I was like, “Oh God, I cannot believe I did this again.” And of course, there's no way it's going to happen again where it's a quick service call, and it took an hour and a half today.

Okay, so do you realize that they were able to break into your car?

Well, yeah, they have special break-in tools.

Well, so do crooks, and now I know how to do it too.

See, all right. You just need a special long hook.

Oh, now you're gonna tell everyone. We tell them what car you drive and your license plate too while we're at it.

Yes, I have a white Tahoe.

Oh, great. Can I get license plates?

Yes, and she shops at the Westport Trader Joe's and leaves the keys in the car, and apparently doesn't mind so much as long as you don't drive off with her laptop.

Please don't take my laptop. Anyway, but yes, you do. You know how it works. It's fascinating how they do it.

How?

And it's actually shockingly easy to break into a car.

I know they have—

They have a long thing.

Yeah, they used to have a coat hanger in old days.

Okay, but it needs to be a little longer than a coat hook, I think. But they take like a blow—like a bladder. You could do it with a blood pressure cuff.

Can you do it with a Foley balloon?

I think the Foley balloon would pop. You need something a little stronger. So anything that you can blow up and inflate. So you slide it in the door, in the door jamb. You slide this flat thing in the door jamb, and then you use the bulb to squeeze it, just like a blood pressure cuff. I was thinking I should just carry my blood pressure cuff in my purse, and if I get locked out of my car, I won't have to call AAA. I'll be able to do it myself. And they squeeze it, squeeze it, squeeze it, and it actually makes your car door open like two inches. It's crazy while the car is still locked. And then they stick the long coat hanger thing in. They hook it around your door handle on the inside, yank it a little, and the door opens from the inside.

Unbelievable. So easy.

With all the inventions we have, we're still relying on little old-fashioned mechanical devices for things that are total crises? Really fascinating.

Yeah. So anyway, that's why we're late. Sorry.

No, I got to play the full two hours of pickleball. I was thrilled. I was so glad to see you were running late. I was sorry to see why, but I was like, “Woo-hoo!” I was thrilled.

I still found a way to blame it on my husband, though.

How? What? Why?

I was like, “You haven't changed the battery in my key fob, so now I'm locked out of the car again.”

Okay. So, and he didn't come back with the obvious, like, “Well, stop locking the keys in the car”?

Uh, yeah, he did.

Okay, good for him. I'd have been disappointed if he didn't. Okay, I got in probably eight pickleball games, feeling terrific.

Eight today? I usually play about one day.

Yeah, in two hours, we usually play seven or eight games per two hours. Yeah, sometimes you go a little over and play more.

Oh yeah, yeah.

Sometimes we stay longer and play more. Yeah, you know, it's really fun. All these people show up. Like sometimes 16, 18 people show up, and you just keep swapping, swapping, swapping, splitting the winners. Swap. It's just, it is the most fun, dare I say, I've had in my life, and I've had a lot of fun, but it's like giddy fun. It is just so—I don't know about the most fun in my life, but it is definitely tied for some of the most fun things I've done in my life.

Being competitive in gameplay is, I don't know. There's a high in it, you know. It's just like that competitive feeling. Working hard, you're exercising, and you're winning and losing and trying, and you have a good hit. It's like so—it's such a nice—it's a lot of good dopamine. That's the healthy kind of dopamine.

Oh, absolutely. And it's such an interesting game. Like the better you get at it, in a way, the harder it gets. I mean, you become a better player, but the harder it gets because you start doing really sophisticated things like evaluating grip strength and angles, and it's just like there's so much laughter when someone has a great hit or when something wacky happens. It's just—

Or you hit somebody in the face with the ball.

Oh God, no, that's frightening when that happens. I mean, it takes a long time to not be intimidated by a really fast ball coming at you. But I really recommend that everyone go try this fastest-growing sport, and you know who turned me on to it. Nancy Wainer. She's been telling me for like a decade to take up pickleball. She plays like four times a week as well, and I'm so grateful to her because she has given me a lot of things in life, and this is quite a big one. I thank her for it all the time. She mailed me a gift at home. I forgot what it was. It was some kind of—they have all this paraphernalia—it was some kind of pad of paper, to-do list, or something, and it was a play on the word “dink.” I don't remember what it was because I've seen so many of those now. But she's very sweet. She mails little cute gifts every now and then. Very, very sweet person. All right, who wants to go to the post office and mail things? You know, I mean, it's quite a gesture.

It's some good old-fashioned fun right there. Going to the post office, I actually kind of like it.

I mail postpartum soothes all the time, so going to the post office is part of my life. I don't really mind anymore, but years and years ago, I used to be like—

It's so antiquated when you walk into a post office. It's just like the stuff that's on the walls and the way they do things. It's still so—it's like 30 years ago.

Yeah, we have this little tiny post office in Greens Farms. It's right by the train station. It's right next to the train. It's this tiny little house. It's so sweet and charming, and it's where I have my post office box and where I go. And it is a very nice country feeling, which I really appreciate.

You really can't rely on the postal service, though. Let me tell you, I had a lot of lost mail.

Okay. Anyway, let's start. Oh, I did have something I wanted to share before we get into our first question that I thought was really good fun. We got a message on Instagram from a woman who wrote this to us. She wrote, “Did you guys watch Jeopardy! last night?” My first question is, “Jeopardy! is still on TV?” I don't even have cable television.

I have never watched Jeopardy! in my life.

I don't think I've ever watched it in my life either. Of course, I know what Jeopardy! is. It's the one where they give you the answer, and you say the question?

Yeah, you have to form the question.

Yeah, that's the answer. Something like that.

I don't get why that is so important. It's like a little—

Thing.

Yeah, it's like a quirk of the game. You can lose on such a technicality. It's so silly for people who know so much. Okay, so, “Did you guys watch Jeopardy! last night? You'd have to YouTube it, but the hint was about”—okay, listen up, everyone—“the hint was about a temporary organ made of maternal and fetal tissue.” Ding, ding, ding, ding, ding, ding, ding. Do we know what that is? Okay, obviously we know what that is. And “placenta” escaped—she's writing this in all capitals now—“PLACENTA escaped all three of them. TWO”—she wrote T-W-O—“were women.” We don't know what placentas are anymore. No, we're doomed.

Okay, we never knew what placentas were. Nobody ever knew. And I've told this story, but I'm going to tell it again because it's probably been years. But I was once flipping channels years ago, and Tyra Banks used to have a TV show, and while I was flipping, she was holding up makeup or something, and she was going through makeup, and she was trying to freak out her young and probably pretty immature young audience about the gross ingredients in makeup. And I was immediately impressed because I thought, “Oh my God, I cannot believe on a mainstream show like this with a young female audience, they're going to talk about the harms of all these toxins and parabens and fragrances in personal care products, most of which are illegal in Europe.” So I was so, “Oh my—I can't believe she's doing this. This is incredible.” She didn't do anything like that. The only thing I remember from the segment I was watching was her saying this: “That's right, ladies. There is placenta in your lipstick.” And she was holding up a lipstick like I am right now. If you're on YouTube, you can see what I look like when I'm holding up a lipstick.

Is that a Chanel lipstick?

Yes. So she—and talk about fragrance. This is the kind that has fragrance that nobody should be using. Anyway—

I just bought one.

She was saying, “Ladies, this lipstick has placenta,” and I'm not saying Chanel does. She was holding a lipstick. This is just all I had. She goes, “There is placenta in your lipstick,” and then the next thing out of her mouth was, “That's right, the sack that holds your baby is in your lipstick.” And I was like, “How embarrassing!”

I mean, the thing is, if I saw that when I was 25, I don't even know what I would know. I don't even know.

Probably nobody caught it or corrected her or didn't even know the difference either.

No one corrected her, and the audience all squealed and squirmed like they were supposed to, I suppose. But I think people don't. But on Jeopardy!, these people are considered so informed in trivia. They didn't know what a placenta was.

Well, how does a woman not know what a placenta is?

If a woman hasn't given birth, she knows much, much, much, much less than a woman who has given birth. So I guess the question is: Were there any mothers up there? Or if they had C-sections, maybe they really didn't feel in touch?

How do you still not have been through pregnancy?

I don't know. Honestly, I don't know. I'm gonna guess that the two women hadn't had babies yet. I don't know. But did I tell you the story of a couple in my class years ago that I was teaching something that had to do with the placenta, third stage of labor, no doubt, and they started cracking up, and they shared a story that when their friends gave birth, the baby came out, and they were bonding and cuddling with their baby. And all of a sudden, the father, out of nowhere, screamed, “What is that?” Because he saw the placenta come out of her body, and he just literally didn't know it existed. Or maybe he thought it was the sac that holds the baby, but he saw this massive one-and-a-half-pound organ slip out of his wife's body, and everyone turned and looked at him, and they're like, “That's the placenta,” and he was just terrified because he thought something had gone horribly wrong with his wife.

Well, I can see if you've never seen a placenta, that could definitely shock you a little bit. But to not know that it even exists—

Or to not know what it is, if they think it's the sac that holds the baby. Yeah. Anyway, that is—are we in like two totally different climate zones? Because you're wearing a T-shirt, like a nice summery T-shirt, and I'm in a cashmere sweater.

Because I played pickleball all morning, and I'm going to be warm for hours. Yeah, I'm comfortable, and in this room it gets really warm. But yeah, after my shower, I was still totally warm. Okay, so there we go. And how many more chances do we have to wear short sleeves?

I know. I feel like I've segued into cashmere sweater season. I just bought this.

I just bought this in Philadelphia last weekend, and, you know, it's like I was motivated to wear it as well because—

It's not your typical style. It's cute. So if you want to see Cynthia in something unusual, check us out on YouTube.

You don't think a little kind of feminine bohemian style? Really? I always feel like I dress in so many of the similar—okay, cool. I'm happy to hear that. I did like that it was black with this contrast stitching, though. That was fun. Okay, enough about us. Enough about me. Enough about pickleball, and enough about placentas. Well, maybe not enough about placentas. We'll probably still talk about placentas, but we are ready to get into our questions.

Let's do it.

Good.

Hi, Cynthia and Trisha. My name is Lauren, and I'm calling with a question. But I just wanted to say that I absolutely love your show, and I'm so thankful for all the information and especially the empowerment that I have gleaned from the two of you. My question is whether or not having gone through postpartum depression once gives you any sort of predisposition to developing it again with future children. I suffered from postpartum depression pretty intensely for five or six months with my first, with severe sleep deprivation and having a high-needs baby certainly being two major contributing factors. Developing postpartum depression again is one of my greatest fears as my husband and I think about when to have our next child, so I've been doing a lot of thinking about this and wanting to know if I have any sort of increased risk. I look forward to hearing your answer. Thank you both so much for all that you do.

I just had an analogy come to mind listening to that that I don't think I've ever formed before. You know how they say—well, I don't know if everyone knows this. It's now, I hope, becoming common knowledge. It's been knowledge to me for about 20 years that research has been really clear that cancer is hardly genetic. Even though every time you go to the doctor they say, “Who in your family has had this and that?” it's hardly genetic. It's less than 10% genetic, and the reason there can be correlations between family members who've had cancer is quite clearly because of the same environmental factors. You might even eat the same generation after generation, but surely you are breathing the same air, exposed to the same toxins in your home, perhaps even suffering the same stress levels, which can really affect cancer. So there can be a correlation, but really it doesn't mean that if your family members had cancer, by any means, you will have that same risk because you can choose to live differently.

That analogy just came to mind in talking about postpartum depression because I hate to give the short, quick, honest answer to her question, which is yes. You are slightly more predisposed toward experiencing postpartum depression again. That is not the whole story. I'm going to go out on a limb here and say you can do a lot to prevent postpartum depression.

Yeah, the important thing to recognize is that it is not a predetermined thing. And when they look at the research on postpartum depression, which there is very little, when you're teasing out recurrence rates, they're not necessarily considering the environmental—everything that you just explained—that might predispose a woman. This isn't just that your body is predisposed to this.

That's exactly it. It's not about hormones, so I don't want you to believe you're predisposed to it systemically. Now, whatever you did the first time, why don't we make conscious plans to change the second time around? First, I would say, this is my opinion. I think a majority agree with me, but everyone doesn't. I think going from zero to one is the biggest life change. Hormones is not the cause of postpartum depression, despite what everybody says, because 10% of men get it. Parents who adopt get it. Women can get postpartum depression out of the blue eight months later, or 10 months later, or as late as 12 months later. When it happens later, it's usually triggered by a life change, a move, a divorce in the family, someone losing their job. So life change.

I'm convinced when there finally is enough research, they are going to find life change, and of course sleep deprivation and all these other things are playing a major role. So, what can you do? As simple as this sounds, how many simple things do we know but we don't do? Exercise and movement. Movement of any kind is an antidote to postpartum depression or any kind of depression. If someone has depression or anxiety, the first thing that should be prescribed is exercise and movement. Connection. You can join my postpartum support group or any good postpartum support group, but you can join it late in pregnancy. So you immediately start to feel—I've had women do that. They join in late pregnancy. They immediately start to have connection. They immediately feel like they have people holding them up, a place to come and talk and get grounded, and know what feels normal, or get strategies for getting out of difficult situations.

Prioritizing your sleep is so important. Self-care is so important. Movement is important. Slow breathing calms the nervous system. Community is a tremendous factor here. Any kind of meditation, any kind of journaling, anything where you take care of yourself can prevent or dramatically reduce postpartum depression. So, have a plan.

We had a mom on the podcast named Lisa a few years ago who suffered from postpartum depression, tied with another woman for the worst I've ever seen out of the hundreds of women I've worked with. She had not quite hallucinations, but a crippling fear of anything sharp and knives, and she was terrified. This was a woman who was a teacher and worked with young children all her life, so imagine how she felt like she could—and she was a runner, and she took good care of herself. She was slammed with really crippling postpartum depression.

For her second baby, she made a list of like 30 things she did to make damn sure it wasn't going to happen to her again, and she coasted into and through her second postpartum experience. So there is so much you can do. So please ignore that little statistic out there that you're at a little higher risk because, again, like the analogy I made, it just might mean that you don't do anything different the second time around. So create a positive belief: This is going to be a very different experience because I'm doing X, Y, and Z so differently from the first time.

Let's say this. Let's say if you do things exactly the same again, your risk is going to be higher. If you do things differently, your risk is going to be substantially lower. I heard a really interesting statistic that I have never heard before on the Huberman Lab podcast the other day, which said that 80% of information that our brain interprets or feels or analyzes or experiences starts in the body and travels to the brain rather than the other way around. Don't you think that most of what you feel and think starts in your brain, and then, you know, it results in aches and pains or whatever in your body? Eighty percent starts in your body, which is an incredible justification for what you said about movement. You've got to move your body, and why bodywork is so incredibly effective at helping support mood. So craniosacral, chiropractic, acupuncture, even massage, these things can make us feel so much better because it's actually changing the chemistry in your body, which then is changing the thought process to your brain.

So that's incredible. Yeah, fascinating. And quickly, I'll just share that there is very compelling research that has been done on postpartum depression and professionally moderated postpartum support groups like the one I run, and the research shows that when women attend a minimum of between four and six of these sessions, they are far less likely ever to develop postpartum depression any time in that first year. And if they come into the group already having it, they get through in a much shorter duration and experience a much lesser intensity than the women who were not in the support group. So I can't explain why, but there is magic to bringing postpartum women together. We had our group yesterday, like just sitting back and watching these women talk openly to each other and support each other. It's like I leave on a high every single time. I'm just like my body is just filled with love every single time we get off another call. It's incredible.

The reason for that is because isolation is the most common denominator amongst women experiencing postpartum depression. I do believe that postpartum depression is also—it can be triggered by an underlying imbalance in the body. So while lifestyle and everything that you described is a major, major factor, if the foundation is off, those lifestyle things are more likely to result in postpartum depression. There's a lot of good research that says that inflammation levels in the body strongly correlate with postpartum depression, and that you actually can treat it by taking anti-inflammatory supplements like high doses of omega essential fatty acids, fish oil, particularly EPA. Also, if a woman has nutritional deficiencies, nutritional depletion, and thyroid imbalance, these are like major underlying triggers. So we do have to take some look at what's going on under the hood too.

Yeah, and let me be clear: It's not that it has nothing to do with hormones potentially. It's very important, though, to say it is not the cause of it, because when we say it's not the cause of it, we don't understand that men can get it. We don't understand that parents who adopt can get it, and probably the biggest risk, or one of them, is we don't understand that after the first six weeks to three months, women can absolutely get it. It can begin/develop anytime in the first year. So hormones can always play a role in everything. Everything mood-based and everything in our bodies, hormones can play a role. I just like to break apart that, like Brooke Shields did so much, in a sense, for the field of postpartum depression and bringing it into light, but the core point in her book is that this is caused by hormones. It's not that it's caused by hormones. Everything plays a role in it: nutrition, movement, hormones. Yes, because they play a role in everything. But we have to break apart this refrain that says they are the cause. What it does look like is life change, and that's where we really need to come together and support women.

All right, let's move on to our next. It was a great question. Glad we got that call.

Hi, Cynthia and Trisha. I just listened to episode 250, and I'm cracking up about the testicle festival when you were asked what the strangest thing you've eaten is. But anyway, thank you so much for your podcast. I explored a lot of different podcasts, and I just keep gravitating back to yours. I've been listening throughout my whole pregnancy. I'm now eight months pregnant, and I have a 40-minute drive to work every day, so I've been able to get through quite a bit of content, and you guys have completely shaped my pregnancy and hopefully my birth experience. I have a doula, and I'm just really excited to give birth naturally. But I do have a question. I have had a history of anal fistulas, and I've had a couple surgeries for fistula repair, and my midwife didn't seem too concerned, but I saw an OB at a separate appointment, and he suggested that I look into getting a C-section electively to decrease the risk of potential tearing and complications with the fistula. Since that appointment at the beginning of my pregnancy, I now have a new fistula, but the colorectal surgeon that I saw said that it's not going to be an issue and that I can deliver vaginally. However, I've just been trying to find resources in all of this, and it seems like a pretty niche topic. So I just wondered if you guys had heard of that or dealt with that at all, and if you had any advice. Thanks so much. Bye-bye.

Okay, hold up. Just for the record, let there be no misunderstanding. This is Cynthia. I'm the one with the dark hair. I'm the one who has an uncanny memory for episode numbers. I am the one who has never and will never eat a testicle. That's Trisha. So for those of you who sometimes get us confused, the testicle consumption was made by Trisha. There, that's the most important thing I had to say about this.

Okay, it was a cow testicle.

How is that better?

I don't know. You know, I don't want people thinking I ate a man's testicle.

We're going too far. It's not that kind of podcast. All right, I forgot you had ever eaten a testicle.

So did I.

This question. So yeah—

So did I. And I since have learned that the Testicle Festival no longer exists. Probably—I don't know why, but maybe it just turned out to not be very successful after all.

Audible.

Audible. Ah, it was a good time though.

Okay. Anyway, business.

Now let's talk about fistulas, anal fistulas. Oof.

Explain what that is first, please.

Okay, I don't know if I really know how to describe an anal fistula exactly. How I have heard it described and understand it to be is like a tube, like an opening in the tissue behind the rectum, not necessarily in the rectum, and it can get infected and inflamed, and it is often the result of like an abscess that develops around the anus and then kind of penetrates into the tissue behind it.

The reason it comes in as a factor with vaginal birth is, of course, when you are pushing a baby out of your vagina, the vagina and the rectum are right next to each other, and when you're putting a lot of stretch and pressure on the vaginal wall and the perineum, if there's a fistula or that inflamed, sort of infected, irritated tissue near it, you're going to further aggravate it. So I think it really depends on the severity of it.

I think it's interesting that her midwife is not concerned, and then her OB, I'm not surprised, is concerned because commonly OBs are going to recommend a C-section for anything that they can justify it for, and it's not that it's like a totally illegitimate concern. Having a C-section would prevent you from creating the risk of tearing. So if you tear and you have a fistula, and the tear tears into the fistula, that can be much more of a problem. So I think that's where the biggest concern is with vaginal birth.

However, there is no really strong data that supports that vaginal birth worsens a fistula. Now, if you have a severe tear that tears into your fistula or through your rectum, that could make it worse. So you do want to take steps to make sure that you reduce the chances of tearing. I don't think, especially if the colorectal surgeon, who's the one who knows this fistula better than the OB or the midwife, said this isn't a big deal—they understand the type of fistula it is, the severity of it—if they're okay with it, I would say go for a vaginal birth.

Right. I remember having a woman in my postpartum support group who had an anal fistula. It was the first time I had ever heard anyone share with me that she had one, and I remember it was like the Greek story of Sisyphus. I remember thinking that when she was telling this because she said every time she had a bowel movement, it ruptured again and bled again. Like every time it was starting to heal, and she thought it was getting better, it would rupture again.

Was that a fissure or a fistula? Because they can often be mixed up.

Does it sound like I'm remembering wrong?

It sounds like that would be a fissure, where a fissure is like a split in the tissue, and so when you have a bowel movement, it stretches, it reopens, and often bleeds.

Oh, I don't know. This is from years ago. I could be remembering it wrong. So that could—so a fistula wouldn't have the same effect?

I don't know that it would reopen and bleed every time. I suppose it could if it were severe, but very commonly with a fissure.

Do they not heal?

Well, it's hard for a fissure to heal because if it's a split and it's not healing and you're going to the bathroom every day, it's reopening, reopening, reopening. So how does it heal?

I meant the fistula. The woman who's calling in about having another baby and all that time later, you'd think everything would heal, but does it not heal?

No, they should. They should heal, but sometimes they are chronic and they can be really, really severe and hard to resolve. But also probably because you're pushing something through that area every day, so it's really important that you have soft bowel movements, high fiber, soft, regular, non-straining bowel movements. Tough, tough, tough thing. But I think in her case, it sounds like she's got two yeses against the one OB's no. So I would go with a vaginal birth.

It's not the first time we've heard an obstetrician suggest a C-section for, in many cases, unnecessary reasons. I mean, they suggest a—

C-section for if you had a third-degree tear. They'll say, “Well, you should have a C-section next time.” What you want to do is have a vaginal birth and reduce your risk of tearing. And we have a whole great episode on all the things you can do.

Wasn't that a Patreon?

It's both. We did both. “No Stitches Required: Preventing and Healing Perineal Tears in Birth,” and it is episode number 353.

1. You made a reference to My Cousin Vinny in that episode.

I did? What was my reference? Yeah, that movie pops into my head all the time. Just came into my head like in the past day or two. You don't remember? You don't remember?

No, I only know that because I was looking at a comment somebody made on the episode.

Oh my God, what could the reference have been? Now I have to know what the reference to My Cousin Vinny was because now everyone—

Well, you'll have to go back and listen to the episode.

Episode 353. All right, good for me. My brothers and I have done that for years. Like mid-conversation, one of us says a line, and then usually we'll say, “What movie?” and the other one will name the movie. It's just a thing we do. But certain movies just live in the head, you know, and scenes come back to you. Yeah, I've seen My Cousin Vinny enough times for that to happen. Okay, so next question.

Hi, Cynthia and Trisha. My name is Lexi. I'm a longtime listener and a big fan of the show. My question is about calculating a due date without a last menstrual period if I don't want a dating ultrasound. So I'm still breastfeeding our two-year-old, and my cycle has not returned yet. But we are open to conceiving our second baby and have stopped taking measures to prevent pregnancy. I know there's a possibility that I might conceive on the first ovulation I have, so I won't have a period to miss. I do track fertility symptoms, but I think breastfeeding is throwing off my basal body temperature chart, and I'm not confident it will help me pinpoint my conception date if I do get pregnant on that very first ovulation.

Now, I think I would be fine with letting my due date or even due month be a total mystery. That actually sounds kind of magical and like less pressure. But knowing my midwife, she's going to want a due date to go off of. She's a home birth CNM with a strict 37-to-42-weeks policy. I don't know how well it would go over to just be like, “I have no idea how far along I am, so let's just see when this baby arrives.” Even though I would kind of love that, are there any other methods you know about out there for determining gestational age besides ultrasound? If you don't know your conception date at all, is there a certain point where palpating the size probably is going to give a good enough estimate to appease a midwife?

I might be open to doing the anatomy scan, but then how would I even know when to get one if I don't know when 20 weeks is? I understand that having a due date can be helpful for monitoring the health of the pregnancy, and I get why NFI under licensing regulations wants to know. But I'm wary of being pathologized unnecessarily based on an inaccurate due date. I don't want them thinking I'm going into preterm labor when I'm really at term, or the opposite, thinking I'm 42 weeks when I'm really not.

I know I could probably solve all of this easily by just doing the early scan when I find out. But I've been feeling very drawn toward limiting or forgoing ultrasounds completely and really leaning into the trust of the process. It probably comes down to weighing the risk of early ultrasound with the risk of an unknown due date. I would love to hear your thoughts on that. At this point, I'm taking a pregnancy test every three or four weeks, just out of curiosity for myself. The only other thing I can think of would be to test more often to maybe narrow down that window of when the pregnancy could have started. But of course, that's really not an exact science either. What would you guys do in the same situation? I can't wait to hear your thoughts. Thank you so much for all you do.

This is a brilliant question. Nobody's ever asked this. She thought of everything. Like, she's really thought this through, and it's an excellent question. And I am really racking my brain to figure out how you would navigate this. I mean, the easy answer is just, whatever, you don't know your due date. The baby's gonna come when the baby's gonna come. But then she put that stipulation of she's planning a home birth, and her midwife is very strict about the 37-to-42-week timeframe. So if you didn't have that, I would say don't bother. Just let it be, and whatever it is, it is. Your baby's going to come when your baby's going to come, and it's going to come, I'm sure, at the right time.

Now, if she really needs to know, there isn't a way to really know. She could increase the frequency of pregnancy tests. She could take a pregnancy test every week. That would help. You don't know exactly how many weeks you are when your pregnancy test becomes positive. She's two years postpartum. She's working on having a baby, and she's thinking if she conceives before she gets her first period, which is possible—

Yeah, happened to me.

It happens. It happens to people. Yeah, she will have no idea when she got pregnant.

Yeah, keep taking a pregnancy test. That's good.

That's probably the best indicator. She could also then, you know, you'll start to get a sense based on uterine growth and fundal height. When the fundus hits the top of the pubic bone, that's usually about 12 weeks, and then by the time it hits the belly button, that's usually 16 to 18 weeks, which is around the time that you would have an anatomy scan. And you could have an anatomy scan. You could probably get some data from that. But she's inclined to not do any ultrasounds at all, so she will definitely be in the dark a little bit. And if her midwife is comfortable with it, then I think it's totally fine. But if her midwife is going to say, “I have no idea if you're 36 weeks and three days, or if you're 42 weeks and one day,” at the end of pregnancy, when she goes into labor, that's going to pose a problem for her birth plan.

But pregnancy tests now can really tell you quite quickly, can't they?

Yes, they're much better. I mean, they can detect pregnancy before you would even miss your period. So if she keeps—

Track of when they—it would be—

Like four weeks, basically. But if she—

Right, because you add the two. But if she keeps track of when—

That's right. She has—yeah, it also depends on how often they're having sex.

She has to keep track of when they're having sex. It's true, though. Like if they have sex on a Tuesday and on a Thursday, and every single Sunday she checks—

That would help.

Then the Sunday comes in, and it's—she can, yeah. Wow, so silly. We're at such a silly, silly point in even home birth midwifery care, right? So silly.

Right?

Come on. I mean—

The preterm is an important consideration.

I know it is. I was thinking that when I was speaking, but there's preterm and there's preterm. I mean, if she's worried about 36 weeks and five days versus, you know, a 31-week baby, you know, that's a different—I just, yeah. I mean, it's just like this is exactly the part of the brain we don't want the woman to have to be engaged in when, you know, she's conceiving and planning her pregnancy.

But the other thing, if her midwife is like insistent that she knows a due date, she could just have an early dating ultrasound that literally lasts two minutes. Nothing else, no other ultrasounds. But those are the higher—you know, those are the ones that you actually kind of want to avoid, is the early ultrasound. So, and the late, late ultrasound. Both early and late. The middle-of-the-road ultrasound, anatomy scan, not such a big deal.

Yeah, and if that's a confusing statement, which I'm sure it is to most people, the risk of the ultrasound technology is greater in the beginning of pregnancy. The risk to a change unnecessarily in birth plan is much greater at the end of pregnancy. We did, dare I say, an outstanding research-laden Patreon event called “Ultrasound: The Risks, the Rhetoric, and the Research.” I believe that was what it was called. And if you're on Patreon, you can get that, or if you just want to download that event directly, we'll put it in the show notes here. But that is a real—I think that's one of the most important things we've ever produced.

Yeah, the one on due dates is excellent as well, and there's a little bit of overlap between the two. So if you're in there, you might as well listen to them both.

Yeah, I hope women understand, as much of the podcast as you listen to, this is not—when we're educating and teaching, it's a completely different tone. It's a completely different style. It's a completely different conversation. So when you watch some of those events, you see it's like a whole other mode that you and I are in, and I think it's very valuable. So if you want to know more about ultrasound, please look at the link in the show notes.

Okay, I think we're to quickies now, right?

Yes, we are.

Good, great, fun. Let's see what was on women's minds today.

Today. It's always like right live.

Yeah, it's fun. I like it like that.

Yeah.

Okay, what are we thinking about today, ladies? What is on your mind? All right. Once a precipitous labor, always a precipitous labor?

No.

No.

My first one was, and my second one wasn't anyway. But that's—it's a no anyway.

Yeah, it's a no. Are your chances higher that you will? Probably yes, but it's definitely not. But it's definitely still a no.

How important are wellness checks after birth? My OB doesn't do them, and no pediatricians are available.

Oh, so she's talking about the baby. Well, I think they're important for the sake of baby's weight gain, mainly. If your baby has had a newborn exam, they're good. You don't really need anything else about the wellness check other than it's a helpful way to make sure that breastfeeding is going well. You can do that at home. You can weigh your own baby.

Tips for going into RSV season with an infant.

Oh, here's another one that kind of goes along with it. We can answer them together. Your thoughts on the RSV antibody shot, not the vaccine, for a newborn.

My answer to both is the same. Breastfeed. Breastfeed more, pharmaceuticals less. Breast milk, you have antibodies to RSV. Don't worry about it so much. If you're not breastfeeding, different story.

I had a glass of wine a couple days before testing positive. How worried should I be?

You should be not worried whatsoever. Not at all. You should never think about it again.

Are the benefits of six dates a day worth the amount of sugar? It won't give you a big spike.

Good question. Depends on how dedicated you are to sugar.

Well, and how dedicated you are to cervical preparedness, ripeness, how much it matters to you. But the simple solution, if you want to do the dates, is just eat it with protein. Stick an almond in the middle of the date, or eat it with peanut butter. Way, way, way, way, way changes the blood sugar balance. Also, don't eat them all at once. Spread them out throughout the day: two in the morning, two in the middle of the day, two in the evening. If you eat six at once, take a 10-minute walk after. Lots of ways to balance your blood sugar and still eat your dates.

That's right. A walk after is great. And if you're looking to ripen the cervix, you can also go the route of evening primrose oil.

Yes, great one. Great method too.

Okay, next one is: Is it actually normal for breastfed babies to go multiple days without pooping?

It depends on their age. If they're older, quite common. I wouldn't worry about it. If they're a young baby and they've been pooping six times a day, and then they go multiple days without, might be worth a weight check, but sometimes it doesn't mean anything. So it's kind of like a yellow flag, not even an orange flag, unless they're really young.

Do kids need their own rooms?

No.

That's interesting. Most of the world doesn't have his or her own room.

No, but we do seem to prioritize it.

Oh yeah, in American culture, of course, yeah.

But no, they definitely do not.

No, my kids each had their own room and chose to share a room until my son was in fifth grade. So he was, I guess, around—what is that?—11, and my daughter was seven.

So in my house, we all had our own bedrooms growing up, and I don't think I could think of a single night that I slept alone.

Wow.

One of my siblings was always in the bedroom. Always. Everybody came to my room.

In bed with you?

Yeah.

How long do you recommend spreading out your pregnancies?

You did a Patreon event.

We did a Patreon event on this too.

We did. Was part of depletion.

Well, it's—oh yeah, it's your big conversation on postpartum depletion and how important it is to be repleted before getting pregnant again.

I don't know that there's a perfect number. I really can't put a number of months on it. I can just say that longer, I think, is better, but 12 to 18 months is kind of the norm around the world, which is like 24 months, 24 to 30 months in between births, two, two and a half years. That's what I tend to think. I do think under 12 months is a lot on the body.

Tell that to all the Irish twins in the world.

Yeah, I mean, it happens, and so—me and my sister. I like that, and it's great growing up. I love having a sister that close in age. I still think I would have been like five-seven if my mom had waited a little longer.

You think you would have been taller?

I think you would have been taller.

You are the smallest of your siblings.

There you go. We got a bone to pick with Laura.

That's right. Got to talk to Laura.

Yep. All right. Is it normal if my newborn doesn't want to be put down?

Yes.

Specific recommendations for natural progesterone if needing to supplement first trimester.

If you're truly needing to supplement your progesterone in the first trimester to support a pregnancy, natural is not the way to go. Doesn't work. Yams, yam cream, it's not going to be enough. Forget it.

Third baby girl on the way, and I am out of name ideas. Suggestions? I love elegant feminine style.

Like the name Cynthia. Eloise. I was named Cynthia by my Italian great-grandmother, actually, but they switched it over to the English translation of Cinzia. Eloise. Oh, there's so many beautiful—and the trend right now is long, feminine, elegant names ending in a vowel. That is the trend right now. Hmm. I heard a great boy name the other day, Benedict. I love that. Benedict. Boy names are so hard.

And you don't think of Benedict Arnold?

No.

Me neither. That was a joke.

I think it's a nice name. Obviously, it is the first thing that came to my mind.

Yeah, Benny.

Yeah, that is very cute. That would be very cute. Hmm. I don't know. Are we here trying to come up with baby names for people?

We'll make a girl's baby name list. We're at a loss right now.

We could post on Instagram. Give us a little bit. They're elegant.

There are so many good girl names. I love Beatrice. I think I've said that before. That's not necessarily long. Victoria.

Elizabeth. Just go—what were the queens named? They had elegant names. They're classic. Boring on one hand, classic on the other. You don't want a name necessarily that's trendy, because then when you're an old woman, you've got the name—I don't know—Gertrude or something that dates you.

Oh my God, I laughed so hard watching a Modern Family episode a few months ago. I was like crying, laughing. Was it Cam, one of the gay guys in the gay couple? He's just such a phenomenal actor. He's the straight actor of the two. He was out, and they stopped a little girl who had a bicycle. I don't remember the scene that well. He was with Gloria, and they stopped a little girl. And at one point, he was like, “What's your name, honey?” And the little girl said—she said Blanche. Isn't that like from The Golden Girls?

Yes, Blanche.

And he said, “Shut up!” It was so funny because we only associate Blanche with an old woman's name. I just thought it was—

That is definitely true.

Brilliant, brilliant humor. She might be the only Blanche ever. It was such clever, good writing. It was just amazing. I really was laughing till I was crying. It was so, so unexpected. All right, what's next?

Okay, final, final—

Blanche.

Final quickies. Did you get to the personal one yet?

Yeah, I'm looking for it.

Blanche.

What's your favorite fall dessert?

Oh, okay. She thinks I'm going to say something like pumpkin-spiced hot chocolate. It's the same as all my other favorite desserts any other time of year, affogato or whatever it is. Affogato. Okay, so the thing about me is, like, I'm a chocolate—I don't want to say addict, but I love chocolate. I think my four favorite desserts are not chocolate. It's affogato, tiramisu, my homemade rice pudding, and mint chocolate chip ice cream. My homemade mint chocolate chip ice cream. Isn't that funny? But none of them—none of them have chocolate. Now, I do have a homemade chocolate pudding recipe that's amazing, but it's not in my top four. So my favorite fall dessert, I'm gonna go with, you know, the usual, or tiramisu. So I'm not into pumpkin spices. Everyone in my family is, but I'm not. Are you?

I like pumpkin pie, but I'm not into pumpkin-flavored everything. No, I do not get excited about, you know, Starbucks coming out with their pumpkin-flavored lattes or anything.

My daughter made homemade coffee pumpkin ice cream last week, and it came out delicious.

I bet pumpkin ice cream is good.

It was mostly like a coffee flavor with, like, the spices. It was really, really good, but I don't like pumpkin pie either.

I do. So un-American.

My by far, though, fall favorite dessert: apple pie. Homemade apple pie, hands down. Eat it breakfast, lunch, really, three times a day.

Yep.

Yeah, I got to start baking it. I've been so busy baking sourdough, I haven't been into the pies yet. I got to get—

You made a pie train.

I've never made a homemade pie in my life.

Oh.

My mom did, like, with the lattice top. I've never done it.

Yeah, the lattice is intense. That's a lot. I haven't done it in a while.

Yeah, but you have to do that part. It's wonderful, right? I mean—

If you're giving it to somebody. If you're giving it to somebody, I'll do a lattice top. But if I'm just making it for my family, no.

What do you do? Like a solid dough top?

Yeah, with little cutouts in it.

Yeah. Nice. That's just as nice. That's just as nice and probably tastier.

Last one. What's your favorite season? I think we've done this one.

I don't remember, but I would have said spring and fall. They're all so good.

I really—I can't. I think we've talked about it. I can't choose. Okay, but there is a season that's not labeled a season that I don't like.

Okay, wait a minute. There's a season not labeled a season that you don't like?

Yeah, yeah.

Let me guess.

There should be a fifth season.

Okay, let me think about it. The season in early fall when HomeGoods starts playing Christmas music.

Oh my God!

I don't like that one either.

No, no. I saw Christmas decorations going up already at one of my favorite, like, outdoor garden places. I was like, “This is—no! I haven't even gotten Halloween decorations out yet. You can't be putting Christmas decorations out. This is crazy.”

Well, my Etsy page went up. It just went up, and most of what I've listed so far are homemade paper-quilled ornaments. So I'm wondering if it's going to get any visibility when people start looking for homemade ornaments.

I'm sure it will.

I hope so. Anyway, no. There's a season called March—no, called February, March, and April.

There's a season called February, March, and April, really?

I'm not a big fan of it.

And what do you call that season? It has to have a better name than that.

Let's name it.

Okay.

Dreary season.

I don't want to call it dreary season.

Let's call it the—it's like you're tapping out on winter. You're like, “Okay, I get it. I get it.” And spring is a little too—

Slow to come. It's like—

Yes, we're ready season. And you think it's going to get warmer, but then it just gets windier, and you think it's rain—it gets rainier. But that's what makes the spring so exciting, and it feels like falling in love again every single spring because we go through that. That's important.

Yeah, I could still totally fall in love with spring if it went from 10 inches of snow in January to buds on the trees in February.

Okay, fair enough.

It's called go-to-the-island season. That's what it's called.

I'll call it tapping-out season.

Now we need like a winter, spring, fall. It needs to be like “linner,” you know, like lunch and dinner.

Yeah, I hate the word “linner.”

Yeah, but it's not kind of like—

Brunch.

Yeah, brunch is a great word, but linner is a silly word. Okay, so it's between winter and spring. So it should be wing.

Sprinter.

Or sprinter.

Or wing or sprinter. Now we have to take a poll. Wing or sprinter?

Ring.

Ring season.

Wing season. No, that implies birds. It has to be sprinter, which implies running. So, all right, fine. I guess it's not our forte. I thought anything verbal would be a good challenge, but nothing creative is coming to me beyond sprinter.

Terp.

No. Somebody's going to call with a great new season name.

All right, and that's the one you like the least.

Yeah, I do like that the least. I love all the other seasons.

So you love winter.

I do. I love the deep, deep winter. I love summer. Spring is—how can you not? And fall is just unique in New England. I mean—

The seasons are fantastic here.

I know. New England is so beautiful. I love it. Love the climate. I love the architecture. Ah. All right. Well, that was quite a deviation from our usual conversation, but that's what we—I was not a quickie. We always end on personal quickies, and then we ramble because we can't come up with our answer quickly enough.

All right. Well, I guess that is a wrap on the October Q&A. We are looking forward to seeing you all next week. Thank you for being here. You can call in any time at 802-438-3696. That's 802-GET-DOWN to tell us a story, anecdote, leave us a question, et cetera, et cetera, your ideas for what to call Trisha's least favorite season. And if you want to see our more serious side, you can spend a little more time over on Patreon.

You think we're more serious over there?

I don't know. That's what you were saying earlier.

Yeah, I guess serious is one way to put it. I think more information-packed and less conversate—fewer conversations about—it's more data. It's more data and less about testicles and seasons and Modern Family and My Cousin Vinny.

Right. We don't talk about that at all on Patreon.

Probably a little bit. I really can't help myself sometimes.