#8 | Q & A: Waterbirthing, Postpartum Anxiety, Breastfeeding, Velamentous Cords, Self-Advocacy, & When To Go To The Hospital

Dear Cynthia, Trisha, I'm writing because I don't know if I have postpartum depression.

When you walk through those hospital doors, it has the potential to change the course of your labor because of the emotional response that if my husband were engaging with a phone, he would have lost some kind of communication with me, but I would have been interested in the phone.

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.
Guess what? have good news. What? The American Academy of breastfeeding medicine just posted a statement on co sleeping.

I didn't know there was an American Academy of breastfeeding, medicine, medicine, but okay,
what is there? Isn't there important good to know? Okay. I'm sure I'm sure I'm really out of the loop on that.

Okay. You and I, obviously are proponents of breastfeeding and you and I both breastfed and co slept. Yeah. All all three of us did.

That's right. And there's a lot of concern about co sleeping. But we know that exclusively breastfed infants who sleep near their mothers are protected against SIDS and the American Academy of breastfeeding medicine just released a statement on January 7 2020, which states safe bed sharing is possible and the existing evidence does not support the conclusion that bed sharing among breastfeeding infants causes Sudden Infant Death Syndrome and the absence of Known hazards. So that is great news for mothers who are co sleeping and breastfeeding that you can feel safe to do so. under the right circumstances, yeah, there's there ways to do it safely. And most women end up doing it by me because frankly, when you're jumping up in the middle of the night, so many times, half asleep and picking up your baby, you can feel weak in the knees and be afraid you're just going to fall down so you can get a lot more sleep when you're co sleeping. But there are ways to do it responsibly. And there are plenty of great articles about that. So you guess what, now now your turn. My turn.

Okay, guess what? We got a bunch of cool questions. I mean, I didn't show any of them to you yet. Oh, my God. Okay. See how you fly. All right.

I'm ready.

All right. There's one for you.

I've been giving serious thought to having a water birth. And I'm wondering if you can point out any key items I should take into consideration. Thank you, Sarah. I think Cynthia and I would both agree that choosing water birth is an awesome idea. One thing to keep in mind is that you may choose to labor in the water and not necessarily birth in the water. I usually would recommend if you're having your baby at home that you set up the tub several days in advance, you obviously aren't going to fill it until you are in labor. Some institutions just to keep in mind, some institutions will only allow you to labor in the water but not birth in the water. But the benefit of laboring in the water is really the most significant part of it. Sometimes women even spontaneously decided to get out of the tub to have their baby. The only thing I would say is that I always recommended water therapy. In the shower in early labor, and the tub later in labor. If you're still in the latent or very early stage of labor, it can actually slow down your contractions because you're so relaxed. Yeah, pretty much.

I always got an early but I had short bursts.

So, I don't I don't know when you were in early labor, you didn't even know you were in labor. That's why, I guess that's it. The tub is very beneficial. But for somebody who's just like, contractions are coming every half an hour every 20 minutes to get in the tub can prolong the period of getting into active labor. However, the shower has the opposite effect.

Oh, I didn't know that.

Theoretically, because of the potential that nipple stimulation it can get the oxytocin levels building and can help stimulate your contractions. Whereas getting in the water kind of calms things down and relaxes things. Once you are in that active stage of labor, it won't have that impact. Other things to keep in mind is that when you if you do actually birth the baby in the water, you do want to either keep the baby's body in the water or if you're going to bring the baby out of the water and put the baby skin to skin. Cover the baby with a dry blanket and try to keep that blanket from getting wet because thermoregulation is is really important and they come from like 99 degrees in Find the body. So even if they're born in open air, it's a lot colder than where they're coming from. That's right. But when you're wet, yeah, it evaporates. Cold are greater risk of getting too cold. So keeping the baby in the water until you can be skin to skin in a dry environment. Also, you need to keep the room temperature really warm. And there is a significant shift in the feeling of discomfort and labor. When you get in the water. It's very calming.

What are your thoughts on that? I am loved getting in the water and made a huge difference, right? That moment you get in you just suddenly feel this immediate relief.

Did I tell you that when I went into the birthing center when I was pregnant with Alex, my first birth, I got there. One hour after Labor began, I was six centimeters and had filled the tub for me. Did I ever tell you this? And they were like, why don't you try out the tub? And I was like, No thanks. And then all they said was, Go ahead, just try it. And I only got in to be polite, really? Like what was your hesitation? And it's not even that that I think is so funny. It's like It's like we shouldn't we shouldn't be doing anything to be polite. Like, it's just so funny to me. I only got in as a courtesy like, there was really this thought that one time I'm like, well, they did feel it. So for me, that's crazy. That's drew me about. So I should take off my clothes and get in. You know, I declined. I think I declined because I was really, I was like, keeping it together. I was good. I didn't want to rock the boat at all. I really felt like I was doing just fine. I got into Be polite. not proud of that. But I got in for that reason. And when I got in, I said, Oh my gosh, you're never gonna get me out of here. This feels incredible. And I'm so grateful that they did that because then I ended up water birthing him and making that choice when I birth my daughter years a few years later, but it's true. So good. And my doula all she really did during the birth was I think it's called effleurage she was just pouring water cups of water from the tub over my shoulders. My husband was lunging into it rubbing my sacrum because I had back labor and at times the doula held the cool washcloth to my forehead but it felt so wonderful is that when each of my babies was born in the water I really didn't want to get out. I did I got out but I was kind of a drag I was so happy in there I agree I was the opposite I couldn't get the tub filled fast enough in in my labor's I wasn't able to have a water birth with my first because actually, I had the the effect of getting in the tub and it slowing my labor down. And my labor in that case went on for a really really long time. And I just I didn't even the tub just didn't even appeal to me toward the end of it. But with my second and third, I truly couldn't get in that time fast enough in the second I got in it was like Okay, now I'm good. Well, there's a weightlessness Because the gravity isn't having its usual effect in water, this is this we become buoyant and weightless. And there is something inherently extraordinarily soothing about water.

Just a reminder, though, that if you are planning on water birth, there may be things that occur in your labor that, you know, preclude you from actually giving birth in the water. Sometimes we do have to change course, but it will be up to your birth attendant to make those decisions. But Sarah, yes, I would say go for it. Have a beautiful water birth, we'd love to hear about it if you want to share your story.

Hi, Cynthia. And Trisha, I wanted to get your take on something and share an experience with you. I went to my midwife group yesterday and they had a student intern with them. I thought it should be okay. So I didn't oppose. They basically let the intern run the whole appointment with me and unfortunately, it was a terrible experience. They had to take a culture and she used a speculum. She was very awkward and rough with me and I definitely didn't feel safe or relaxed. I actually feel so much traumatized by it. And I wish I had just said, No. My midwife told me I can state in my birth plan that I want no interns present during my birth. I just feel bad about this because I know students have to learn somehow. But in this case, it was too bad of an experience and I just can't What are your thoughts? I can't seem to let this go without feeling guilty. It's not your responsibility to help any intern get their education or experience. This might have been a little blessing in disguise. Because this might be what helps you to find your voice and find your boundaries before you actually have your birth. You figured it should be okay. You didn't oppose. So it seems like you just acquiesced. It is well within your right to say No, I'd rather not I'm not comfortable with that. So this is it was a bit of a painful learning experience for you. And now you understand the scope of how women can feel them. labor. So take this lesson, and do find your voice. And I would say in your pregnancy at this point, go back and speak to your midwife about this. You can take responsibility for the fact that you didn't speak up. I'm thinking she probably could have probably read your body language a little bit and picked up on that. But what's standing out to me the most here is that you're feeling guilty. And I'd like you to explore that. And the reason I say this is that in postpartum, one difficult emotion, that's extraordinarily common is guilt. and pregnant women don't ever seem to see that one coming. Why are you feeling guilty is something worth exploring? This is your baby. This is your body. You don't owe anything to anyone with respect to the care you're receiving. So I hope that you can get over the trauma of that experience, and that you can explore how to go about doing that particularly before you give birth. But really, this is about boundaries. And about recognizing that your key responsibility is not to your provider, but it's to your baby and it's to yourself. It will also benefit the provider for really thinking about this fairly, this will benefit the provider. We all get better in our work by getting feedback. And if you speak to that midwifery group about your experience, they can take that opportunity to get better, not only at reading women and understanding who's really comfortable having an intern, treat them but teaching her to be more gentle and more respectful. So you can you definitely can see this as doing the right thing, not only for yourself, but for them as well for if that matters. I do think there's an argument to be made for that. What are your thoughts on all this?

Yeah, I agree with you. It's a little tough because you know, students need to learn, but how they learn can be modified and adjusted and you can adapt to the circumstance of the person that you're with and every person has The right to say no. And that is okay. But there is a way for students to be involved and to learn that is not traumatizing. And it does not make the woman feel disrespected. And I think that's where we have to do the work. This has happened to me twice. I think it's really unfair to ask the client, are you okay with having this person here? Oh, look at her. Here she is. And in one case, I was like, I yeah, I'm okay. And then about five years later in a different situation. I said, right there because I was a little more emboldened, it was post giving birth. And it had changed me in a in an empowering way. I said, No, I'm not really not comfortable with that. And so, yes, so So how can we do that better the woman should not be put on the spot with the person, the intern, the student right there in front of them be the provider should come into the room and say, you know, I have so and so here with me today. This is her name. This is who she is. This is what I'm trying to teach. Are you comfortable with this student performing this exam and the woman should have the opportunity to say yes or no in the privacy of her and her provider and not to be made to feel guilty about it. My other thought is, so many women have suffered abuse at some point before giving birth. This is a very big question to some women. This is no casual question like, Oh, hey, it would be really helpful if you would just dot dot dot, this is a very big deal to some women, and they're not going to wear it on their sleeve and explain to you why. So you have the right to say no, you don't mean to give a reason and you don't need to let the words sorry, escape your lips when you do so.

Totally agree with that. The point is that they need to become more considerate of how they're doing that. Yes, these students need to learn but how you approach the patient, the patient deserves respect and deserves the privacy of you know, making that decision between them and their provider.

Here we go with a question. breastfeeding. Hi, Trisha and Cynthia. If I bottle feed and breastfeed my baby, will she get confused if I am the one giving her the bottle? I want to be able to go out with her sometimes and give her a bottle rather than breastfeed her. I am afraid if she gets used to taking the bottle from me, she will stop breastfeeding and that's assuming she even takes the bottle for me in the first place. Do you think my husband should be the only one to give her a bottle? I really want to start pumping and using a bottle but I've been terrified that she will get confused and choose the bottle instead of me. Thanks in advance for any advice, Susanna, Susanna, lots of people have this concern. And it's totally a valid thought but you need to not worry so much. If you have a healthy breastfeeding relationship established with your baby you should be able to easily go back and forth between bottle and breast. Now that doesn't mean that your baby won't prefer the breast when you are giving her the bottle. There are some stubborn babies who just won't do Take a bottle from their mom. And they will only take the bottle from somebody else. But you don't have to worry about this, you just have to try different things and see how it goes. Some babies are very flexible and will go between bottle and breast from the mom and all within the same feeding, you can switch back and forth. So a lot of it has to do with just personality and preference of your baby. But I think the most important thing here is just to know that you want to make sure that you're doing this after breastfeeding is well established. So you've been if you have been exclusively breastfeeding for several weeks and everything is in sync and going well then it is totally safe to try introducing a bottle and see how it goes.

Dear Cynthia and Trisha I'm writing because I don't know if I have postpartum depression. For the most part. I think it's just that I have a lot of anxiety. That was an astronomically high with the baby having reflux our recent move into a new house. And all the sleep deprivation etc. I just have no idea what's normal and what's not or where to go from here. I guess this is what people mean when they say it's going to be hard. Thanks for what you do. Kathleen, Kathleen, there are a few things to know here. What you're feeling is certainly normal in that it's common. But that's not to say it should be dismissed. postpartum depression is a very broad umbrella that includes many components, not just what you would think of. In terms of depression, we penis sadness, that's what we think of, or some people think of harmful thoughts, which is actually postpartum psychosis and is quite rare, but postpartum depression is common. And under that umbrella, you not only have what you would think of as depression, but you have postpartum anxiety. In fact, postpartum anxiety specifically is four times more common than the quote unquote depression type postpartum CD, postpartum rage, there are all sorts of common emotions that fall into this umbrella and they can be extremely uncomfortable if not scary. So, one of the first things to do and there are several that would serve you very well and your family First, make sure your partner and anyone in your support system in your family is aware of how you're feeling. One quick thing you can do right away is look up on the internet, the Edinburgh postpartum scale, which you can download and complete, and it will help give you a little bit of a window. It's a little bit of a screening as to whether you might have postpartum depression. I would say find a healthcare professional who not just any healthcare professional, not just any therapist, specifically one who specializes in postpartum depression. The global authority in postpartum depression is psi postpartum support International, and you're looking for a therapist who works with women specifically in this field. Now One thing I'd like you to know is if you are suffering from postpartum anxiety, and it does sound like you are, it's a function of how bonded you are to your baby. So that's ultimately a good thing that's going to serve you and your baby very well in the long term. But you have risk factors here that indicate that it wouldn't be surprising if you are diagnosed with one of these disorders. Again, this is very common, but some of the risk factors are what you're mentioning a baby having something like reflux, or moving into a house is a risk factor. And certainly the sleep deprivation is difficult enough to deal with. So the first thing is, include your partner in what's going on and make clear to that person that you need support that this cannot be ignored and that that person has to be proactive with you, and making sure they're looking out for you and that you're taking care of this. They have to be proactive about it. Not just telling you that they're there for you, but they have to be invested in this with you. tell anyone close to your parents or anyone who's helping you or in your network about what you're going through, then look for a health care professional who is specializing in this and take that Edinburg, postpartum depression screening, just to give yourself a little sense of what is going on. I do assure you whatever you're going through, it is temporary. If you join a support group with a professionally trained moderator, women are less likely to develop postpartum anxiety or depression. And if they already have it, research shows they will experience it with a lesser intensity and a shorter duration if they have a support group. So what you ultimately need are their moms, private clinical work would definitely serve you so both a support group and a private clinician would be ideal. It would be optimal. So professionally moderated is important. But the real beauty of that room is that women are there supporting each other and what we always say in that space is you're here for yourselves as well. As you're here for each other, you're here to give as much as to receive. But everywhere else in your life Kathleen in your household, and with all of the people in your own private life supporting you, you need to be in receiving mode. Because you're spending all of your time giving to that baby, everyone else has to view you as being in receiving mode. The last thing I want to mention is perinatal mood and anxiety disorders are rooted in isolation. And if you're a postpartum Mom, I know you know what we mean by that. It is a very isolating experience being home with a baby. So that is why support groups are so beneficial but any means of getting out of the house, getting outside, connecting with others. These are the path to your wellness and again, it is definitely temporary. So the key question is how do we support you between now and when this is behind you? Good luck to you and please let us know how you're doing.

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We have an umbilical cord question. Dear Trisha and Cynthia, I wanted to get your advice on something. Our 20 week ultrasound revealed a low lying placenta so they had us follow up about two weeks ago. During that ultrasound, they noticed that I have a velamentous s cord insertion. The doctor didn't seem too worried. The baby looks totally fine, thank goodness. But of course, he wants to keep monitoring me. Thankfully, the placenta is moving up, so that's good. They did however, mentioned that a C section might be needed, depending on how things look moving forward with the chord placement. We of course really want to have a vaginal birth. So this news was emotionally distressing. We're just not sure if this is a serious enough situation to require a C section. Do you have any suggestions or thoughts? Well, let's start by explaining what development is cord insertion is. So normally, the cord inserts into the placenta and is surrounded by a protective gel called the Wharton's jelly element is cord insertion is a variation of cord insertion which has Have the vessels of the cord exposed. So there's different different degrees of element as cord insertion. But the consideration here is that if the Wharton's jelly is not protecting the vessels that the vessels are potentially at risk in really severe cases of rupture, so it is something that will be monitored throughout your pregnancy and it is something that will be monitored during birth if you're having a vaginal birth, which is definitely possible. But if there's any sign of bleeding, it is good to know that you have this element is cord insertion because that would be a warning sign that you would need to move to necessary note that the baby could be at risk, but most of the time of element is cord insertion is okay. And birth can proceed normally.

So, I hope that answers your question. And we'd love to know how this plays out. So please keep in touch.

I have just one more question that I'd like to address today. And it came up when I was teaching on Sunday. One woman in class it's Cynthia, how will we know when it's time to go to the hospital? And I know my response to that question is a little unconventional. So Trisha, what is the correct proper response to the question first?

Well, I would bet it's probably the number one most common the asked question in pregnancy or late pregnancy when do I go to the hospital? So generally, you're going to get the advice that you want to wait until your inactive labor before you go to the hospital. And this is like you know barring any other concerns or high risk or anything like that this is just like the general response certainly we're not talking if membranes released and you have to be strapped board right we are here and you don't feel your baby moving or anything that's wrong. You have a fever. I'm this is just like you Okay, so once you start having contractions, once you think you have a contraction, you you'll kind of be on like notice, I think that this might be the start of something and time will go by 15 2030 minutes, maybe an hour and you won't have anything once your contractions start coming about every 15 minutes. That's kind of what we would consider early stage of labor. And that's the time when you are going to be starting to think about arranging your day arranging your plans. After a while, those contractions will start to pick up in frequency and duration. So they'll start lasting longer, maybe 3045 seconds, maybe even up to a minute and coming closer to every three to five minutes apart. Now that first part can go on for a long time, hours and hours or even days or even days. Yes. So once your contractions are occurring at regular intervals of about three to five minutes meaning the start of one contraction to the start of the next and lasting about 45 to 60 seconds that's generally considered the time where you are entering active labor. And active labor is the time where you would be wanting to go to the hospital. Or if you were having a birth at home, you would be wanting to notify for sure your provider at that point.

And one indicator of active labor is sometimes that a woman isn't speaking through her surges or contractions.

Yes, my gauge usually when I would get a woman on the phone as a home birth midwife. If the woman was passing the phone off to her husband, when a contraction came on, I knew immediately that I needed to grab my birth bag and get in the car. Hmm, that's interesting. Makes sense. So I always have a little bit of an addendum to this Question. I've never heard anything to refute anything that you just said. But there is so much concern for women who are working in a traditional hospital. And they know in some of those places, they're going to time their labor. And they're concerned rightfully about getting there. And having labor continue a really long time to the point where the doctor is encouraging, administering pitocin for no medical purpose or saying this taking too long. These are very legitimate things to consider. But the other part of this that I have to comment on only because it would be disingenuous of me personally not to is that we did not time one single surge of mine, my husband never suggested I never wanted to, I will come up at 5am and I said, I don't know if this is labor and five minutes later, I said, we have to go right now. It was all instinct and my son was born. You know how quickly just a couple hours after that. There's no wrong thing. do hear if you timed it, that's all good. It's just so interesting to me that you can make fun of me for how I can be so into analytics, and how I can, in my experience in my own life have learned, I don't do so well in that space. with certain things with like yoga and meditation and childbirth, anything requiring trust, I've learned I have to get out of that part of myself. Because if I cross a line with it, it turns into anxiety for me, I get too into controlling and managing. I really believe in the beginning, we just feel safer at home. And I feel like we cross this threshold where we say I need to be in the place where this baby is coming out. It's time I need to be there and you feel safer not at home. So timing is fine, unless you have that propensity like I do toward getting too much in the conscious mind or too much worry or concern or measuring. I had to really relinquish totally Am I called the midwives. The midwife said, Okay, you've been in labor for 15 minutes. You're telling me I If you come by I'll be there. But if you're not dilated Not for long, I have to send you home. And I had another surge right then and said to my husband, he was still on the phone with her. And I said, Tell her we're coming right now. It was just pure instinct. And boy, it was a good thing. We listened to it, because she might have talked another woman out of it, saying you haven't been in labor long enough.

I love that perspective. I love that message. I'm with you. I, in my experiences, I never ever documented a contraction, a starting time and ending time. Nothing. Same with breastfeeding, like same feed does, you know it's let's get out of the left brain into the right brain and tap into our inner intelligence on this. So I think that is the message women need to hear. That's not the message they're going to get from a general provider because they're going to be more data driven. When you walk through those hospital doors. It has the potential to change the course of your labor because of the emotional response that occurs. So you want to be in the place where you are most comfortable for the longest. period of time until you feel that need for more or you know, your body's just saying like you said, it's, it's, it's time I gotta go, this is the moment. So you can use those reference ranges that we talked about in the beginning as a general guideline. But what Cynthia and I would both really encourage is that you try to trust yourself and really tap into that inner intelligence that tells you now is the time.

I've had a few clients at this point who went to the hospital and did decide it was too early. And they had one in particular I'm thinking about right now in Connecticut, and I'm thinking of another one from New York, and the one in Connecticut, went to the hospital on a Friday and basically spent the weekend going in and out of the hospital. She arrived at hospital a total of three times that week and then had her baby on Sunday night. And it was so great that her provider agreed with her. She said look if labor is this slow, I'll just go back home and her provider was like that's fine, great. Go home, come back when it feels like it's happening again. And I don't want women to feel like they're trapped wants that. They're that they're not allowed to leave. I can't see how that isn't an option that's on the table more often, when they're talking about speeding things up without a medical indication, just why don't we talk about going home for a bit if she wants to? I hope that that is happening more and more I do. I do think it is I know, at least in a midwifery led practice that would be standard. They know, we know that you're going to labor better at home. And we know that once you're in that building, you're on the clock.

And we don't want you on the clock. And speaking of being on the clock, they have iPhone apps now, and this is something I also discourage I'm like, Look, you guys you're going to do it and enjoy it and you have to birth your way. This My opinion is only my opinion. You tell me later, what worked for you, and then it'll educate me and it will teach me and help to open my mind. But an app would have messed with me. If my husband were engaging with a phone First of all, I he would have lost some kind of communication with me. But I would have been interested in the phone to like how long was that one? Oh, boy. How long was it? Oh, and then next surgery thinking? I think This one is longer. And then you can have that panicky feeling like, oh, gosh, I think they're, I think they're getting more intense. You don't want to be thinking of the past, you don't want to be projecting what the next one is going to be like, you just want to be in it like it happens and you just read, hopefully relinquish to it, relax, breathe. Let's not analyze it. Because then what are we concluding in our mind?

Right? Well, we know what stress does to the body when it's in labor, and it is not helpful. So it is just moving into that trusting place, trying to get away from the control in the organization, and the calculating and just being in the flow of the process.

As with everything else, it always comes back to trusting yourself whether we're talking about in the roundtable discussion, we talked about getting babies to sleep, and breastfeeding, it's a matter of listening to your body, your breasts, the signals from your baby, even though everyone around you likes to tell you to get the baby on a schedule that can be really contrary to what your body is telling you and what your baby is telling you about when your baby He needs to breastfeed. We're always going to this place of measuring and timing things and I just don't think it serves us birth and breastfeeding. And even becoming a new mother is one of the most profound opportunities to learn how to truly trust our own instincts.

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