#58 | Q&A: Milk Supply; VBA2C; Second-Pregnancy Symptoms; Urge to Push; Sitz Baths; Vertex Babies Who Flip

October 28, 2020

What does it mean if my baby won't stay head down in late pregnancy? Can I prepare my perineum for birth by taking a sitz bath during pregnancy?  Let's talk about VBAC/VBA2C and why Failure To Progress (FTP) is NOT a risk factor for another cesarean birth. Here's the biggest worry for new mothers planning to breastfeed: making enough milk and how to do it. What if I get the urge to push before I am fully dilated? How late in pregnancy can I change providers? Am I pregnant? My symptoms are completely different this time. All this and more in this week's Q&A episode! 

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View Episode Transcript

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.

I'd like to start off today's q&a episode by publicly thanking you and Zhu who works with us behind the scenes on the wonderful birthday weekend in Maine. So Trisha and Zoo when you're listening, thank you so much. We had so much fun. We had a great time. That was the best working networking was the hashtag of the weekend. Speaking of Maine, I came across this really sweet story and the news apparently it went viral. There was a baby born on a little island off the coast of Maine. She was number six, I think fifth or sixth baby. Her name is Azalea Belle gray, and she was the first baby born on the island since 1927. Was birth just happens it just just happened like two days ago. It must be a tiny island. There's so many little islands off the coast of Maine right there. It must have been a home birthing, right? Oh, yeah, it was a home birth. Yes. Sorry, not in a hospital. There's no hospital in the island. It was her first the mother's first home birth, but her fifth or sixth child I'm not sure which. And it was unplanned home birth. And she wrote about the story. And it got picked up by the local newspaper in Maine, which then got picked up by like NPR, which then got passed on to Good Morning America, she got interviewed people magazine. And look here, she's now being talked about on the downbar show her true claim to fame.

You know, I was just thinking, wouldn't it be nice to be able to give first time pregnant women the confidence of a fifth or sixth time pregnant woman? You just know she felt fine, because she had done it five times before, I assume and hope they had a plan B anyway. But you know what I mean, the first time or is even that woman her first time? You know, she just had so many doubts. Right? But you you know that if you're giving birth on an island off the coast of Maine with no probably no emergency services of any kind. You know, you're pretty confident in your ability because imagine what what do you do if you have to make a transport across the ocean?

I mean, that that still is a possibility. So I do wonder what their plan would have been. You know, there's, I'm sure they obviously go back and forth all the time. They have boats, there's ferries, a helicopter maybe I don't know, they can probably hang glide.

But like remember when we were there and they were gale warnings.

Well, what if it's a night like that? Like, here on the East Coast, we worry about the nights that there's snow storms or rainstorms getting to birth but imagine having to cross the ocean at three in the morning under like stormy conditions. Yeah, and like in labor. Yep. Anyway, kudos to her. That's a really awesome story. I love that. Very cool. And also it I think we should see if she'll tell her story on the show. Um, no. That's great. Good. That'd be fun. I'm gonna call her up. We'll be like, we've made you famous. She'll be listening to her voicemail from People Magazine.

And then me from the Thunderbird show, oh, she'll be like, oh my god. It's Trisha. That's right. Just like, you know, just like the people in the restaurant in Maine that night. Yeah, remember how they kept looking at us? Yeah, cuz podcasters are so recognizable by their appearance. Totally. The faces almost no one ever sees. All right, unless you follow us on Instagram, in which case you see a lot of us. Alright, so let's jump in Trisha, we got so many good ones from my own clients and on Instagram. We had a really big response. So I think I'm gonna ask you, why does my baby keep turning and not staying head down at 33 weeks.

Well, you haven't every active baby. That's, I mean, the fact that your baby is turning and not staying non vertex not staying head up is a good sign, it means that there's plenty of room in your uterus, and it's totally okay and normal at 33 weeks for your baby to still be moving around. Generally women who have had more babies tend to have a little bit more space in the uterus. And we see this more often where babies are, you know, doing gymnastics, I suspect that your baby will eventually settle head down just fine. 33 weeks is still early. You know, there's really nothing that you need to do if your baby was fixed in a transverse position or a breech position that that would be different. So I would say not to worry.

How about this one for you? All right. I've recently heard of women incorporating a sitz bath into their daily routine in the weeks leading up to birth. Is this helpful in the same way a hot compress would be during birth? That doesn't seem to be a thing that women are taking sitz baths during pregnancy, and I'm getting the feeling that this mom was under the impression that might help to reduce tearing. So there is a practice that is controversial, by my estimation, and that is perinatal massage. Yeah, I think. Also, I agree, this is not something that I've, I've heard of before, but I think that that's probably getting mixed in with the perinatal massage thing that you know, if you massage the parent, even if you use warm compresses prenatally Will you reduce the chance of tearing and like you said the evidence on perinatal massage is somewhat mixed.

There is good evidence though, to support the use of warm compresses in labor. That is definitely true. It definitely does seem to reduce tearing, especially, especially significant tearing, but I don't think that there is anything to sitz bath prenatally that would be helpful. Other than that, it might feel good. And that's okay, there's nothing harmful. But one thing you can do is take an Epsom salt bath, I would first start by saying make sure you're buying good quality Epsom salts, I wouldn't go to a store where they have ones with added fragrance that actually does have some known benefits for pregnancy and even for any of us. So in pregnancy, it can relieve sore muscles, round ligament pain, even leg cramps, and they definitely help you sleep better if you do about the night. And Epsom salts are magnesium sulfate. So it does increase your magnesium level in pregnancy which is certainly beneficial. And you know, just relief from any kind of dryness, itchiness discomfort. So I would say there's only benefits to be derived from enjoying a nice Epsom salt bath. And if a bath is not convenient for you if you're not Tricia and you don't take the time for ideally long morning bath because you because you treat yourself that well. You can just fit it into your day by doing a foot bath yet the feet are very porous, and it's extremely beneficial just to do an Epsom salt bath.

I'm forever going to tease you about your baths. Hey, go for it, man. It's my wake up routine. I have to put a time I have to use a timer though. Otherwise I'll squander the day away. It's unfathomable to.

All right, why don't we have Okay, well, we have been talking a lot about VBAC lately and so we got several questions on VBAC. So, here's the first one. Hi, ladies. I heard episode number 55. For the woman who had a DBA to see, that is a VBAC after two Syrians. I've had two c sections, and we're also planning on having a third, a third sectarian or a third birth, I'm not sure she means a third birth. Okay. I would think yes, I think we need to assume that the woman in your episode had two scheduled c sections. And in my case, my first c section was due to failure to progress. And my second was scheduled, is the fact that I had failure to progress for my first something that works against me.

I would say very much on the contrary, I'm comforted to hear that your first birth was due to failure to progress. Not that that is a legitimate reason for a C section. In most cases, it certainly is not. However, that means your body went through labor and the more that your body has experienced being labor, the more easily that VBAC is likely to go. It's the scheduled c section. So we had the woman in Episode Number 55, who had had two scheduled c sections. She had a very easy badgal birth despite the fact that her body had never known anything but scheduled c sections. So you've got that going for you. I would really say it's quite the opposite of what you are concerned about. Trisha, I totally agree I just failure to progress is often simply failure to weight failure to be patient, you just didn't have the opportunity to be in labor long enough to potentially deliver vaginally and I don't know the history of the birth. I don't know the reasons but what is really important is that in working with your provider, for this next birth, if vaginal birth is what you're going for that your provider and you discuss the history, why you have the C section and that story isn't something that they believe is going to be a repeat. So I agree with you that it is the opposite of that failure to progress as a good reason to go for a VBAC. Yeah, so even though you don't know her history and the situation around it, if it were called failure to progress, then everything all with all the information you have, it looks like that's a very good starting position for her in going into a VBAC. Yes, Trisha, we got a couple of questions that were phrased differently, but asking the exact same thing. We have one of my clients and a couple on Instagram who are writing in and asking right now while they're pregnant, what they can do to ensure that they will produce enough milk postpartum. I never realized how many women worried about this in pregnancy. I know it's really common postpartum, that women are constantly wondering whether they're producing enough. But I guess we're at a point now where whatever women are hearing from their friends and the people around them, they're going through pregnancy already worrying about it. Yes, this is one of the biggest fears I think women have around breastfeeding, the concern that they're not gonna be able to produce enough milk for their baby is in the top one or two reasons that women stopped breastfeeding. So I actually just did a minisode on this. It's Episode 56. And it was all about the first four to six weeks of breastfeeding, and basically, about milk production. It's a common belief that it is the mother's breasts that are the determinant of whether or not she will make enough milk. And it's not the case, it is the baby who determines your milk supply. So what can you do to increase milk volume, if you have trouble producing enough for the baby, your supply is based on demand. So it's all about how often you feed your baby. That is what determines your milk supply, there isn't anything you need to do to try to prepare your body to produce enough milk, you have the ability to make all the milk your baby needs, so long as you listen to the demands of your baby. So that means basically throwing out the schedule, throwing out the ideas that your baby should only feed for this long on one breast and only eight times in 24 hours or only every three hours, you need to really try to let go of those rules and feed on cue. Cynthia, you and I can both speak to our experiences with breastfeeding. I don't think I ever wrote down a time, a time limit the time the length of a feed or time in between feeds. I certainly didn't. And I remember bringing my son to one of his first pediatrician appointments ever. And the nurse came in and measured his head and did everything and she saw me breastfeeding. And she said okay, and do you have them on a schedule yet? And I was just totally flabbergasted by the question because I had read the womanly art of breastfeeding, published by La Leche League. They had never mentioned anything about a schedule. And I said, Oh my God, my first thought was, oh my gosh, I missed a key point. What have I missed? So I said, No, I haven't. And she said, Oh, yeah, you're gonna want to get them on a schedule. And I said, Okay, and I'm always looking for me always. Look, I'm always asking why. I was like, Okay, what can you tell me why? And she, she truly stammered. She looked at me and just stammered, and she just raised her shoulders a little and said, I mean, cuz it'll be easier for you. And I said, Oh, for me, Oh, no, nevermind, I'll keep doing what we're doing. I was just like, You got to be kidding me. I thought you're gonna give me some major benefit for the baby. I can't believe there was ever a time I questioned my own intuition that much it. I feel so much self compassion for that young mother, who questioned herself, because it felt so right to breastfeed him every time. He woke up from a nap and when he cried or when someone handed him to me every time he wanted to, which was constantly and it felt so right to me, and to him, and we were in this really nice rhythm and to have someone intervene and say to me, did you get them on a schedule yet? And the fact that I even questioned it and said, Oh, like I was prepared for her to convince

Otherwise, it's just stunning to me, right now that you're experienced. But as a first time mom, we always think, you know, our health care provider knows best. And the reality is what she said is totally not true. Putting the baby on a schedule isn't actually easier for you. It's harder. And it's harder because you're having to fight this, like, natural instinct, you know, your baby's crying, and you're like, no, they have to wait another half an hour to eat. I can't even imagine doing that to the baby. It's shocking how many people still give the advice of putting your baby in a schedule. However, I will say as they get older, it's okay. And you'll see in the minisode I talked about there's this critical window of four to six weeks when your milk supply is at is fully established. And once you're in that place, once you've gotten there, and you're so your supply equals the demands of your baby, then you can start using some scheduling techniques and your milk supply will your milk supply should not be affected. But you have to feed on cue in those first four to six weeks to get your milk supply to meet your baby's demands, because they're growing, and your milk supply needs to increase with them through that time. Once you get to that four to six week window, you don't actually ever have to produce more milk than that, regardless of how much your baby grows. So the best thing you can do to increase your milk volume, if you feel you're having trouble producing enough is to feed your baby more. The only exception to that is that if your baby is not gaining weight well, so that is the one variable that you definitely have to keep track of you do need to weigh your baby. You also should track output at least in the beginning. So poops and pees. That's a good way to know that they're, you know that they're getting enough. But most importantly, is weight weight gain. If your baby is gaining weight well, and you feel like you're not producing enough, simply feeding your baby more should solve the problem. You can drink mother's milk tea, you can take some lactation blender or galactic dogs to help increase your prolactin levels. But it doesn't matter how high you increase your prolactin levels if you're not stimulating your breasts.

That you just say the word galactagogue. I did. What is that? galactagogue sounds like a fake word. galactagogue is a crazy word, isn't it? It's a it's a galactagogue is something that increases your prolactin levels. Is it a hormone? Or a supplement or what? Yeah, it's a compound. It's something in it's an herb. Like it's a classic og? It's a black dog. It's it's self explanatory. It's it's fenugreek Oh, it's fenugreek Oh, you mean fenugreek is an example of a galactagogue? Exactly. I got it. And you Greek is an herb that has a galactagogue function galactagogue effect. Now we're truly making up words.

It has to have an adjective. Alright, so sorry. It's so hard for me to answer these questions simply because there's so much to it. Well, the mini episode is 10 minutes long. So for anyone who wants to learn about increasing milk supply anyone early, postpartum or pregnant, that is a valuable 10 minutes to pick up everything Trisha put out there on the topic. So thank you for the question, because we now have an appreciation for how many women are concerned about this? Yeah, I was I was fascinated, Trisha, when you talked in that episode about how once you do that, in the first four to six weeks, you basically can relax and you're set. By the way, it's raining. And you I'm sure you can all hear the rain behind me. And I'm sorry about that. But I cannot control the teacher. Let's move on. I do want to. I did want to mention that in my current HypnoBirthing class, I have to same sex couples. And they submitted some excellent questions. And Trisha and I have decided that we're going to dedicate a separate episode to a q&a for same sex couples, because they're very interesting questions that are definitely unique to the families with two mothers. So stay tuned for that. And if you are among my same sex couple clients who submitted those questions, or who would like to hear the answers, we will be putting out that episode in the very near future in the coming weeks. It'll be one of our regular Wednesday episodes. Love it, doing it.

Mom power? Yes. What's better than one mom two, or three? Well wait a minute. Three is definitely a whole different story.

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I have a question about the urge to push. In HypnoBirthing we believe we should listen to our bodies. And when we have the urge to push, we should do so. But what if we're not fully dilated yet? Won't that cause harm? This happened during my first birth. I was at seven or eight centimeters when they first checked me at the hospital. So they transferred me to the birthing room right away. I remember having an unmistakable urge to push while they were transferring me. But they told me to hold it. I guess I did. Because I ended up giving birth on my back in a bed. Thank you for your time. And thanks again for the great podcast. I think this one is a little bit more in your domain. The only thing I want to say is yes and HypnoBirthing. We will Mickey Monson goes a little bit far with it. I don't really completely agree with her. She actually says we don't push in HypnoBirthing. And I disagree. I do think the vast majority of women get a wonderful urge to push and then they push as they should you get a surge of adrenaline and push as your body is telling you to this comes very easily. When you're having a natural birth, it's a little harder when you have an epidural and you don't exactly know when the body is surging. Someone who don't have that urge. And that's certainly healthy and perfect and fine as well. But I just don't like the I don't like the notion that there is a right or wrong way to go about it. The only thing I would say is we don't want anyone to command you to push or not to push. And it always pains me to hear about a woman who has the urge to push who is told to wait and to hold it. However, and this is Trisha is area. Trisha, what about that unlikely situation? where a woman has the urge to push and they do check her and she is only eight centimeters is I don't I'm not sure that this woman was checked. So I'm not sure how she knew she was seven or eight. But can you talk about that? Yeah, absolutely. So she said she was seven or eight. But I'm not sure that she got this urge to push. She may have been a little bit further along when that happened. So she might have been nine or 10, you might have already been nine or 10. At that point. Yeah, that can happen in a moment that happened in one surge. Absolutely, especially if it's not your first baby. So yes, it does sometimes happen that women get the urge to push when they're not fully dilated. And unfortunately, yes, if that is happening, you do need to try to resist the urge to push because pushing on the cervix that isn't fully dilated can cause the cervix to swell. This happens a lot when women have just a little bit of cervix left when they're maybe nine centimeters, or they have an anterior lip. And I've been there, I've had to deal with it. It's as a midwife and as a birthing mother. And it's brutal, because that urge can be really overwhelming, you hopefully just have to get through a couple contractions like that, it means you're very near full dilation. And you do, you do just have to breathe through those contractions. So an anterior lip is when there's just a little bit of the anterior part of your cervix left. So it's basically being about nine and a half centimeters. In some situations, it's just the way that the baby's head is sitting on the cervix. And if it's not evenly putting pressure on the cervix, so it might be putting more pressure on the posterior part of the cervix, the posterior part of the cervix melts away and the anterior part of the cervix is left remaining, but you really need to get to that full dilation of the cervix needs to be totally gone before you really want to work with your urge to push to push the baby through. If you have an anterior lip, hands and knees is generally a good position because it puts a little bit more weight on the anterior part of your cervix and helps it dissolve. Sometimes providers will also insert their fingers in and use their fingers to try to just slide the cervix up in over the baby's head just to get that last little part away can be uncomfortable, but it can also be effective. Once you're fully dilated, you can go with the urge to push. I agree with you that you want to use your own instincts to push you don't want to follow controlled pushing or guided pushing from anyone else. It's best just to use use that surge use the contraction. Use the urge when you have it and yogurt, you're good to go.

So here's a quick one for you, Cynthia. Is it too late to switch hospitals for a VBAC birth?

Well, the key question is, how far along are you? But the deeper question I would rather talk to you about is what are your reasons for wanting to switch? I'm a big proponent of switching providers and I know the listenership knows that well, because of the feedback we get on all the way women who have changed providers since starting to listen. But frequently hospitals will draw the line at around 36 weeks. They'll say that's a little bit, you know, after that they're not going to take new clients. But I have had countless clients in my community here, where they've switched at even 39, 40 and 41 weeks. And the reason for that is sometimes that's when a woman really gets to know her provider. Sometimes they seem very supportive of her birth plan all along. And then right at the end when she needs the most, they're suddenly pressuring her into induction for no reason, or something else comes up that makes her want to run. I would rather talk to you about why you want to switch and frequently when it comes down to VBAC, switching from one obstetrician to another lands you in a similar situation. Rule number one often for a VBAC is not to give birth with the doctor who performed your C section. Because whatever circumstances may have led to that C section might still exist. But why are you switching to another hospital? Have you considered birthing with midwives in a hospital? For example, really changing it up? So I, I think the straightforward answer is around 36 weeks. It frequently can be later, but why are you switching? Are you running from something? Or are you running toward the right provider? And I think just that's a much bigger discussion if we had more information. The only thing I would add is that we do know from speaking with Dr. Neil Shaw, that the number one risk factor for a C section is the hospital that you give birth in and if this woman knows that the hospital that she's currently planning to give birth in is one of those horrendous hospitals with a 50 plus percent c section rate. And she has another option where the C section rate is significantly less even though it's we're talking about VBAC and puts you in a little bit different category.

Then, you know, if that's the case, I think it's a quick and easy decision. It is a bigger discussion and more a little tough without some of the details, but hopefully helpful. All right, here's a fun easy one. Can the symptoms of your second pregnancy be completely different from your first? The answer is yes.

Next question. I mean, it's it's actually surprising how different one pregnancy experience can be from another.

Personally, for me, I had like tons of pregnancy symptoms with my first like, like every pregnancy symptom you'd have imagined. And I didn't even know with my second that I was pregnant until I was almost three months pregnant, which is kind of ridiculous for a midwife to not be aware of that. But I think I was in denial, I would say unacceptable.

I remember going to work one day. And and I asked my, my the other midwife, my colleague who is working with us, like, Is it weird that I haven't gotten my period for two and a half months? You were like, what could that mean? Yeah. So what did they get a stress?

And they just, they actually had there were two of them. And they both just looked at me, like, What is wrong with you?

You're pregnant? What are you talking about? You're playing like, I can't be pregnant. I don't even feel the slightest bit pregnant. It's not possible. It must be because I stopped breastfeeding, like, you know, a couple months ago, and I was still having lactational amenorrhea.

You were just in denial. I was totally into now. So yes, your symptoms can be one way with one child and another way with a second child. And it does not mean that one pregnancy is a boy and one's a girl. Because I thought that to know, my pregnancies were almost exactly the same. I had no nausea, crippling exhaustion. And you know, the same little backache, starting at about five and a half months. Same thing. But here's what I like about this question. This question is evidence that women can't get away from their first birth experience when they are pregnant for the second time, they obsessively relive their first pregnancy and their first birth. And what happens when I'm working with couples, let's say in my refresher class, I say to them, I know you keep replaying your first birth. And I promise you, after you give birth to the second child, you're not going to call me and say, and this one one exactly like the first one, you're going to have a very unique experience. And this is important because if a woman has Group B strep the first time around, she can obsessively worry that she's going to have it again, or preeclampsia. Or if labor starts really slowly, then she's expecting it to go slowly. Or if the baby came two weeks late, she thinks well, I just give birth late and it's only because we create these totally false beliefs in our mind that we have any clue as to how any of this is going to go. So when the pregnancy is different from the previous one.

I think it's a nice reminder that you are in for a very unique experience. And you will look at those two children one day and say the same thing. They have such different personalities, it's, it's fascinating. It's part of the journey. And any reminder that you're in for a new birth experience is is a good thing. Because you want to detach from your expectations, it doesn't mean lower them, it just means detach from them. By the way, that's a great metaphor for life. Because anything that we experience once in life, we expect that when we experience it, again, it's going to be the same experience. And it almost never is, that's true, we get we get, like you said, attached to an idea of how something is going to go based on a past experience. And that's actually what creates anxiety for us. And if we can learn to release that belief, or release that expectation. And know that same experience repeated a second time is actually a different experience. In Buddhism, it's what causes suffering. That's radiations. Right? So Exactly. Look at us, figuring out life, explaining everything there is to know about life. In a simple episode.

Life explained, should we change the name of our podcast? Yeah. I got a question I feel we need to answer. And it's gonna be a really hard question. What can I do about body image issues in pregnancy?

I think that you just have to really trust that your body and your baby are doing exactly what they need to do. As long as you're taking care of yourself.

Right, if you're eating well, the changes that your body goes through are the necessary changes that need to happen. I think we really should try to find the right person to bring on the podcast Trisha and talk about this because it is a major issue postpartum for women as well. You know, it comes up in every single support group.

It's very difficult culture that we live in very difficult as far as women being judged. every which way on how they look, even women being called beautiful when they're pregnant is still a judgment on how we look. It's just very difficult. So we're going to try to see what we can do to give you the answer that this important and relatable question deserves. All right. I like your suggestion. Let's let's really get an expert because there's a lot to that question.

So, I think that is it for today. Also, just a reminder that we have our new website up and running if you haven't checked it out yet. We are busy on Instagram, and we love to have conversations with you through social media. We We really appreciate reviews. But the best thing you can possibly do for us is if you're enjoying the podcast, post it somewhere, share it where other pregnant women just might hear about it so that we can spread the love.

Hey, it's all about love. That's it, man. That's what creates family.

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About Cynthia Overgard

Cynthia is a published writer, advocate, childbirth educator and postpartum support specialist in prenatal/postpartum healthcare and has served thousands of clients since 2007. 

About Trisha Ludwig

Trisha is a Yale-educated Certified Nurse Midwife and International Board Certified Lactation Counselor. She has worked in women's health for more than 15 years.

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