#4 | Q & A: Induction, Due Dates, Placenta Previa, Glucose Drink, Ultrasound & Baby's Size, Plugged Ducts, Family Boundaries

Today's exciting totally. We're doing our first q&a episode. Yay.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate 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 Podcast.
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.

Alright, everyone have some awesome questions that have come in.

Yeah, I love this. So we just want to remind everyone to reach out to us. You can email us contact at down to birth show calm, or you can call our phone number and we would love you to start Doing that we have this really great phone number. It's it's 802-438-3696. That's 802-GET-DOWN, call us and leave us a message. We'll play it on the show if we use your question. And you can also tell us stories, anything unusual that comes up at your prenatal like can you believe this happened story, or anything you'd like to share or have us comment on? For now? We're starting with some q&a that came in for me and, Trisha, you ready? I'm ready. Okay, this one is from Amy from New York City. It says hi, Cynthia and Trisha. I wanted to touch base and ask you about a few things. So I'm at 41 weeks tomorrow, and the baby still hasn't come. I'm getting a little frustrated but trying to stay positive. Do you have any advice on what I can do to move things along? Also, my doctor is letting me go to 42 weeks and she has been very encouraging about wanting a natural birth, but told me it's a good idea to have an epidural. If I have to be induced because it's more painful. Do you have any advice about this, I'm praying the baby comes naturally. But I want to be prepared. If it doesn't, any advice would be greatly appreciated. Thanks, Amy. Okay, couple of things jump out at me, I just can't resist. Your doctor is letting you go to 42 weeks? Well, first, it's great that you have a doctor who is following what evidence has shown us for a very long time that it's safer to wait statistically speaking, right. And it's not an individual case. But statistically speaking, we know it's safer to wait until 42 weeks before being induced without a medical indication for induction. So that's great. I don't love hearing the word letting and I wish you could change your thinking in that way a little bit. If you can go into this birth and do this pregnancy, thinking in terms of partnering with your doctor and hopefully your doctor is taking that same approach. It's not for the doctor to let you do anything. You're a grown adult responsible for Your own health care responsible for your baby. It's for you to let your doctor induce you, if you so choose at 42 weeks. So that is your choice even at 42 weeks. Whether you want to be induced it is a reasonable choice, but it is your choice. It's not your doctor's choice, not a matter of permission going from her to you, but rather from you to her. I never like it when doctors or anyone will use the word painful with a birthing mother because it simply doesn't serve us I know culturally, we attach the word pain to childbirth, but certainly it's my influence to HypnoBirthing but I'm convinced it just isn't serving you to interpret anything as painful. If you were to start running a marathon and interpret the first sensation as pain, you would tell yourself and experience something that's negative rather than something that is manageable. So please try to strike that word from your vocabulary. If someone uses the word painful at you, replace it in your mind with sensation or whatever else you like. Labor does typically feel like cramping for most women. And in fact, one woman described it as it's like having cramps, but they come and go rather than being constant. So that might help you or it might help you to appreciate that we have uteruses without nerve endings. So we certainly can still feel an intense labor and sometimes a very mild labor, but the word pain is a good mechanism in your body to get your attention when something is actually wrong. So I just wanted to make a comment on that word as well. With respect to you, praying the baby comes naturally. I think it's going to serve you if you think in terms of trusting implicitly, this baby knows exactly when to come. This baby is definitely coming and he or she is coming when ready.

If you do want to encourage the baby to come, that thinking can sometimes build the very stress that builds sufficient tension or maybe adrenaline that can keep the baby in. So we always want you and maybe you two as a couple to have a good time. Just enjoy these last few days as a couple, have some fun, go to your favorite restaurant got on a date because that's probably not going to be something you'll do for quite a while and look forward to the baby coming. Yes, you can take a relaxing bath with visualization. Talk to your baby if you want. But keep sticking with that message of trusting your baby knows when to come you can go for foot reflexology, and some of them no pressure points or acupressure points to induce the baby but it's not a sure thing because the baby is the final determinant here. If the baby is close, he or she will maybe be prompted to come if you go for acupressure, acupuncture can do the same thing. Many of my clients have done that. And it works beautifully and there's no risk to it whatsoever. Unlike a medical induction with a chemical say x is a great way to get the baby to come as well. The best way to get the baby out is the way the baby got in. And prostaglandin, which is found in semen is a cervical ripening, which is in fact, what they give women when they go in for induction anyway, with something like cervical that's synthetic prostaglandin. So my main message is we don't know when your baby's coming, but you're going to be best off trusting the process, relaxing and having fun to every extent possible. And good luck to you. We'd love to know how things go.

Our next question comes from Samantha in Stanford. And this is in regard to the glucose drink that is offered to pregnant women around the 28 week mark. Hi, Cynthia and Trisha. As you know, I'm planning to birth with midwives. I am approaching the point where I'm supposed to get the glucose screening test. I was initially very against drinking the glucose drink, but the midwives insisted that this was important alternatives to the glucose drink were not as accurate. Now I'm finding out that the glue cola drink offered at my lab is also full of synthetic orange flavor and dye. I wanted to know if you had to take on this issue and if you or any of the women you worked with were able to find acceptable alternatives. The idea of drinking this makes me very unhappy. It seems quite silly to have been very vigilant during my whole pregnancy, only to chug something so clearly processed and unhealthy. I'd really like to seek an alternative if possible, and would love your advice. Thank you, Samantha. This is a very valid question Samantha and one that many people inquire about. The problem with the glucose tolerance test that is offered is that there are yucky side effects. Basically it kind of makes a person feel pretty crappy after they drink it. It's a high load of straight sugar. And sometimes it can even trigger nausea and vomiting. So yes People do seek alternatives. Sometimes women just decline it all together. Both are options. You will need to speak to your care provider about what type of alternatives they do offer. There is a now a clear, I believe it's lemon or lime flavored option. I also know some practices will offer a grape juice alternative. What about the jellybeans, jellybeans were that went around for a while, but I think it was determined that the results didn't come out as accurate. So they're trying to really keep with a standardized, standardized standardized solution of glucose. You can also request to have home monitoring I know some practices will send you home with a glucose monitor. It's a little bit more involved. You have to take a fasting blood sugar and test your Blood Sugar one hour after eating three to four times a day. And you need to do that for two weeks. And if your results come back under a certain threshold 90% of the time, then you're deemed to not have gestational diabetes. So yes, there are alternatives. It is something you need to speak with your care provider about. And Your other option is to simply decline the test altogether. And then your care provider should give you some counseling on the potential risks of gestational diabetes and how it may impact your birth.

I'll just add a comment that I hear when concerned about this for a slightly different reason, not necessarily like just that they're grossed out by it but a lot of women are concerned about the chemical load. It really bothers women who eat well to be told by their, quote healthcare provider to drink this thing. So if you've already drunk it, or you end up drinking it, the main thing is just don't feel guilty about this. This is such such an insignificant thing, everything really comes down to habits if you eat well, that's the kind of thing that determines the outcome of your health, your baby's health, not something like this. But if you do want to just take matters into your own hands a little bit, you can go get a green drink, or make a celery juice at home and just drink it and trust that the glucose drink already served its purpose. And now you're just cleansing yourself and you're pulling the chemicals out of your body, and then just move on. It's it's all good. And it's you know, it's just one thing you had, right?

Totally, totally. I mean, we're exposed to a lot of things in pregnancy that we can't necessarily control. But the issue with this is that we do have control over this and, and I think it really does make people feel pretty crappy sometimes. So think about alternatives.

I have a woman told me that her daughter recommended a milky way and a coke as an alternative.

So that is that people do recommend that. You've heard that before. Oh, yeah, definitely. They're not any better for you. No, that's not really standard recommendation either because the way that your body metabolizes glucose in the 50 gram glue cola drink that's prescribed to you is very different than consuming milk and a candy bar that has protein and fats along with it, your body's going to process those sugars differently. So it's really not accurate.

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Hi, Cynthia and Trisha I had my 32 week ultrasound today and my baby is in the 75th percentile for his weight. I've spent the day trying to calm my nerves and not to worry too much. Do you think when women birth larger babies, they're less successful at sticking to their natural birth plans. Thanks, Kelsey from Arizona. Kelsey, don't worry about this. Please don't worry about this. Your big baby. First of all, we don't know That your baby is big in the first place. But let's assume for a moment you have a big baby. That is An indication of two things. One, genetics, whether you and your partner were big at birth, which is in no way linked to the size you are now you can have big strong people, as adults who are tiny at birth. You can have smaller adults who were big at birth, I was 10. Three at birth. My mother is, you know, as as small as can be. So there's no link there. But if you have a big baby, it's an indication that it runs in your families, or you're just eating nutritiously because the more nutritiously you eat, the more nutrient dense the food you put in your body, the more your baby is going to say thank you and become robust. You know, when a big baby is born. Nothing happens when a small baby is born. There everyone surrounds the baby and takes the baby away and test the baby and there's all this stuff we're concerned about with small babies and somehow our culture has women worried about birthing big babies, the one where there is isn't a concern. When the baby comes out, when I had my big babies 814 and nine, seven, everyone in the room just laughs they're just happy when a big baby comes out. So, I want to just give you a few things to think about. First of all, as far as wishing and hoping for an easy birth, we want to put our focus on fetal positioning, not on the weight of your baby. fetal positioning is a very important determinant as to whether this will be an easy or challenging birth. And not only is fetal positioning an important issue, but your positioning, the position you are in when your baby is descending, is going to impact how this birth goes. If you're on your back, that is going to be significantly more challenging, not only more uncomfortable for you, but more challenging for your baby to traverse horizontally rather than a position that works with gravity. So you're empowered there because you're in control of the position you put yourself in Even if you choose to be in a hospital bed, you can be in a semi reclining position where you're at a 45 degree angle from your hips up to the top of your head. So you have a lot of flexibility there. Your baby's positioning is something you can put your focus and energy on and empower yourself there as well. You can influence it. Look up all of Gail Teles work with spinning babies or find a spinning baby certified practitioner who can help you do exercises during pregnancy to increase the likelihood of a well positioned baby, but one of the most important things I want to say is ultrasound is a notoriously poor predictor of fetal weight. Not that fetal weight matters. Anyway, I can't say that enough because fat is squishy. babies don't tend to get stuck in the middle after the head and shoulders are out and some babies are 21 inches long and some are 17 and a half inches long. So you can't put all the babies of the same weight in the same category anyway. But ultrasound is a very notoriously poor predictor. So when they tell you your baby is in the 75th percentile, it doesn't mean anything.

If you're actually the 75th percentile is a great place a great place to be like, there's a whole lot to do about nothing right here.

And if they do tell you, let's say, let's say you go for a checkup at 38 weeks, and they tell you your baby is eight pounds, what we really know is that is plus or minus one to one and a half pounds on either side. So that baby could just as easily be six and a half or seven pounds as nine or nine and a half pounds. And in fact, the bell curve is skewed. So it's not an estimate in the middle, there is a greater likelihood that your baby is smaller and weighs less than the ultrasound is indicating there's not a 50% chance the baby weighs less. It's a more than 50% chance that the baby weighs less less than what they're telling you. So it's a skewed curve. So don't worry about it. Be happy, your baby is growing, you have everything that we want, and put your focus where you can control things. And by all means don't let this be a reason you're talked into an otherwise unnecessary induction. Be grateful for your baby growing so well it sounds like everything is perfect. And if you do want to calm any nerves, the way to do that is to focus on the position you will be during your birth and work on some healthy fetal positioning techniques through spinning babies. And good luck to you.

So our next question is around breastfeeding. And this is from Janine. Hi, Trisha. And, Cynthia. I'm hoping you can answer a breastfeeding question for me. My baby is 11 weeks old and I have been pumping since she was three weeks old in preparation for returning to work and hopefully continuing to breastfeed while working. For the past two weeks I have been getting clogged duct after clogged and I have become so paranoid about developing mastitis that I can't tell anymore if I'm experiencing clogged ducts or if I am causing all the pain and tenderness even if I see a lactation counselor right now, I'm not sure how she would be able to tell either. What do you suggest I do? It sounds to me like there is a definite possibility of clogged ducts going on here. If you have been pumping since three weeks, and you're now at 11 weeks, it's likely that you have a bit of an oversupply going on. And that's the reason you're having the cloud ducks. And yes, clogged ducks do put you at risk of mastitis. So when a woman is preparing to return back to work, I usually recommend that they only save a couple ounces a day, beginning maybe two to three weeks before they return to work. So I don't know what you have set aside. I know that a lot of women feel very concerned about when they go back to work running out of milk. And they want to stash in store as much as they can. But remember that healthy breastfeeding requires the mother and the baby diad to be in sync with supply and demand. So if we're pumping a lot of milk and storing it, we're creating an oversupply situation, which the only way our body knows how to deal with that is to potentially end up with products which can lead to the mastitis. So, if that is the case, then I would say to slow down slowly on the pumping so that you can return to that equilibrium of supply and demand. You probably have more than enough milk stored and saved at this point. For you to return to work. You really only need the amount of milk that is going to be required for the baby to consume while you're at work because while you are away you will be pumping the milk for the next day. It's great to have a few extra bags on hand in case one spills or it goes bad or something happens but to have a freezer full does put you in the position of oversupply, senior lactation consultant at this point correctly. might be helpful for having a little bit more guidance on how to ease off the pumping so that you don't get a severe plug doc. You can't just stop. You have to you have to taper back slowly. You're very fortunate that you haven't gotten mastitis and hopefully you can kind of ease off this without anything like that developing, give it a try, see how it goes or get in touch with a lactation consultant and see if you can get a more specific plan for how to wean back from the pumping.

Can you just explain what mastitis is yes. So, there are two different kinds of mastitis. One is inflammatory mastitis and the other is infectious mastitis. So often when we have plug ducts that result in mastitis we're talking about an inflammatory mastitis. That means basically that you are getting an inflammatory response that goes off in the body due to the due to the plug ducks and this the basically the the breast system saying something is not right here we're overlooking Were clogged, it triggers an inflammatory reaction, you get a fever, you feel sick, you can feel fatigued. It almost can feel like the flu. That kind of mastitis doesn't actually require treatment with antibiotics because it's not a bacterial infection. You can get a bacterial mastitis is well, that can happen for a number of reasons, especially if you have any break in the skin but it also can happen from oversupply and clogged ducts. Usually I give women 24 hours of ibuprofen, Advil, treatment to see if fat can reduce the inflammation. If it is in infectious mastitis, they will the fever will persist. It won't self resolve and they will need antibiotics.

Next question is from Jennifer in New Jersey and she is writing dear Cynthia and Trisha, I'm hoping you might have some advice. I've always wanted a natural birth and recently switched from my ob practice. To a midwifery group at a birthing center. I've been very happy about this switch. However, I've been experiencing a lot of unsolicited negative feedback from my mother in law over the last few weeks about our choice to give birth in a birthing center. But she keeps making upsetting remarks about how important it is to have a baby in a hospital. I'm Try not to make a big deal out of it by appearing upset in any way. And I'm also not trying to, quote convert her to see things the way that we do, but the negative energy can be exhausting. Do you have any advice? Yes, I had a woman call me yesterday. One thing she said about her husband was all he's thinking about is wanting healthy outcome. And he's really not thinking about how she's going to feel during the birth or her options or choices. And I said, that's the norm for the people supporting the mom until they get educated and get informed on how important some of these specific issues are like how you will feel emotionally during your birth and how that has a physiologic response in your body. It's easy for them to be stuck in their notions of what's going to result in a safer birth. And it's natural for her to believe that. So I would say the real issue is I don't really think it's your job to inform her or educate her because that can be exhausting. And it can also create this impression of your being in the role of having to convince those around you. Sometimes your own family members who love you so much won't agree with the choices you'll make. And maybe if you're close enough with her, feel free to have that conversation and help her. Find out how you both arrived at that decision to have your baby in a birthing center. I brought my own mother along so she could ask all of the questions that made her feel better when that was my first choice. And that appointment was enough. She was really comfortable after that. She asked questions like so what happens if this has to be a transfer to a hospital? That's a legitimate and fair question. So I don't know if you're close enough with her to do anything like that. But ultimately, this is your baby. Now it's your turn to have a child now. And this is the beginning of receiving unsolicited advice from people who love you and believe they know what's better for you or your baby. So I would say, have a discussion with your partner and think about how to handle these situations, because it's really only the beginning, it's going to happen once the baby is born. And again, if you're close enough to her, and if she is open and receptive, then try to educate her a little bit. And at the very least, let her know that her concerns and worries aren't serving you. And that's really the bottom line. And maybe think about the best ways she can serve you. So it's a very personal choice. Good luck with it. I know it's difficult with people we love and I'm sure you'll figure out the right way to approach the conversation with her but you do have a right to ask not to have negative comments be made around you in your pregnancy. It always depends on the family.

Yes. And it's all just fear based, really. They're just afraid. They're trying to Love you and protect you. But they're, they're afraid that you're making the wrong choice. So I loved your suggestion about taking the woman to the prenatal taking the mother to the prenatal visit, because once they can see that it's a safe space with a, you know, a professional person and a good provider.

it alleviates some of those fears, and usually they can settle in and be more accepting. And midwives aren't that they're never offended by that they're happy to sit and be heard and answer the questions. They're not like, well, I'm the expert, I will be there they'll, they'll be happy to reassure anyone involved. Absolutely. When you're having a conscientious birth, and when you're a conscientious parent, you kind of have to get used to being the person who is forging a different path who's doing things differently. This whole generation of moms who are doing attachment parenting or co sleeping, or picking up their baby when they cry that these women's parents often said let the baby cried out Well, you're gonna spoil them if you do spoil them if you pick them up. And even if you're you eat particularly well or you don't give medicine or drugs or interventions casually to your child unless you're convinced they need them. You might be in the minority and you have to get comfortable making your own decisions. It's not easy. It's a little isolating. That's why we've got to find your people. Right? But it's the beginning probably event Some people think you're crazy for it. You know, you're not, you know, you're doing what's right for you and your family. But it's it can be hard.

Yeah, it's a practice of learning how to stand in your own belief system.

And no complaining, no explaining. You don't have to convince everyone else and to come around. You don't have to do that. It'd be great if they did, but you don't have to.

That's right. You're the parent now. Just show them the way.

So here is a question on the placenta. Hi, Trisha. And, Cynthia, I'm hoping you can touch briefly on placenta previa. I've learned at my last ultrasound that I have this it is not complete, but rather partial. So there is a hope. It may change but I would be curious as to your thoughts on this. I am around six and a half months pregnant right now. Thank you, Diana in New Jersey. This is pretty straightforward, Diana. The fact that you have a partial placenta previa is good news, it is very likely that the placenta will continue to move away from the cervix. So just to step back and just make sure our listeners understand that placenta previa is a potential complication of pregnancy when the placenta is partially or fully covering the cervix. So in a full placental previa, the placenta is covering the cervical opening, and it makes vaginal birth, a contraindication or not possible. A partial placenta previa is when the placenta is either very, very near the cervical opening or partially covering the cervical opening in that 10 To resolve on its own as the uterus grows, and the placenta moves up and away from the cervix. So you're around six and a half months pregnant, it's partial. I think it's very likely that it probably will resolve I can't say that for sure. But you're in a good place. You have a ways to go. And I'm sure your provider will want to check on it again another few weeks. If we answered your question today, feel free to leave us a message with a follow up we'd love to hear how you're doing how things go and let your pregnant friends know they can reach out to us as well.

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