#250 | January Q&A: Cervical Massage, VBAC Provider Red Flags, Due Date Calculation, Infant Sleep, Sufficient Milk Supply, RhoGAM and More

Hello and is it too late to still say Happy New Year?! Cynthia & Trisha are back with the first Q&A of 2024 in season five of the Down to Birth Show! We kick it off today by sharing some of your highs and lows from the holiday season. Next, we get into our questions beginning with a mother who had low milk supply with her first baby and wonders what she can do in pregnancy and birth to prevent it from happening again; one curious listener wants to know if she can check her own cervix to help determine at what point she should go to the hospital; another caller asks us to explain why due dates are based on your last menstrual period rather than your ovulation date--what happens to those two weeks?

In our extended version, available on Apple subscriptions and Patreon, we first answer a question about normal, healthy sleep patterns for infants and the pressure mothers face to have the baby "sleep through the night." Then we answer if and when "cervical massage" is indicated for a cervix that might be scarred from a previous cervical procedure. Another mom is concerned that her midwives missed a case of early jaundice in her newborn and inquires if getting the RhoGAM shot in pregnancy could have prevented the jaundice. Finally, one mother explains her OB's behavior around her choice to have a VBAC and we chime in with our take on his audacity!

Last, we close with a round of quickies addressing morning sickness, postpartum hemorrhage, GBS swabbing, IUGR and the strangest things we've ever eaten!

Thank you for your great questions and keep them coming at 802-438-3696 or 802-GET-DOWN.

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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.

All right. So I posted on Instagram the day after Christmas. Tell us your favorite or least favorite thing about the holidays. The tricky thing about the holidays is we go into them with expectations often too high. But for some too low because they're anticipating drama that may never come. My mother in law complained about her gift and my sister in law also included her two cents on the gift. We got my mother in law. Nice. Typical, I don't know typical, but his mom honored our boundaries. No screens, no processed foods, no questions asked see. Wonderful. Awesome. Had to host Christmas Eve at the last minute due to my aunt getting COVID I usually don't read anything with the word COVID in it, but there I slipped. Like one of my least favorite topics. My three year old favorite word. It's just even during COVID I was sick of hearing that word. So everyone got Wednesday. Okay, I don't want to hear any sick ones. We're going to skip all those. I received a book series not a book. She received a book series on how to be a good wife and homemaker from her mother. Wow. Wow. Wow, who wrote that series?

Wow. Very curious. I don't know we can ask her but holy cow. My entire household got Okay. More about the flu. We're not interested in that. Found out husband of seven years has been cheating. I am leaving. Whoa. A pinkeye 101 seconds. We want to talk about health care. No, just kidding. I'm 38 weeks pregnant. Grandma asked how much weight I've gained. It's no surprise. Another about the flu. We wait, what was the original question? Tell us the higher low the best. That's what I thought. Okay, well, what was it?

I asked for it, I guess. Yeah. What was your Hi, my? Yeah. Oh my gosh, at my brother's house. So we had our beautiful brunch with everyone here. From like 11 to, I don't know, three or four or 5pm. Now we all went to my brother Nick's house. They have a beautiful, enormous tree. And we did all of our usual traditions. But this year before we open gifts, we dimmed the lights. He has a big Great Room with a ultra high like two story ceiling. And we blasted music and we danced. We just blast it not Christmas music. We just blast it in with my nieces and nephews are all in their early 20s. And it was just amazing. The eighth cousins like all of our kids, and we just danced and then I have a lot of musicians in my family so a lot of them gravitated over toward the piano the drums like guitar and before we When my son was playing guitars, my nieces nephews, my brother was at the piano and their music kind of took over from the music. We were blasting, but it was just awesome. It was wonderful. Debt. Nothing feels better than dancing in the world today.

Nothing is better than dancing. That is, that's where he let it all go.

Yeah. And, you know, a lot of my favorite movies involve dance like West Side Story and Billy Elliot and I'm a dance fiend. That was what was your high? I think the spontaneity of it all was what made that really special, but usually see spontaneity. There we go again. Of course. Yeah. So speaking of spontaneity, we had a that's a spontaneous outing to New Canaan. One night, the night before Christmas Eve, I think it was met up for a little I was actually working that day in New Canaan, and my family all just sort of met there and did some last minute Christmas shopping on the strip. And then after the dinner, we just felt like there was a nail salon next door and we don't we all get our nails and our toes done. And the whole family like 10 of us descended upon the nails. Salon. 45 minutes before they were closing. There was nobody in there because they were getting ready to close and took over every pedicure chair in the place. So that was fun. And Christmas Eve was just I had all my wrapping done before midnight. I was in bed, got a good night's sleep and everybody was so happy and Christmas morning that one complaint.

People complaining Oh, I've had some complaints in the past.

About why I can't even imagine what have I have one child who has a tradition of crying on Christmas? I can guess which course you want, say her name. Or name.

It's just terribly all about expectations.

Expectations. A little too high on Christmas morning.

I know. It sounds bad. Anyway, so mother in law only got me a $5 bathroom towel set and a snowman wine stopper. Maybe that's how the mother in law shops. Maybe it was not me. That's how she rolls. Maybe it's not supposed to be about the gifts. Right? Isn't that true? Well, I mean, it isn't it isn't. You know, I mean, it's it sounds made it that way it sounds perfect to say it's not about the gift, and it's not but it but it also is I mean, if you're giving someone special. If you're I don't know gift giving is not just a money thing. It is a lot of thought meaning and they're really touching lovely gifts you can give some right? So in stopper is not very meaningful. See it is and it isn't about the gift they'd like when it has meaning to it. It's it's so valuable. Okay, shall we get into the questions? Now?

Let's get into the question. All right, let's play the first one. By

Cynthia Trisha, this is Veronica from Virginia. And I just want to thank you so much for all the truth that you're spreading and the lies that you keep on squashing. And my question is in regards to breastfeeding. So I had somewhat of a traumatic birth, which I know contributed to the difficulties that we had with our nursing journey. And then my son had a heart latch, and we had the tang cards released and it still didn't work well. So I'm exclusively pumping and almost at a year at this point. What I want to know is as I prepare for conceiving again, what can I do for myself to ensure a good supply for my next baby? What can I do preconception once we conceived and immediately post part on knowing that there are some things that are out of my control, but want to know what I can do that is in my control? Thank you so much. Look forward to hearing the answer.

Squash some lies today. Yeah, so you know, I mean, prenatally pre birth, there really isn't too much you need to do for breastfeeding. There is obviously a trend to harvest colostrum these days. And I'm not opposed to that. But I also am not adamant that women do that. I think getting comfortable and familiar with your breast through learning hand expression prenatally is really helpful. Because if you do need to have Express, early postpartum, it's much better to be comfortable with it, rather than trying to learn it in those early hours just after having a baby when you're exhausted and not as receptive to learning things. So I like it kind of for that reason. If you have a little classroom on him, that can be helpful if you have a particularly sleepy baby. It sounds like a lot of her problem with breastfeeding though was really related to the fact that the baby had a tongue tie Yes, traumatic bursts can impact breastfeeding and birth interventions absolutely can interfere with establishing good latch in the beginning and frequency of breastfeeding, which is really important for getting your milk to come in and for keeping the baby's blood sugar levels up and keeping them energized. And so the best thing she can do is make sure that she is skin to skin with that baby after birth and not separated, just keep your baby with you and keep trying to get your baby to feed as many times as possible in those first 24 hours. The more they feed, the more colostrum they're going to get, the more energy they're going to have, the less likely they are to be jaundice, the better your milk is going to come in. Everything is just improved with more frequent feeding in the beginning. And if mom and baby are separated, that's very difficult to do.

What's the top reason? Learning how to hand Express is so important.

Because if a baby doesn't latch Well, in the first 24 hours, which many of them don't, because of birth interventions, then you can hand express your colostrum. And give it to your baby via your finger, a syringe a cup, and that helps get them energized and awake so that they can latch on to it just your hand works so much better than a pump when it's just colostrum.

Hi, ladies, my name is Laura. And I was just wondering, I'm gonna be going into a hospital and to give birth. And I'm just wondering if there's a way to tell if you are how far dilated you are? Just curious if you could do that at home. All right, thank you so much. Bye.

That's hilarious. That's so funny. Well, sure, you can check your own cervix,

You cannot. You can. You can.

You can?

I cannot.

Yes, you can.

I know. It's not that I can like maneuver myself, I practice yoga, I'm sure I can do all sorts of fun. I wouldn't know what to make of it. Most women, that's an art that you learned in midwifery school, that's most of us wouldn't know. Yeah, you wouldn't know what to call it. But it does get us into the mindset of who really cares, no one has to do a cervical exam. So I don't think going the the main thing here is that the decision to go to the hospital or not shouldn't be based on your cervical dilation. That's not the determining factor, right? Because you could be one centimeter and go to the hospital and be nine centimeters by the time we got there. Or you could be four or five centimeters, which is usually when they tell you to come in, and you could be four or five centimeters for the next eight hours. Right? So that's not the determining factor. The determining factor is your sense of I need to be in the hospital now. Right? I know I'm no longer in the right place. I'm no, I'm getting close to having my baby. And this is not where I'm having my baby. So I need to go. That's exactly the feeling I had my first pregnancy, my first and I had just gone into labor. And it was exactly that feeling. It was the feeling of I need to be in the place where this baby is coming out. I'm not at the birthing center, and I need to be there. And it was within five minutes of labor beginning I was just like I need to go right now. And sure enough, I got there. We went immediately got there. One hour after Labor began, I was six centimeters, two hours later was holding my son. And that gut instinct, like all I know is I need to be there. So we need to listen to that. Women never seem to love getting that advice of an engineer and they want a data point. They want a data point, they want to measure it, but you are most likely undermining your own incredible intuition. We really have great intuition and it takes a long time in life to start trusting it. Usually it doesn't happen immediately. When we're adults, we learned to develop it, we learned it as mothers as well. But just get quiet every now and then especially when you have anxiety about something and just ask yourself, Do I really know everything is okay right now, test your intuition and start to cultivate that trust in yourself. Because that's no better than you with things like a mom having her second or third or fourth baby knows when when it's time. It's just the first time you're going through labor. It's really hard. Yeah, to trust that feeling. But if you're still in doubt, you probably don't need to go yet.

I remember my husband called I was on my hands and knees labor had just begun. And I was like we need to go right now. And I remember the midwife who I didn't want, of course, was the one on call. And I heard her through the phone. My husband was right near me while I was on my hands and knees and I heard her saying, look, it's five in the morning. If you say you're going that I have to go and meet you but you just went into labor. And if you're not at least x centimeters, I'm going to send you back home. And I just had like another surge in that moment. And I said, tell her we're going right now. But she could have discouraged me if I didn't trust that instinct. I could have stayed home. And I was an hour from where I needed to be I was an hour away from the place. She shouldn't have said any of that. But I listened to the instinct that just said Nope. As a first time mom, I said, Nope, we're going anyway. And I hate that feeling of inconveniencing someone, and I did worry, oh, what if I'm wrong? What if she comes out of her way, but can't you can't do it? So go ahead and feel your own cervix. If you want. You're not gonna know what to do with the information when you get it anyway. You Yes.

Probably best not to do that.

Hi, my name is Melissa. And I just finished listening to your November q&a, and it was great. I did have a question. You talking about going over 4142 weeks. And I was just thinking back to when I was pregnant and how I have a very regular cycle. And with my daughter, I could tell when I ovulated they some cervical mucus. So I knew that I didn't ovulate on day 14. But it was more like the 80. I know I didn't concede my daughter until two weeks after my over two weeks after my menstrual cycle. But yet, I'm still calculated at my menstrual cycle as being two weeks over conception. So I just don't understand why we look at. If you go to four, you want to 42 weeks, that's going to increase all these issues. I wasn't even pregnant those first two weeks that they calculate into my measurement. So I'm just I'm confused about that, and how that pretty much put onto every woman. And even with my son, you're not pregnant the week of your period. And when I went to get my ultrasound, I was exactly eight weeks pregnant, but I wasn't pregnant that week, my period. I'm just interested to hear your thoughts on that. Why do you calculate like that? And why does that pose a risk for later in pregnancy? Thanks.

So there are two issues. One is she realizes like every other newly pregnant woman, this is totally weird that they count the first two weeks. They do for everyone they start with your last menstrual period makes no sense at all. And we're all like, what, what, like even pray there's a reason for it. Okay, so you're gonna explain that. Okay. So let's see, I know you will. And then the second part is that she ovulates about four days later than they assume she ovulate. So let's address that as well. Go ahead.

Yep. So due dates are calculated based on a formula called Nagle's rule, right. And it is based on your last menstrual period, because that is the marker that most women can track prior to ovulation kits and all the knowledge that we have with fertility awareness. Now, most people would really didn't necessarily know when they were ovulating, or it wasn't that talked about, but everybody kind of knew when they got their period. And that was something that was kept track of. So that was the best marker. And the assumption with Nagle's rule is that you ovulate on day 14. So pregnancy is 40 weeks from the first day of your last menstrual period. But that accounts for the first two weeks that you're not pregnant, why don't they just why didn't they just make it 38 weeks? And they start with when you actually can see, even if they're assuming the 28 day cycle, which is not always correct to assume? Why did they factor in those first two weeks?

Because the LMP, or the last menstrual period was the date that most people remembered. So it was just easiest to base it off that instead of adding 14 days, and then I don't? I don't know.

And 40 is such a nice round number, even though Yeah, wrong.

You calculate the due date based on your LMP plus seven days and then subtracts three months. And so there's like sort of this window of time, where you have seven days, which allows for some variation in ovulation, and then another seven days, which allows for the extra day of each of the seven months that have 31 days. So it is actually assuming you ovulate on day 14, calculating your due date based on ovulation. That is so weird. It's a little confusing. How does I'm adding three months is because you're taking that date and you're subtracting three months, but for the following year, it's for the Yeah, yes. Okay. Yeah, totally.

So the problem where the problem comes in really is just around women don't all these ovulate on day 14. Some women ovulate on day 10. Some women ovulate on day 18. And that matters, because that's four or five days different if you ovulate on day 18. Your due date is actually four days later. But that is generally not factored in since we're using LMP instead of ovulation date. Does that mean we're ssuming that we're using an ovulation date of the day 14 instead of 18. So just going through it again one more time. If someone's period is two In First, how do they get to the due date?

Seven days?

June 7, so June 8, yeah, minus three minus three months, march 8. Yes. And that's the 40 weeks of gestation.

I don't understand this extra seven day thing, even though they're seven months with 31 days, because if you go from March 1, two, if you go from June 1 to march 1, you already did factor in all those 30 and 31 day months, just because you're saying March 1, right away, you factored it in, you're not doing 30 days times nine, you're doing it by month. So you already factored in the extra day, per month. So that doesn't make any sense to me. I wonder why they do that. That doesn't make sense. Because to go from, you know, July 1 to August 1 is 31 days. So you're immediately factored in if you're gonna go by the calendar month. So that's really odd that they add the seven days, I'm glad they do, because they push us out the date a little. But I it doesn't make common sense to me at all. It's just one of those weird things as well.

I know. But this seven day thing, I don't get that I don't I don't think that can represent the extra day in the seven months. Plus, it doesn't even make sense because it's only nine months, it's only going to be four or five months with this. That's why it's that's why it's a loose. They say that your your actual due date is two weeks before or two weeks after, because dates are just due dates have gotta go. They've just got to go surveillance, things that we do in pregnancy require understanding, having some understanding of where you are in pregnancy.

I just always think of Carolyn angles. And she didn't do any of that. I always think it was very with everything. They didn't do it just went into labor. And you know, Doc Baker, I
don't know Nagle's rule has been around since Carolyn angles days. I think it's problematic. It's very problematic. We just didn't put so much emphasis on the end date. It's good to know about when you think you got pregnant and have a sense of when your baby is coming what I write but what I don't like is when a woman knows when she conceived, and women, Laura Ingalls, by the way, oh, Carolyn is the mother I think of Carolyn the mother. Yeah, Laura Ingalls Wilder is the daughter who grew up and wrote all the books. But Carolyn, I always think of Carolyn angles, because in the TV show, she's pregnant a few times. What I don't like is that a woman knows she's when she conceives a lot of the time, and then they just disregard her completely when she tells them. She's like, this doesn't make sense. I know when I can see her. They're like, No, nonetheless, this is our formula. If you know your conception date, and it does not align with your LMP date, then you should speak up.

Yeah, I mean, my feeling is just say like, I, I refuse your due date. And because if you simply say that, they're going to have a harder time coercing you into an unnecessary induction later, when they say, look, you're 40 weeks, and we want to induce you, you can say, I don't, I don't buy it. I'm not 40 weeks, and they their hands are a little bit tired. If they know they haven't convinced you of that. There's not really much you can do. But it's kind of easier if you just say, Well, I'm really not 40 weeks, and you know it for a fact.

But establish that in the beginning. Because you know that in the beginning and right off the bat when they give you a due date factor in the day you conceive, and then when they change it based on ultrasound, that's just crazy. I mean, if they move it out great, grab it, but if they tried to push it up, heck no. Heck no. She said, said the professional.

Hi, Cynthia. And Trisha, I was calling in to ask if you could talk about cervical massage in labor. I previously had a leap surgery and was told that I might have either an incompetent cervix or a stubborn one that won't open and needs a little help. Opening during labor via massage. I was just curious if you could talk about this because I want no cervical exams, if possible, and this potential issue would conflict with that. I really appreciate your insight on this, and I'm excited to hear what you say. I'd really like to know if there's any evidence anywhere in the world of a single man's penis being referred to as incompetent under any circumstance. Is it ever called incompetent? Or is it just us stubborn?

It's called dysfunctional?

Hostile, incompetent. I know it's called dysfunctional but incompetent. Yeah, that's a terrible name.

Incompetent touches the ego. That's not a nice one.

It's a terrible term, terrible term. And the idea of cervical massage. Sounds horrendous. So the idea of cervical massage and labor, I mean, don't call it massage. You know what that is? Not massage that is not going to feel good.

What even is it? What is this? What is what should we What is she thinking of stretching? Massaging Polycom membranes?

No, I mean, who would do such a thing to this woman who would do this? Her midwife or OB?

Do they call it him? Anyone?

Anyone? Well, that's what I'm saying. Don't call it a massage because a massage is intended to relax you. This is not going to relax you this is going to cause pain. I mean, talk about how uncomfortable a vaginal exam is, you start stretching and massaging the cervix on top of examining it. That is painful. Can we just get out of there? I can't believe how we go inside women's bodies and touch stuff. I mean, I cannot believe it. I swear if the baby's head were not at the cervix, people would stick their hand all the way into the uterus and feel around and we get the heck out of women's bodies. The baby is going to come out of her body. We don't have to climb in there. I just find it so offensive. And we're normalizing it like as a society, we're normalizing going inside her body. It would be like going inside someone's body because they have to go to the bathroom. Like what has what has to come out will come out, including a baby. We can't normalize this. I don't know I I, my my friends. Nancy Waner calls such things barbaric. And I'm with her, I find all of it barbaric. When I just take a step back, and again, I think of like heroin angles. For the cavemen who preceded us, it's just crazy. When you think about anyone sticking their hands up inside of a woman, get the heck out. Get the heck out. You have a different opinion?

No, you have a point. I mean, I I'm a trained midwife who has learned to evaluate progress of labor through, you know, feeling a baby through the cervix. So, but have I learned over time that that's really unnecessary most of the time? Yes. Is it sometimes helpful and provides information and are situations where you actually, to protect the mother and baby do need to go inside? Like the potential for a cord prolapse? You need to evaluate that? Yes. So that we're not talking about you know, it's like at the end of pregnancy, we shouldn't just be doing this to women, I definitely understand that there is a reason for some of these things some of the time, but I think it's important to keep that big picture perspective. You know, you have like, let's say a pregnant dog, it the idea of us putting on a glove even and sticking our hands inside the dog is so offensive, disrespectful, scary to the dog, freaky weird to the dog, but we're normalizing humans. And I just want to remember I want to remind all of us, this is not something we should treat as normal. Yes, fine. Maybe it serves a purpose from time to time, but of course, but just like, it happens to virtually every woman.

Well, and it happens on an on a regular basis, you know, every two hours. That one an update on the cervical progress in many hospital births, and that I completely agree with is completely out of line inappropriate, not necessary, excessive. And if a woman is progressing, normally, there's no reason to ever feel inside her. Truly, it's really like late pregnancy isn't only

a variation in late pregnancy no and trying to massage a cervix. There's no such thing as massaging a cervix, it's never going to feel good. If you're, if your husband isn't doing it, you're not going to do it and he's not doing it just is string and that yeah, these euphemisms, they have these negative words for our bodies, like incompetent and stubborn. And then for what they're doing to us, they have this euphemism massage. It's like nice try. Right, right, right. Now, language is so powerful.

It really is. It's crazy. Do you know that estimated due dates used to be called estimated date of confinement and find meant confinement then it was changed to due date or delivery date, then it was changed to birth date, estimated date of birth.

All right. If you are with us on Apple or Patreon, we're moving on to our extended questions. Otherwise, it is time for quickies. But if you haven't joined us yet on Apple, it's less than $30 a year for ad free episodes every week and every month, the extended version of this of our q&a episode, so please consider joining and supporting us and if you're on Patreon with us, there's a whole host of other benefits that come with that as well. So we hope to see you in the extended versions and ad free versions of these episodes. Again, otherwise, it is time for quickies.

Okay, quickie time. Our favorite time. Let's see how quick we can be huh? Oh, work on it. All right. There we go. Okay, do you have any quick tips for morning sickness? My quickest tip for morning sickness is to eat frequently. Don't go more than two to three hours between meals and eat protein and fiber at every meal. Because that stabilizes your blood sugar keeps your tummy full, it makes your food digest over a longer period of time. And the thing that causes Morning sickness is the build up of the HCG hormone in your belly. So if you have more food in there, you're not going to be as influenced by that. Cool. And Ginger, Ginger, throw that in there. Why do you have to sweat? Okay, next, why do you have to swab your butt for GBs? Sorry, I don't know why find that funny.

You find it funny because a lot of even midwives say that's weird. We don't have to do that. They just have to swab the vaginal area. Why did it go to the anus for some women stay because, right? Well, because GBS lives in both locations. And so if you swab both locations, the concern is that if you swab one location and it's in the other location, you could also have it in the other location but not pick it up. That's why also if you test GBS positive in your urine, you have it everywhere because that means you have a higher colony count.

That's why I found my best way to keep these quick is just not to speak. Okay. If I speak I can't promise I'll keep it quick. Okay.

Well say something. Okay. Your second baby was if my second baby was IUGR. What are the chances of that happening again? Ooh, well, the first question is what your was your second baby? Actually? IUGR?

That's always the question. Right? Probably, and probably it wasn't right. And the chances are actually pretty low.

So how would she know? Okay, so if it was based only on an ultrasound that was reading of 10% or lower, that doesn't tell us anything? Did her baby's growth rate actually slow throughout her pregnancy over a period of time? And was the baby particularly small at birth? All right, next, if you blood too much in the first birth, can you prevent it in subsequent birth? So if you bleed too much, if you have a postpartum hemorrhage in the first birth, can you prevent it in a subsequent birth? Yes, episode. Say it, Cynthia, what is it?

Episode 227 tips for preventing postpartum hemorrhage with Ally woods. That was a great episode very informative, numerous ways to prevent hemorrhage and her story had a ton of credibility.

So head on over there and have a listen to that. That'll keep it quick. Does an IVF pregnancy automatically mean a high risk pregnancy?

Well, we were just talking about this today. That's so strange, isn't it? Yeah. Was still okay. So it means she's at higher risk of certain things developing in pregnancy, possibly, possibly a higher chance of certain things, certain complications occurring, but that does not necessarily make her a high risk pregnancy now, right? At my five month old exclusively, breastfed baby won't take a bottle What is your best tip? Skip the bottle. Five months, they don't need to start on a bottle. They can start on a sippy cup of transitional sippy cup. Open Cup, a straw cup. It's not as convenient. bottle is a little more convenient. But my best fastest tip would be just do skip the bottle. Straight to stemware.

I can talk. Martini glasses. They work every time their fine motor skills will become outstanding. If they learn to drink with a martini glass. Yes, it will do the brim way ahead

of the bell curve. Breast milk and a martini glass. I mean if you haven't tried it, you should. Oh, this one specifically to me. Wow, look at that. Trisha, did you ever attend a surprise twin birth? How often are twins missed these days? No, I never attended a surprise twin birth but I did one time attend a surprise breech birth. I remember that very early on in my midwifery career.

I thought a soft head was coming out and it was a scrotum? Yes, exactly. No, I thought it was a CT actually. Oh. Oh shit. Right. Here we go. i It was this great medical good. It's just a scrotum.

Yeah, way relieved. I mean, twins should not be missed these days because most people have an ultrasound but we also did an episode recently. With purely persons who had a ultrasound in late pregnancy and they still missed twins.

Yep, that was episode 240. Really good birth story.

Super fun story. I mean, unfathomable. I still try to imagine you think you her placenta is coming out and another baby's coming out. It's just like, unbelievable.

All right, what items should I have on hand for mastitis? The best, best thing? Yeah, your hands and your hands are going to be really helpful. They're not to massage your breast, though. Massage is overrated when it comes to plug backs and mastitis and can make it worse. But just to gently do some physical therapy with your breast breast gymnastics as it's known. And you should also have ice packs cold packs, the Lansinoh purple gel packs are my favorite because they have a little hole cut out for the nipple and you can just put them in your bra and they feel great and ibuprofen, anti anything anti inflammatory if you don't want to take ibuprofen, some natural Tumeric anti inflammatory treatment.

So the red cabbage leaf thing that is just soothing because it's nice and cold, but it's not. There's nothing magical about it.

No actually cold cabbage leaves the those are commonly recommended for enlargement. You could also use them if you were experiencing mastitis. But the cabbage does have a compound in it that helps draw out. Swelling. Cool.

See, that's what Carolyn Ingalls would have used that.

Exactly. her hands and her cabbage. Okay, last one. What is the weirdest thing you've ever eaten?

Oh, God. I was in South Korea on business once and that was definitely a time of eating weird things.

I'm sure you probably didn't know what you were eating.

I mean, I was not very comfortable. Where you registering them. I was but I'm pescatarian and they had all sorts of sorts of sea animals. So I didn't have to eat certain things. But you know, it's a lightness. You kind of have to eat some stuff. Okay,

well, mine is really easy, because it's really weird and crazy. When I was living out west, I went to the testicle festival in Rock Creek.

Just stop right there. Are you kidding? It's,

it's a it actually doesn't produce anymore.

There's a man on Instagram who has a whole page of cows and I'm telling you they're as precious as dogs like they can't I know you're such beautiful gentle animals.

They really are. Finish your testicle story. This is your second one for the opposite. They should not be this way. Okay, well, it's a it's a festival of testicles and people eats the cow testicles. Okay, and I did try one.

Did you swallow it whole?

No, that's very large. I got fried chicken Biden said no, I can't do this.

I don't remember. Wow. But I like the question though. It's fun question. I know I'm forgetting something. I know. There's something I'm totally forgetting. went right to South Korea, because that was the most uncomfortable I've ever been around food. Because there felt like there was pressure on me to to eat all these beautiful fancy things that they've put in front of us. But I know I'm blanking on something I hate bear one time. Yeah, you talked about that once. That was said. All right. That's a wrap.

That's a wrap for January. Please continue to call in with your fantastic questions. 802-438-3696 or 802. Get down a to two get down, get down. We will not pick up we promise. And if you only did that once. So impersonal. Never again. Never again. It is officially forwarded you can call 24/7 I promise I will not pick up.

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Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.