#52 | Q&A: Hilarious Husbands; Birthing Positions; Flat Nipples; Gentle Cesarean; Unassisted Home-Birth Tips; Anterior Placentas

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.

Hi, everyone, welcome back to our September q&a episode, it's good to be back, we have an exciting announcement to everyone that we just launched our new website down to birth show.com. And now you can reach out to us with with your q&a questions. Or if you have a birth story to share. There's a forum there for you to fill out and submit to us. So we love to hear from you for any reason at all. Check out the website down to birth show. You can see all of our episodes, all the show notes, etc. It's a great way to get in touch with us.

Yes, it's very exciting. So be sure to head on over there and take a look.

Okay, so what have we got today?

Yeah, so we are we started offering last q&a with the hashtag shift my ob said, and this time I thought be sort of funny, I came across an article about shit My husband said, oh, god, that's gonna be a long list. So on social media, and just to clarify both is particularly this shit. My husband said, this is just purely for entertainment person purposes. And, you know, shit, my ob said is real. I mean, these things do come out of OBS mouths. But I think it's also important that we make it known that this is not about husband bashing or be bashing in any way. This is purely purely for humor.

Well, we are big proponents of changing providers as necessary. So you know, change partners as necessary too --

Yeah, I mean, whatever. Just switch them out.

Hey, the one constant in life is impermanent. So change. Okay, just kidding. Just kidding. All right, you know, buddy, yeah, let's just these are just for a good laugh. Okay. But this, but it's real stuff. It's real stuff. Okay. So here's the first one. I had just finished getting stitches when my husband turned around and said, You have no idea how much my balls hurt from these tight jeans.

Oh, stop.

Kidding. I mean, I don't know. I hope she she threw her bed pad at him.

All right. Moving on. When I was pregnant with my third kid, my waterbrook in the middle of the night, and my son's father hurried to the hospital, dot dot dot. Without me know, now that I totally believe how, how is that possible?

I mean, because sometimes the panic and the frenzy and the car is ready to go. And they're rushing in there. Whatever. I mean, I've heard I've Well, I've heard similar stories. I haven't actually heard a story where the husband left without her. I have a I can't believe it. I can't believe it. I mean, he probably just got to the end of the driveway and then realized, oh my god, you know, right. He's not walking into the emergency room, but my wife is not in the backseat. Okay. So that's pretty funny.

Funny to everyone else.

Here we go. While discussing different positions I can deliver in with my nurse. My husband asked if I could deliver doggy style. Now, I hope he's a really funny guy.

And she wasn't far enough along in labor. Like to punch him in the face.

Come on. Okay, for the record, excellent position for birth. Absolutely. Call it hands and knees or all fours. I think the word style is what makes it so funny. Instead of position, I have to think that this guy's just like a super funny dude and you know about trying to make a really witty joke.

You should switch husbands then.

I mean, that would be the easy thing to do. But the comments about the tight jeans Come on.
Okay, yep. Marriage is a beautiful thing.

Oh, wait, there's more. Okay, should we sure I have to read this one.

My husband was incredibly helpful during my labor and delivery, except for when he was counting. Well, I pushed and thought it would be funny to go 78999 and a half.

When I explained that I was going to need to punch in the poor guy instantly regretted trying to wait. You know, anyone with a funny birth partner is so they have a leg up. It's always a benefit when you have a funny or amusing birth companion. It really is. You don't want someone who's overly intense.

Yeah, you just gotta pay endorphins are good. You got to pick the right moments, though. I mean, you know, crowning, Ring of Fire. You know, timing humor is all about timing.

Yeah, timing. Exactly. So just guys, if you're listening, just Good. Good. funny stuff, humor and chat. Make sure it lands in the right place in time. Oh, wait, there's one more.

Okay, last one.

Ready. I was in the sweatiest moments of labor with my first child. So the nurse pointed my partner to a cool washcloth to wipe the sweat from my face. He picked up the washcloth, folded it then dab gently at my forehead like they do in the movie. Give me and snatch it from a white male forehead and I threw it back at Hanson. This is real like I did. I It's not time for that. Let's all give our own partners a big hug tonight. All right. Well, those were fun questions.

Here we go. I'll start off. I am 39 years old and 27 weeks pregnant with my second son. Your podcast has made me question my choice of the group I have in Long Island. I have seen two of the seven doctors and I don't even get to see all of them before I have this baby. My last labor and delivery was so quick. I was only in the hospital for one and a half hours. I wanted to be more upright for the delivery. But at that point, all I saw was a bed with stirrups and I was in a complete fog. So I didn't question it. I ended up tearing pretty badly, almost a third degree tear and the stitching was harder than the entire birth. This hospital does continuous fetal monitoring. I was wondering what positions for birth I can take while still being monitored. But positions that are better than lying down. One of the doctors I talked to said I could be on all fours while pushing. But when they see the head, she would have to have me lay back.

In other words, doggy style. Yeah.

That's exactly where my head was going. At least. She said, Oh, it's catchy. All right, gone. But I learned from your podcast that they can't force me to do anything. I would love to hear your recommendations besides the one I know you'll tell me, which is to change providers.

Yeah. I mean, I would never tell anyone to change providers, I would just like to say when there are red flags. And I do like to say no matter who you are, no matter where you're giving birth, just always look into your options. Even if you go back to your original provider. It's a validating. It's a validating feeling to know you've at least looked around a little bit. So a couple of things on this. One is this hospital, I heard the word does do continuous electronic fetal monitoring. I think we just have to think about that they do continuous EFM. What does that supposed to mean? Right? Just because the hospital quote does, that doesn't mean it's evidence based, or that it's right for this mom. And it's not evidence based, as we know, intermittent auscultation is, so she can first request intermittent monitoring. That's the first point, if that is what she would like. So in that case, they would typically like to do a baseline of maybe 20 minutes, and then periodically throughout the birth, they will want to monitor again, they'll strap it back on it's a bit of a nuisance that can use a Doppler instead. And you don't have to be essentially tethered to the monitor the entire labor.

And just to point out to if that is not an option, if the hospital truly will not do intermittent mantra monitoring. One, you can look for a different provider and a different hospital that does to at that point, you would definitely want to request to have the telemetry the monitor that can move with you so that she could move about and be out of the bed.

Yeah, a walking monitor, right? Yes, yep. And then the other thing is, regardless of how you're monitored, if a woman has an epidural, she is essentially tethered again to something she can't just be free and walk around and roll around. So there are some options. I mean, I think one of the easier options that tends to work is a position called the semi reclining position. Some hospitals like to show that they have these really nice beds that fold upward. But regardless of whether you do your partner can get behind you and straddle you, you can put a lot of pillows behind you but essentially what you're looking for is to have the space between your tailbone and the end your head at at least a 45 degree angle because that allows the sacrum to open full Which makes birth significantly easier. So your pelvis is going to open about 30% more when your baby is descending through you. And that is a lot of space that nature intends to give you. So when we put women on their backs, we're robbing them of that space. And God knows how many of them are ending up with tears as a result, or unnecessary c sections as a result, or pitocin, because the labor isn't as efficient that way. So the key is, you just want to get off your sacrum, I would say try semi reclining, I would definitely suggest hands and knees if that's possible. If you have an epidural, I'm really not sure that it is. Or if you have continuous monitoring. I'm not sure that this but another position that is officially a good position. It doesn't sound particularly comfortable to me personally. But it's sideline position, in which case you lie on one side, you let your back be completely free. And then all that space can open up, the only thing you then have to manage, it's not a big deal, but the leg that's not against the bed, sometimes you need a little bit of help, as the baby's coming through with holding that leg up because it really can get fatigued. But it is it is officially considered a good position for birth it is and your partner can hold your leg up or the nurse can hold your leg up. The other thing is a squat bar across the bed or a birth stool in the room. Those would also be good options. And squat bars are pretty readily available in most hospitals. And you actually can squat right on top of the bed. But I was just looking back at this question and realize that she said she had a very quick first birth and was only in the hospital for an hour and a half. So I'm thinking that she's probably going to walk in there and be very close to giving birth and there's not going to be time for an epidural. And she'll probably be able to give birth in whatever position that she wants. And if you find yourself in your hands and knees or whatever position and the baby's just coming out and you don't feel like moving.

You don't have to move. Yeah, it's fine. The baby, the baby will come and your and your doctor will catch it. Right.

Okay, here's a question for Trisha and it says, I'm hoping to breastfeed. I'm going to stop right there for a second. In hypno birthing the whole component that focuses on how the subconscious mind works. What we always want to eliminate words like hope and try. Like when women are talking about vbacs they often say I'm trying for a VBAC, we want to change that to a word like planning. So let's just change that right here. I'm planning on breastfeeding. I recently saw my friend breastfeeding and her breast looked much different from mine. This led me to a Google search. And now I'm thinking I might have flat or inverted nipples. I guess I'll just wait and see how feeding goes. But is there anything I can do to help condition them before feeding?

Yes, flat in inverted nipples. So first of all, women's breasts and women's nipples are so many degrees of normal. I mean, there's so many varieties, in fact, reminds me of that little thing you were just showing yesterday of your pouch you sent me

I put it up against on my Instagram story that was it was fabulous. And it was an example of all different shapes, sizes, colors of both breasts and nipples. So it's no surprise that your friend's breasts look different than yours. And flap. an inverted nipples are common. Flat nipples are common variation of nipple is common. Truly inverted nipples are very are not so common. And, and if you have truly inverted nipples, it can pose a challenge to breastfeeding. It's important to remember that breastfeeding is not nipple feeding, it's, it's the breast so then the size and the shape of the nipple is less important if you have the right kind of latch. Otherwise nipple degree of flatness or protrusion is really just not that important because again, we're not nipple feeding, we're breastfeeding the nipple is going to be sucked into the baby's mouth and into the back, posterior part of the baby's mouth and they're going to be feeding on your breast. So no, there is nothing that you need to do to help condition them before feeding unless you truly have an inverted nipple and you might then want to talk to a lactation consultant and just be prepared for what feeding with an inverted nipple looks like.

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Okay, so here's a question for you, Cynthia. If my baby, well, actually, this is probably going to be a good conversation for both of us looking at it. Now, if my baby isn't an optimal position, and a C section is needed, are there any things to read up on prior to having one? Or is it just a routine procedure? c section do's and don'ts maybe Are there any different procedures they need to do to the baby that would differ from a vaginal birth? I would want to make sure to have skin to skin bonding without intervention, assuming that the baby is healthy. Do they have to take the baby away before they stitch you back up? And can the baby still do the breast crawl?

Is that it? Yes. Okay. This comes down very much to the doctor who performs the C section. So I'm sure you have a lot to add to whatever I say Trisha, but one of the first things that always comes to mind is I had a client once, who had a very satisfying c section a long while ago. And she told me all the things she did to feel empowered in that room. And I learned a lot from her. And one of the first things she said was, as each stranger walked into the room, she introduced herself to them. And she asked them their name and their role, their purpose in the room. So immediately, she had this feeling like she, everyone knew each other just the sense in the room that they had this common shared goal, which is a lot like the episode we just published with Dr. Neil Shah, where he talks about this. So she just used her intuition to get herself there. So you can look into what a gentle c section is. But you start with that, I just want to back up a little bit. First, the most important thing regarding a C section is that you believe you need one, because we have this intention in mind all the time. That what matters most is that you feel deeply at peace with your birth the rest of your life. So when we're talking c section, we always stop and say, Do you believe you need this surgery? And if the answer is yes, do everything you can to switch over into a state of gratitude. Because when you truly need a C section, and when you know you need one, that is the primary emotion and thank god they can come and do this for us right now is the thinking. If you're not feeling that, then it might be too rushed. And you might need to slow down and have the conversation and really satisfy whatever it is that you're still wondering about. But when it is that time, there's every reason to be absolutely grateful. And yes, you can still do skin to skin, it depends entirely on how much you assert yourself, and then the doctor and the staff and how supportive they are. So certainly ask to have your baby immediately put on your skin to skin and they should support that. And if for any reason they don't, because they can't, there's no reason that baby shouldn't go on your partner's skin to skin without a medical issue at hand, of course for the baby. course you change your plan immediately if that were the case, and we trust that you can trust yourself to know when that's the better course of action than having the baby go right on your skin to skin. And then one other thing I'll mention is that there are more women now asking the surgeon to allow some amount of delayed cord clamping with a C section. And we do have surgeons right now who are supportive of it. And there are surgeons who still flat out say no. So when you do your research on delayed cord clamping, you might find that this is very important to you that it's a high value of yours. That should become one of the important questions that you do ask beforehand, you have every right to carefully select your surgeon for a C section. to whatever extent possible, make sure you have a natural start to your labor and as long a trial of labor as possible, because these are the things that will work very much in your favor. The second time around if you decide to have another baby after this C section.

Yes, I would just add also that if this is a planned cesarean birth and you want to be in as involved in it as possible, you may wish to choose to decline any type of medication that will make you become more relaxed. Just stick with the epidural for anesthesia but don't take other medications that may interfere with your ability to be present. You can also ask for a clear drape or if they don't have clear drapes at your hospital a that the drape be lowered at the time of birth so you can actually receive your baby over the drape. You can also request that breastfeed initiation begin in the O r, if your baby is ready to do that, I would make sure that your hands are free and not strapped down to the operating table. That's a big one. Little things like putting the IV in your non dominant hand so that you're free to use that hands. And you don't have the, you know, the IV interfering. Interesting. I've never even heard of that. Yeah, it makes so much sense.

Just small things like that you can you can request your own music in the hour. So it's feels more comfortable to you and relaxing. But everything else that you suggested. Totally agree with.

Yeah, I want to add one more, because I heard another story this week. And I realize, you hear sometimes about doctors who are talking to their staff, even like about what lunch they're planning on ordering that day, during the surgery, and they really should be either quiet or unnecessary words only or just speaking to the mother and reassuring her telling her how well things are going. I feel like these things are really important.

The thing is to you know, early in her question, she asked, Is this just a routine procedure? And unfortunately, for obstetricians, it is so for them to talk about what they're doing after work or how they're mourning when leaving the house. Is it you know, it feels very normal. But for the woman? Who is this is a major life event for her right?

Yeah, it's not routine for her.

Not at all. It makes total sense. And I think just agree with you that having that conversation beforehand is important. So all right.

And here, let's switch course to a whole different kind of birth, Tricia, because the next one says I heard your Episode A few weeks ago about a couple who had an unplanned home birth. We've had a few of those Haven't we sure have?

Yeah.

My first baby came pretty fast. And I've always wondered slash worried that it might happen to me pretty fast the next time around. What can I do to avoid this or more important to have any tips in case it does happen? I remember Nancy Waner preparing me for this Tricia for my home birth, because Alex's birth was so fast that she said, Look, if your baby comes out quickly, before your midwives get there, she just gave you some tips. Well, I can speak to this personally, because I had a unintended unplanned home birth because of a precipitous labor. And, you know, honestly, when babies come back quickly, they they come very easily. And the best thing you can do is stay calm, and stay present and just be there to receive your baby, because your baby's coming. If you are planning a home birth, like I was, I already had a care provider in route on the way. So we didn't need to do anything further in regards to in regard to the provider. But if you're planning a hospital birth, and you know that this baby's coming, you have to make the choice, whether you're going to stay put where you are and have the baby or you're going to try to get to where you're going and potentially have the baby along the way. So it depends a little bit on how far away you are from your from your hospital, I think it's a lot better to stay home and have your baby at home than to have your baby on the road or in the car, even though it does happen into probably stills are going to be fine. And so if you decide to stay home, you know that you're not going to make it I would advise you calling your care provider, you can call 911. So that there are some health care professionals that can get there faster and help in case the baby has any issues which it most likely will not. You definitely want to have somebody there with you. A few warm towels or blankets something to receive the baby with and you really don't need to do anything else. Just let it happen. I remember hearing that the baby comes out from 99 degree temperature so it's normally the mother's instinct to receive the baby and to keep the baby warm. But typically you want to put your hand on the top of the baby's head and keep the baby warm.

Definitely you definitely want to put the baby skin to skin with you and cover the baby when we are planning to give birth at home. You know we we keep the room up significantly. For that reason, because that transition is you know it is hard on the baby and but skin to skin is perfect with a covering. That's all you need. I think I think most of all, just stay home. Trust yourself. trust the process and call call somebody to be there.

Yep. And then come on down to birth and tell everyone your story. Perfect because they're fun stories. Trisha we have one about an anterior placenta next. And the question is, are there any special considerations I should keep in mind with an anterior placenta. I've heard I may not feel as much of the baby's movement. Hmm. And in the event that a C section is required, are there increased risks or adjustments to the procedure with this plus saddle placement?

I've never heard of that. Is there? So increased risks or adjustments?

Yeah. I mean, I even had an anterior placenta and I never had any worries or thoughts about it, because isn't like 20% of the time that women have them.

It's Yeah, it's, it's no, it's really not a big deal. It's true that if you have an anterior placenta, you may feel it may be later in pregnancy before you feel the first movement of the baby because the placenta is kind of in between the baby and and your belly. anterior placenta sometimes make the baby more prone to being posterior position, oh, sometimes it can be a little bit harder, especially early on in pregnancy to find the baby's heartbeat. In relation to risks, and C section, the only time that there's really an increased risk is that if it's a anterior placenta, that doesn't, that's a placenta previa, that's it's over it's anterior and over the cervix. So normally, wherever your placenta implants, as your belly grows, it moves up and out of the way. But if it stays down, where you would, you know, have to do an incision for a certain section, then that can be a little bit more complicated, but only only if it's a previa, or an accreta, which is where the placenta actually gets into the uterine muscle and attaches and it's difficult for it to come out. So I would say most people have an anterior placenta, not a big deal. The placenta just is on the front side of your uterus instead of the backside.

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