#83 | February Q&A: Plus-Size Pregnancy; What to Wear During Birth; Waking a Sleeping Baby; Implications of a Subchorionic Hematoma, Waterbirth & Baby's First Breath; Best Times to Pump

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.

Trisha, I told you I have a podcast listener from Idaho and my current HypnoBirthing class, right?

Yes, you did.

So she sent me a text today because we talked about vitamin K in class yesterday and listen to this, I just as you know, I just posted an Instagram TV video about medical rhetoric. And check out this example that she just shared with me, and I'm gonna read this to you. So she's telling me the story about her previous birth. And she said that the doctor said she would kill her baby, if she didn't do the vitamin K injection.

To her baby. Yep.

She said she would kill her baby. If she didn't do the injection. I just want to know what that doctor thinks has happened. Through the millennia, like what has happened with all the mammals who roamed the earth without the vitamin K injection, they all died. I mean, this is what I'm saying it's it's a it's the decision for some people like to get the injection, it's a decision for other couples to do the oral vitamin K. But to decline, it can do really want to tell someone your baby won't survive. Had we not manufactured this injection,

I can think of a lot better way to share the information about vitamin K injections?

Well, I would I would imagine that whatever you would share would actually be truthful, unlike what the doctor has said to this couple. But she knew better. And now with this mom on her third baby she has hired elsewhere. And she's thrilled with her decision. But you know, it reminded me of another unbelievable story that I don't think I've ever shared on the podcast. But and I don't even know if I've told you. But I had. I had a couple who gave birth in a local hospital a few years ago. And when they arrived, they said they were having a natural birth and the nurse. And I hate to tell these stories, because so many nurses are just so incredibly loving and supportive. But the stories that stand out among the 1000s of stories, they're always these dramatic stories. But this one, this is just unforgettable. This was like 10 years ago, the nurse said to the couple, you're not getting an epidural. Do you know autism rates are higher when you don't get an epidural?

Whoa, yeah. I'm pretty sure there's research that just came out that says exactly the opposite.

thing. So but I mean, how like, how does that nurse get away with saying that to anyone? And have anyone believe such a thing? How is the default, which is a natural birth? How is that more likely to cause an error processing disorder? Like it just doesn't even make common sense?

In the medical world? nature does not know best?

Yeah, I mean, I guess so. It doesn't have to be nature or science. If we're forced into that decision, then we'll all we'll, we'll all find our paradigm that's right for us. But it doesn't have to be that way. Like it doesn't have to be science to the point that nature is completely faulting, everyone's about to die. without some scientific invention or drug or chemical. It just doesn't have to be that way. prenatal vitamins don't have to be chemical concoctions of the vitamins we need. They can be food based vitamins like, well, it's as they should be as they should be. And that's nature. That's not science, right? I mean, it's a little combination of both. But yeah, these stories are just there. Let's call them entertaining. I'd like to share them because I don't want couples to feel like they're alone or isolated when they are faced with these things. And I want them to know that most providers don't say such things. But if you're hearing that from your provider, it's a red flag. Most providers would never dare give you misinformation and a fear tactic like that and you deserve Better, you will easily find better because most of them are nothing like that. And wouldn't say such things that are so false and fear inducing.

Yeah, I think that's that's a good point balance. It's all about balance. We need medicine, we need science, we need nature. Right? And they need to be imbalanced. And we need to know it's all about knowing when to choose which and how to support which for what are you ready, Shelly?

I'm ready. All right.

I'm eight weeks pregnant. And I'm actually going today for my first prenatal. I've been binge watching your podcast in preparation, I am a plus sized lady, I am 230 pounds and five foot three, although I carry my weight well for being this short and heavy. Any advice or does anything change in my plus size case with being pregnant with labor and delivery, I'm trying so hard to eat healthfully. I'm naturally minded in general, and I so desperately want a natural pregnancy and delivery. And I have no health problems. I am wondering if any of what you ladies talk about on the show changes if pertaining to plus size. I mean, the reality is that a high BMI definitely puts you at increased risk of certain pregnancy complications, gestational diabetes, hypertension, preeclampsia, even c section are at, or more likely, in, in women who have higher BMI. But what's really important is that to understand that BMI alone does not make you high risk. So if you find a provider, who puts you on the scale on your first prenatal visit, and says, you know, your BMI is considered high or obese, that does not mean that you cannot have a natural birth, that does not mean that you can't have the birth that you desire that you have to be labeled and treated as a high risk patient. So the most important thing I could say that you could do for yourself in this situation is to make sure that you choose a care provider who is supportive of your birth plan, who is supportive of your desire and who doesn't treat you differently, because you're a plus sized person.

Yeah, I think that's the point, Trisha, that the provider might treat her differently just by virtue of having a higher BMI. As to the healthy eating, if it feels overwhelming, start with this and all everything is going to be a change, everything will take an adjustment. But start with this. Can you start your day with water with lemon before you put a bite of food in your body? Can you wake up prepare a pitcher of water with lemon or lime or any kind of whatever berries in it, cucumber, whatever you like, but lemon or lime is easy. And just whatever you do, whatever you end up eating or drinking that day, start your day with that little mini cleanse, that will be extraordinarily healthy for your immune system, for your vitality for your energy. And if you get really comfortable with that, you're going to get hooked, because it's going to feel so good. And to be very healthy for your baby as well. And if you want to take it a step further, just see about turning your breakfast or your lunch into anything that's just pure, raw produce. Like if you can turn your breakfast or lunch into a smoothie, or your lunch everyday into some kind of salad. You might be surprised at how good you feel and how hooked you get if that's something you want to pursue. Because you said you're trying so hard. And if you embrace this is something that feels really good to you that it won't feel like an effort, it won't feel like you're trying. So just enjoy that feeling of vitality, you're you know, you're young, you're healthy. And it's just something that you can pursue with this motivation based on being pregnant.

Right. And I think it's also important just to mention that, you know, dieting is not, not the way to go.

Yeah, not the way to go in pregnancy. Right, right. Like putting it because you're pregnant, putting yourself on a strict diet is not the way to go. There are recommendations for gaining less amount of weight in pregnancy if your BMI is high, but you still need to make sure that you are eating balanced, healthy, adequate protein to support your growing baby. And the final comment I just want to make is that even very well meaning care providers have their own inherent biases. And if you meet somebody who doesn't feel right for you, if you feel judged, if you feel like they're going to treat you as high risk. And this is not just for overweight people, but this goes for people of different races. Lots of different scenarios could play into this. But you have to understand that people's inherent biases can set the stage for how they practice. So if something doesn't feel right, Cynthia and I talk all the time on this podcast about how choosing a care provider that you trust, and who makes you feel supported. And when you leave your appointment you feel better than when you walked in. That is what matters. So if you don't feel good, if you don't feel supported based on your plus sized situation, go elsewhere.

I think that's a really good point, Trisha that this is subjective. I think the key point that this woman made is that she's helped

And she has no matter. She has no underlying medical conditions. So we don't need to assume that she's going to develop them.

Right? We just don't want anyone using that against her now. Right, right. All right, Trisha, the next one came in from one of my current clients today. She said, I hope I'm not too late to throw this into your next q&a. She said, I have a quick breastfeeding question. If the baby is sleeping for four hours or more, she says, do you suggest waking her and if so what's the best way, I've always been told to let her sleep. But obviously, people will always instill fear that she won't be getting enough milk.

So my recommendation as a lactation consultant is always this, in the first couple of weeks of life, one four hour stretch per 24 hour period is absolutely fine one, you know, even maybe the occasional five because as a new mother, you really need that stretch of time. Beyond that, and that that one stretch of time should be while you are sleeping, not during the day. So if your baby is taking a four hour stretch of sleep during the day, I would advise waking, and any other time besides that one time at night while you're sleeping, where your baby can take a four to five hour stretch. Yes, you should wake them if you are planning to exclusively breastfeed. And the reason for this is that if you go longer than four hours more than one time per 24 hour period, it's hard to get enough feeds in in a 24 hour period to have supply equal demand. This is a general statement. There are exceptions. But in my experience, this is the best way to ensure that you produce enough milk and that your baby feeds frequently enough to gain weight adequately to stimulate your milk production. The best way to wake the baby is an alarm clock. Yes, crank it up.

You know, but one of the Zen ones, loud music and nice alarm clocks.

You know what the best alarm clock is? your nipple?

They'll probably barely wake up and start nursing. Right? Right.

Yes, the best way to wake up your baby is simply to pick them up and put them to your breast. Or, you know, usually the wake up in the process of you picking them up. But waking them to feed, the best way to do that is to wake them up and just put them right in the position of feeding. They'll smell the milk, they'll be stimulated by you. And they will generally latch on and sometimes they'll even go right back to sleep and then that's fine. That's great.

Babies tend to wake up quite gently, wouldn't you say they don't jolt awake. They tend to kind of rustle today, do you have a story? A story? Oh, what?

What have you done to one of your babies?

It depends on your baby. Depends on their their innate personality. I mean, I've experienced both I have had babies who wake up extremely peacefully, and you wouldn't even know that they had awakened and then I've had other babies who wake up with a rage. Can you guess who's who?

I can guess. We're not gonna name names. We won't do that to your children. We don't need awkward dinner conversation that episode airs.

Anyway, so I think they all wake up differently. There's no one size fits all. No. All right. So here's a great one. A very popular question. And I think you'll have fun answering this. This is one You did a great igtv on. So if you haven't seen it, go check it out. But you'll hear it again here. The question is, what do I wear for birth?

This one cracked me up capital letters, question mark, question mark, exclamation point, exclamation point. As if this is very important, and it actually kind of is important. Hi, wonderful. Ladies. I'm pregnant for the first time and have loved your podcast for introducing me to natural birthing. I plan to have my baby at a birth center. This question is absurd, but I cannot get it out of my head and I keep having dreams about it. I literally had a dream I was stuck in overalls and they couldn't get them off me to do skin to skin with a baby when it was born and it was a whole big thing. That would be a thing. Do you have recommendations on what to wear to be the most comfortable during labor and delivery? And if I'm wearing a T shirt or something logistically How does that work with skin the skin will my midwife just take my top off. haha I'm laughing as I'm writing this but seriously I am actually stressed out about it. Thank you so much.

I love the all caps but I'm actually strapped she's dreaming about it.

Well, hey if this is her big concern Good for her. If you go to a hospital to give birth, they will hand you a hospital gown. You do not have to wear it now you can wear it if you're fine with it. Go ahead and wear it because it's like you know knock yourself out. Give me anything to wear and I'm fine if that's how you feel go ahead and wear it. If you don't feel great wearing a hospital gown. It might be because the fabric isn't very soft. It doesn't fit people very well because it's this one size fits all thing with these weird awkward snaps on the shoulder. It keeps open in the back with these strings that tight and then they're like, Oh, sure walk around and women say yeah, when would I walk around with the back of my clothes?

Well take a walk to the cafe, grab a snack with your ass hanging out

-- exactly. Like we're all about walking around. We're cool.

You know, it's it's shocking. It's how is it possible that hospitals have not developed like a unique birthing gown? Why are they still using the same hospital gown that a sick patient wears?

We are I hate to say this, but by every measure that I've seen, pregnant women were just the lowest priority where a low, they haven't tested vaccines on pregnant women. Like they never know what to say about they there was kind of a good thing.

They haven't tested them I know, but they're recommending them as a class B drug. So then pregnant women who are informed on that are single, what am I supposed to do? It hasn't been tested. So why is that? Why are we not? So why isn't there a unique out there millions of women a year giving birth in hospitals? Why don't they have a cool gown that hospitals Listen up? Like if you want to be cool, get a good birthing outfit.

And frankly, the fact that it opens in the back, that is not even the greatest issue. It doesn't open in the front. So when the baby is born, how do you breastfeed? How do you get them you have to take the entire thing off or bunch up this immense amount of this this tent of amount amount of fabric, because it's it's a one size thing, it's this huge gown to bunch it up to your neck to bond with your baby. How did they not think of doing something about this?

Well, you know, they do a lot of people wear them the other way around.

When they get Okay, good for them. Why not? However still, that is not sufficient. I don't understand

I my font is gaping open? Yeah. I mean, I just I don't understand why they have not created a birthing people have it's just a private private companies have the hospitals haven't. And I think that they really should, because it's fun, and it's great. Yeah, they make like wraparound dresses, they can open up in the front. But here's the main thing, you need to know whether you buy your own special birthing gown on the side, or bring your own garment to where you can wear your own garments. The bottom line is, if you get any pushback from the hospital, it doesn't matter because you can always wear what you want. But they do have one fair argument, which is your let's say your night shirt that you sleep in or whatever. It's not, quote, medically appropriate. And what that means is they can open it up at the shoulder with snaps or Velcro, if they need to thread an IV, they can't get that through the neck line and the sleeve of an ordinary top. So that might be their argument, you can still wear what you want. But if you have something that does open up at the sleeve, you kind of get them off your back, not that you need to. But the bottom line is where what makes you feel comfortable. And you're right on for thinking in terms of being able to bond as soon as that baby comes out.

You know, it's not just about being able to be skin to scan and bonding with the baby. It's also very much that your instinct, the instinct for most women, when they're giving birth is to want to get rid of every thing that's touching their skin, everything wants to come off you like everything feels like too much. And at home birth, it's very easy to just get naked. And most people end up that way. Sometimes people end up just staying in a bra. But I've seen that come off plenty of times. And the thing is in a hospital, it feels awkward to get naked because God knows how many people are in the room with you, you know, strangers in the room with you. And then these hospital gowns just are so impractical for birth, and it's so uncomfortable. And it's just one of those things that is like this little distraction in labor that is not helping the physiologic birth process made up I'd like to just say, we're nothing. But I understand to that, you know, when people were walking in and out of the room every 10 minutes and who knows who's walking in? That doesn't feel great either. Although plenty of women end up that way.

They've seen it all no matter where you give birth.

Right? Yes.

I mean, the day you met me I was wearing Absolutely not.

Well, yes, I mean, that is almost always the case at a homebrew you were naked when we met.

Well, no, I wasn't when we met but a few hours later I was pretty quickly after.

I cannot say that anyone else I've ever known in my life. So good for me.

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She writes, hi, we just found out we are a surprise pregnant with baby number two. Pretty soon after we had baby number one, we're really unsure about timing. So we had an ultrasound to figure out the dates. I was a little bummed about this because I wanted to avoid ultrasounds with my next pregnancy except the 20 week anatomy scan. I met a traditional ob right now but I'm planning to switch to birthing center to do a more natural route this time. In the ultrasound, they found a hematoma. She wrote, they found a hematoma slash hemorrhage, whatever you want to call it. I had one in my first pregnancy, and I got pretty big at one point. So I was getting ultrasounds fairly often. I had four ultrasounds before the 18 week mark with my last one and it had gone away. My main question is how big of a deal are hematomas I'm on pelvic rest, but I'm still breastfeeding my first and lifting him all day long. They had me not lift more than 10 pounds at one point in my pregnancy with him. I don't want to ignore it. But I also don't want to continue getting ultrasounds to monitor it if they're not necessary. I know if it doesn't go away, a traditional ob would want to do a C section. But would that be necessary? I don't want to not take necessary precautions. But I also don't want to make a mountain out of a molehill. Thanks for any input you have to offer. She said it so well. I don't want to not take necessary precautions. That's the uncomfortable place. We're usually and we don't want to not do the responsible thing. But then how can we keep it more natural? And how can we keep it safer? To every extent that we really should? So Trisha, what do you want to say about this?

Well, I believe what she's referring to is something called a sub chorionic hemorrhage, which is a small bleed that happens between the uterine lining and the outer layer of the amniotic sac. It's actually fairly common in pregnancy. And oftentimes, this occurs and it's if you don't have an early ultrasound or an ultrasound before the 18 to 20 week anatomy scan, it's not even picked up. Or if you don't have spotting in pregnancy, that's another that would be another indication for getting an ultrasound that may lead to this diagnosis. But the truth is they are common and they are self limiting. And they don't really change the outcome of the pregnancy. There has been some studies in the past that have said that people with subchorionic hemorrhage or bleeding in early pregnancy have a higher rate of miscarriage. But there are also others more recent studies that say that it has no impact on the rate of miscarriage, I think that she should feel reassured that this is okay. And that she doesn't need to have excessive monitoring, that it will resolve and that it really should not have any impact on the outcome of mode of delivery. So her concern about having to have a C section, whether she stays with this ob it sounds like she's not going to but whether she did or not, she should absolutely still be able to have a vaginal birth. The point about having not having been on pelvic rest and not and being advised to not lift more than 10 pounds at any point in your pregnancy. You know what, with a toddler? Now, that's just not possible

with a grocery bag that it's impossible. 10 pounds. Yeah. So

you know, you're gonna have to let that go.

Okay, here's the next one. I have a question that's been driving me crazy. And I'm hoping you can answer. I've been working so hard to make sure I'm in healthy fit shape to birth at the birthing center. So I can have a water birth. My recent fear is what if the baby's head comes out, but his body gets stuck. I'm so nervous. Too much time will go by between the head and body coming out that he would inhale some of the water. It seems silly, but I've been totally freaked out about it. Does this happen? Trisha, why don't you explain?

So this is another one that we recently did a little igtv on? Because it is not a silly question. This is a question that so many people wonder about and even birth professionals sometimes wonder about this. And there is a lot of misunderstanding and misinformation about what happens when a baby is born underwater. And the truth is that your baby's head will be born under the water and it will take some time before the rest of the body comes out. I mean, sometimes it happens really quickly. Sometimes it takes

minutes.

minutes. Yes, even though even you know more.

No, no, no, no.

Definitely not days. It should happen within a few minutes. So basically after your baby's head is born underwater, they are going to still be getting oxygen via the placenta and the umbilical cord and they also have a protective reflex. built in so that they don't breathe underwater, the instinct to breathe for a newborn baby happens when they are in contact with room air. It's actually the effect of gravity and the level of oxygen in the air that that causes them to have the reflex to take their first breath. So as long as they are still underwater, they will not have that instinct to breathe.

And it's common sense when you think about it, because a baby is in water in utero, and they're not, they don't have the instinct to use their lungs to breathe. So when they go from the water inside of you to the water outside of you, nothing changes for the baby, except maybe a mild temperature change in the water, but nothing in those reflexes changes at all until they touch air.

I actually mentioned in the igtv, that the hormones of labor actually reduce fetal breathing movements in the labor process, so they are less likely to gasp and breathe as well. And I don't know if I mentioned this in the igtv. But I will say it here too, that when a baby is born, the compression that their lungs and their thorax, their body goes through coming through the birth canal. When they come out, it expands. And that's another mechanical mechanism that helps a baby to take their first breath. So while their head is out, and their body is in, none of these things are activated. Just another important note to make that once a baby does take their first breath once you have lifted them out of the water, and that instinct to breathe has been initiated. You absolutely do not put them back under water.

Yeah, once we're using lungs.

Now word we keep using them. Yes,

yeah. So that no longer filled with water. And yeah, everything changes at that point, even if an hoard is still intact, you're saying we do not put the baby back underwater,

even though infants and if you've ever, you know, seen infant swimming classes and stuff, they do still have that instinct to hold their breath when they go underwater. But it's certainly not something we practice in birth.

So Trisha, you remember having Elena Trinity law demon OVA on our podcast, you say her name. So take pride in that law dimitrova. She had that beautiful documentary out called birth as we know it. And I don't know if you've seen it, but they have water births in that movie where the baby is born into water, in some cases, right in the Black Sea. And they intentionally holds the baby underwater after the baby emerges. They hold the baby and you see this little human being under the water a few inches below the surface of the water, looking up, blinking, taking it all in. And yeah, part of your brain is like, Oh my god, it's a human being take it out, and you realize they're fine. I mean, it's shocking when you look at it. But they do that intentionally. They do that purposefully, slowly, because they want the baby in this approach of spiritual midwifery, to slowly acclimate to the world outside. So the baby comes out and gets a little bit of light for the first time, they get a little more sound than they've had in utero. And they still wait a little bit of time before they experience air, which is such a shock, coming from 99 degree water into 70 something degree air. And that's the last thing they finally do after 30 years, or 60 seconds, they just slowly let the baby come out. And the last thing is to feel air, it's very cool to witness in her movie. It is beautiful to see and you know, the slow transitions and waterbirth absolutely, you know, can be done that way. It's just it's hard, it's hard to get enough. It's hard enough to get support for for medical practitioners in general to do waterbirth that the recommendation is generally to bring them to the surface right

away. I love to see babies brought to the surface, just their face, breaking the surface of the waters, their their face in their heads. So they take that first breath, but keeping their whole body underwater so that they better thermoregulate or bring brought right up to the mom's chest and covered with a towel because remember, when they come out of the water, they are going to cool off faster because they're wet. And they should be well covered. I just have a little funny story to share. When my second born Ruby was born. She was born underwater. And I had this idea because I had seen those videos. Birth into being videos.

Yeah, that was her first movie. That's right.

I had seen that and I thought it was so beautiful. And it inspired me and Ruby was my first waterbirth and I kind of had the same idea that that would go that way. And I remember I was on my knees giving birth to her. And I looked down and I saw her face come out. And her mouth was wide open. Like she was yelling. And of course she wasn't actually yelling. She hadn't taken her first breath.

But I just looked down and I thought oh my god. I have to bring this baby to the surface and I immediately brought it to the surface. It's like she looks like she's gasping for air right?

She looked like She was shouted like, and her mouth was wide open. yelling, and but she was hilarious thing. No, she wasn't, she just had her mouth open. But she didn't inhale any water. She hadn't taken a breath. And I brought it right to the surface. And she immediately cried. And literally, every picture I have of Ruby for the first six months of her life is with her mouth widen. It's just just, it's her thing. It's just her. It was her. But that whole idea of like, letting her drift under the water for a while and slowly bringing her up went out the window. That's hilarious.

Okay, I think we have time for one more,

right? Sure.

So we're not gonna get to that really deep, long one right now.

We'll take that on another time. Okay, that's a big question.

Okay, Trisha, this one is in from a mom who's expecting any day now. And it says, When is the best time to pump in between feedings?

Hmm, the real question here is what's the purpose of the pumping. So if the purpose of the pumping is to increase milk supply, which often is the reason people pump, then you would want to pump immediately following the feed. And the reason for that would be that after you feed if you if you're not producing enough milk to meet your baby's needs, you want to give your breasts the message that they need to make more milk. So if you put the so if you feed your baby, and then you put the pump on after the feeding, your breasts are going to get the signal that they need to make more milk. So immediately after the feed is the time to pump if you are trying to increase your milk supply. If you're pumping simply because you want to give your baby milk in a bottle your breast milk in a bottle because you're going to work or you're going out for the afternoon or you're going out for the evening or whatever it is, then pumping closer to the time that you would normally feed would be recommended. So that you can pump the right amount of milk. So really depends on the situation. Anytime you need to pump though, I think it's a good idea to be in constant be in consultation, or at least have had a conversation with a lactation consultant. So you really understand why you're pumping.

I think the most common reason is that women are storing up for when they return to work. And I know you have a lot to say about that, that you don't need a major stash of the freezer before you go to work. You want to just have like a few days at a time. And when you're at work, basically pump for the next few days sort of thing.

Yeah, I'm glad you said that, actually, because that would be the other most common reason that somebody would be pumping and that if that is the case, I usually recommend starting to pump just about two weeks before you go back to work and pumping after your first morning feed. And the reason for that is that in the morning, we tend to make more milk so you feed your baby. And then you pump after that to get whatever amount of milk that your baby didn't drink because it's the time of day that we tend to make the most milk that's usually when we have the most leftover and you don't need a lot of milk stored before you go back to work because you're going to pump the amount of milk that your baby will need for the next day. The day you are at work.

Thank you Trisha. And thank you everyone who sent in questions this week. If we didn't get to your question, we may be answering it on an Instagram television video so be sure to follow us at down to birth show and go to our website down to birth show.com to submit your questions for the next episode. Please share this episode if you're willing to give it a review if you are willing and thank you so much for listening and being a part of our community.

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