#267 | May Q&A: Pre-eclampsia & Gestational Diabetes, Steroids for Pre-Term Labor, Declining the Anatomy Scan, IM vs. IV Pitocin, Preventing Mastitis

Hello everyone! Cynthia and Trisha are back with the May Q&A episode. Today, we kick it off with an enlightening discussion on the worst parenting advice you have ever received--here's to all the things we never need to hear as mothers! Next, we hear one woman's beautiful take on her cesarean scar. Then, we dive into your awesome questions beginning with:

• What is the likelihood that if I had pre-eclampsia and gestational diabetes in my first pregnancy that I will have it again, and what can be done about it?
• If I have a history of pre-term labor twice, should I take steroids preventatively at 30 weeks by my doctor's recommendation?
• I am pregnant with my fourth baby, planning a home birth, and I don't want any ultrasounds. Do you think this is ok and will my midwife approve?

In the extended version of the episode, available on Apple subscriptions and Patreon,  we discuss the pros and cons of the midwifery lifestyle for one woman trying to decide if she should go the CNM or CPM route; when it is appropriate or necessary to take a urine sample in pregnancy; and why one mother may have been given intramuscular Pitocin instead of intravenous when she already had an IV in place.

As always, we close with a round of quickies touching on how to keep breastfeeding while pregnant, getting induced for "mild" pre-eclampsia, what a high LH reading means, preventing mastitis when you have a plugged duct, our recommended prenatal vitamin, and our most embarrassing moments in public!

Thank you as always for your wonderful questions! Please call in your question to 802-GET-DOWN or 802-438-3696. To get the extended version of today's episode (and all episodes 100% ad-free) just click the subscribe button on Apple Podcasts or download the Patreon App and join any tier.

If you enjoyed this episode, please see our April Q&A episode:
#262 | April Q&A: Prenatal Vitamins, Premature Rupture of Membranes, Painless Breech Birth, Precipitous Labor, HypnoBirthing, Prenatal Hypertension

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Transcript

Hi, Cynthia Trisha, I have a question about steroid injections at 30 weeks, everything I found online has specified that the injections are for birth imminent within the next week. Are these injections a good idea?

Would there be a reason not to do and I've been thinking about getting pregnant again. But I'm just terrified of the situation happening all over again. So I've been very wary of who to trust and who to select. As a provider, I really feel strongly that I do not want a 20 week ultrasound. I also don't want to find out the sex of my baby and I really don't want anyone else knowing before I do. What are your opinions and how can I approach her so that she can understand my choice and be okay with?

 Okay, my period suggests they do one due date. But my anatomy scan says it's two weeks later, which is more accurate.

The later one.

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.

It is so lovely. I'm so happy. I say that it's 80 degrees and gorgeous out because we don't talk about the weather on the show. Now, but nice to hear about the weather. But it is gorgeous.

I love love that I can be in a tank top and shorts and be perfectly comfortable.

We just posted a couple of hours ago. What did I ask? What's the worst? Let's say? What is the worst pregnancy marriage or parenting advice you've ever received? And that was a couple hours ago. So let's open this up and see what's coming in. All right, let me open this up because I haven't seen these yet. All right, this one says, Oh, this is right. Bad advice. I forgot where I forgot the question for a second. So this one says Don't let your kids go outside with wet hair or they'll get pneumonia. Oh, silly pneumonia. Oh, this can't this i This is painful to read sandpaper, your nipples before the baby comes.

Oh gosh. Oh my gosh. Well, yeah. Oh, yes. So many women are told that toughen them up.

I would love to know what your man came up with that.

I want to know if anybody's actually tried that. Please don't, ya know, very bad idea. It will never work. It will never help anyone saying

it. Yeah. Sleep when the baby sleeps. Everyone gets that one. I was told postpartum depression isn't real. And we all survived when we had you guys. Nice.

Wow. That survived. Right? What does that mean? If that's true? How about how about when we like you

stay at home, then your husband won't be responsible for as much anymore mother in law. What does that mean?

If you stay at home, your husband won't be as responsible meaning that she will take on all the home responsibility and he won't learn how to be responsible at home.

I don't know why would a mother in law say that anyway? Follow the science. Okay, that's definitely valid. When babies cry, it's good for them. It's exercise valid. At follow the science is a valid bad advice.

Oh, thank you. I thought we were ever gonna have a big problem here. And it's and it's and it's bad advice because it's rhetoric. That's why follow the science doesn't mean anything. The science is always changing the science can manipulate data. The science is the science exists as much to be contrary to what the typical standard mainstream rhetoric is. And that too is science. So what does it even mean to say follow the science? Yeah, I mean, sometimes the science is shit. Right? Now we have to mark this episode as bad language because of your potty mouth. Good. Scrub your nipples with the costs to prep for nursing discomfort see here. And here it is, again. Women are told that they need to toughen up their nipples. I mean, mothers still say to me in the early weeks was sore nipples. Isn't this just what I'm supposed to endure? Isn't this just part of it? Aren't they going to just toughen up, they'll still say that. It's very ingrained.

Well, you don't want to hold your baby all the time, because then you'll spoil him. That is one of the most. The one that's just one of the biggest myths of parenting. Right there. So many people believe that and that's deeply embedded in mothers. And it is so far from the truth.

I just wanted me The adult that was held too much, who's now spoiled, and they're just like going through life and no one can get along with them and no one can deal with them because they were held too much. Baby is thirsty, give them some water. Someone at my two month old baby. Someone said that regarding her two month old baby baby's thirsty, give them water. No, no, no milk. Only milk, which is a liquid.

The doctor will do an episiotomy anyway, so don't worry about tearing roof. You know what women just have to stop talking to people. You just have to go a few years talking to no one else but other moms.

And stay off social media. Oh, we heard this one's look at this one. Remember this one. Don't raise your arms above your head, it will tangle the baby's cord and will die. I see that to me. You know that's unforgivable to me. If anyone says the word die, that's unforgivable. Like that's it relationship over I don't care if a doctor says it. I don't care. Because anyone who cares about your baby should never speak that way. But this Don't raise your arms. From that would resolve so much of this stuff. Just the common sense. Obvious, I guess, doesn't attach to the arms. And obviously, I can't, I couldn't get my mind around how they make this correlation.

They just heard it and they repeat it they people repeat things mindlessly. That's the that is exactly the problem. People repeat things mindlessly. And that was one of the things that some other woman heard and as she is mindlessly repeating it. If we if we bet share, we will never be able to have sex again. See now who would give advice like that to a woman who would like get out of my bedroom? Oh, yes, life. I was once given that advice from a family member. Someone told you you're never gonna have sex again. Well, not exactly. But basically never left the children in the bed. Or otherwise your marriage would be ruined. I did get that advice.

Because if the baby is in a crib in another room, you're definitely having very hot sex all the time.

And here. Yeah, your husband can do no wrong if the baby sleeps in the other room. Right? And you just you have to have him all the time when you're on hours of sleep every night, right? All the time every night. Right? Okay. Every old lady ever telling me that my child would be happier if I put some white? If I put socks on her? happier if I put socks on? You're happier. Babies without socks are not happy.

I mean, I love socks. Don't get me wrong. No, some babies are so annoying. They just constantly fall off. Pregnancy, I would say the opposite. They're happier without them.

You shouldn't go too far past your due date. You don't want to overcook him. Nice, smart and intelligent person commenting. Very helpful. Over over cook. Very nice. Pregnancy was hard. A man told me quote, it's way easier to be pregnant than to have a newborn. Well, that's not true for everyone.

I'm sure he knows from personal experience. Yeah, exactly.

That I had to eat processed carbs or the baby would die. What There we go. Another person that has to be cut out of somebody's life that I had to eat processed carbs. Or the baby would die. I had GD and was trying to control with food.

Next one, but the whole thing makes no sense. Oh, no, it makes no sense. Or the baby would die process. Okay, here's the here's the kicker, processed foods, which no one throughout history had until like, I don't know, 70 years ago, no one had processed food. And somehow babies didn't die.

Right? opposite, right? Avoid the processed foods, of course, but I'm just saying how can anyone even believe even how can anyone even believe it? Because we've been doing this for like, millions of years, and we've had processed food for seven days. So again, just a dose of common sense would really save a lot of pregnant women from hearing this nonsense. To wait to give my baby solids until a year old my babies were all begging for solids at six months. Don't sleep with your you've a comment. Well year who's saying that? Why that's never the advice. Six months is the advice. Don't course they were begging they're way past the developmental stage of wanting it. By the time they're a year. Don't sleep with your baby.

worst advice you're eating for to eat more. And another woman wrote I'm really sick of hearing how co sleeping will affect my sex life told my mom I'll start texting her every time my husband gets lonely so she can stop worrying.

Perfect. Wow, way to shut her up.

Wow. That's impressive. Wow, that'll make that mob never speak again. Yeah. All right. I'm gonna play a message we received from a woman that I wanted to kick off our episode with so let me pull it up.

Hi, my name is Heidi and I've been doing a deep dive listening to your show for the last few months. I had my baby girl just over a year ago on Valentine's Day and And then currently six and a half weeks pregnant with baby number two. And I am very enthusiastically pursuing my very first VBAC. And I just wanted to say I've been listening to all the feedback episodes, and they've been fantastic and super empowering. And one little comment, I wanted to make something that helped me process. My VBAC after my birth story. It wasn't too traumatic, it was a failure to progress situation. But my husband and I were okay and at peace with the decision until after the fact, after a few weeks, I realized, you know, I wish things could have gone differently. But now, when I look down at my C section, Scar, I think of it as a tattoo. And I do have a couple of tattoos and I'm a fan of them, they tell a story. So I like to like to share this with women who are maybe having a hard time processing their C section story. And it is my C section is my tattoo of my baby girls birth. And I try to look at it and the the lens through the lens of I'm grateful and lucky that when I look down and see this scar, I'm reminded that she came into this world and she was our little she is our little Valentine. And it's something I get to carry on my body for the rest of my life. And it makes me process it a little bit easier. So thank you for everything you do keep up the great work, and I will enthusiastically continue listening to your episode. Take care.

I love it. I love when women call in and just share stories like that really enjoy it. This reminds me of when we did a recent birth story processing session with a woman and we had to talk with her about the story we tell ourselves. And this is a perfect example of a woman who decided on the story she was going to make out of her birth, where some women can say my body failed me, or everyone else failed me and all of those things are very real experiences. But she could have just as easily done that. But she chose to turn it into this cute little uplifting story like well, it's another tattoo on my body. And she feels great about it. And I just, it's it's great. I love it. It's a way of controlling how we think we do have control over our thoughts.

I know you can can look down and hate it and resent it and think it's you know, damage done to your body or you can look at it and think that it is a beautiful mark of the sort of challenges that you faced and overcame in your life. Are you familiar with the I'm going I'm there's no way I'm gonna be able to say the name correctly. But there's a Japanese tradition of the breaking of the bowl and the putting back the bowl all the pieces of the bowl with gold like how it makes the bowl stronger. Yeah, right wounds in the healing make the whole unit stronger. Japanese pottery. It's fascinating to look at Yeah. Kintsugi it Yes, and it means golden repair. And the philosophy is that the value of the object is not in its beauty, but in the imperfections and that these imperfections are something to celebrate, not hide. That's right. Thank you for that analogy. That's a great one.

Hey, Cynthia, and Trisha, this is Genevieve from Michigan calling in to ask a question I wanted to ask on the show. So other people who are curious about it might have the same questions and answers. So I had pretty bad severe preeclampsia, my first birth that was totally unexpected. I was going the natural birth route. And it caused a very traumatic birth experience for me in the hospital. And I've been thinking about getting pregnant again. But I'm just terrified of the situation happening all over again. So I've been very wary of who to trust and who to select as a provider. So I guess I was wondering how common is it to get preeclampsia in the next pregnancy? And also, gestational diabetes is something that I was told I had as well. And is that going to automatically eliminate me from midwifery care or natural birthing center? Or does it just depend based on the midwife and what they're comfortable with? Is there anything I can do? I've tried to do some research on preeclampsia. As far as the baby aspirin I've heard trace minerals, eating a lot of trace minerals throughout pregnancy can help. So just curious how to kind of prepare and go about setting my own expectations and providers. I appreciate everything you ladies do. Thank you.

So there is definitely a risk of recurrence with both preeclampsia and gestational diabetes. The risk is a little bit greater in the research with gestational diabetes than it is preeclampsia. I believe it is about a quarter of women on average who have preeclampsia in one pregnancy will have preeclampsia in a subsequent pregnancy. And it's a little bit higher. Almost half of women who have gestational diabetes will potentially experience gestational diabetes in a subsequent pregnancy. Both of these conditions are sometimes out of a woman's control, but often If we can influence them. So there are definitely associations with the development of preeclampsia and gestational diabetes that are within our control and things that we can do in our lifestyle and nutrition to help prevent them. Once they are sort of set in motion. It can be difficult, especially with preeclampsia to really turn the tides, gestational diabetes, you can, you can certainly manage your blood sugar. And if you can manage your blood sugar and you have a diagnosis of gestational diabetes, you really don't have anything to worry about. It's all about that blood sugar control. But some of the things that have been identified as key players in preeclampsia prevention, or have been done have been shown to be low or deficient in women who have preeclampsia are magnesium, vitamin D, choline, potassium, so yes, trace minerals. Most people are deficient in magnesium and vitamin D. Most people are not even eating or consuming enough sodium or they're getting their sodium from the wrong sources. Things like choline are really highly prevalent in eggs. So the recommendation to eat eggs and pregnancy is a great one. protein deficiency is a major player. Women who consume less than 6065 grams of protein a day in pregnancy have a higher risk of preeclampsia. So one of the first recommendations if you're trending in that direction is to increase your protein in pregnancy. Um, high intake of those refined carbohydrates highly correlated with you know, abnormal blood sugar abnormal insulin resistance, which correlate with both gestational diabetes and pre eclampsia. So definitely there are things that can be done.

And the National Institute for Health also released some information recently, just one or two years ago that vitamin E can significantly reduce preeclampsia, which was interesting.

Yes, vitamin? Yeah, vitamin E. And also, I forgot to mention glycine, glycine, which helps with the integrity of flex or the flexibility of blood vessels.

And I think it was vitamin C, vitamin E in the first trimester. That was interesting. And what else Oh, and exercise Did you say exercise? I didn't hear that.

I mean, exercise movement, you know, that controls your insulin and your blood sugar, which is a major, major player in all of this. If you are concerned about getting enough magnesium, potassium, and sodium in your diet, it's a great chance for us to give our little sponsor element a plug here. They make those amazing flavor packets that use

our link, because they'll get in at only use our link. Yeah, they'll get a free eight day supply. If they do. That's right, significant, but makes water drinking easy, and gives you some of those trace elements.

And the other part of her question was whether she could remain in midwifery care. And the answer is absolutely yes. Midwives are very much used to supporting women through these conditions. Yes, yeah. Totally. Doesn't risk them out.

Nope. Hi, Cynthia. Trisha. I have a question about steroid injections at 30 weeks because of the history of preterm birth. I am pregnant with my fourth child and my previous two were both born preterm one at 31 and three and the other 35 and six. Both children had NICU stays for breathing support and team support. My 31 weaker the stay was a month long and I was able to get a one dose of steroids before it had fully dilated and she was born. With my almost 36 weaker they determined who was probably going to be fine and didn't know he needed to be sent to the NICU until they noted he was grunting to try to keep his lungs inflated. And he got to come home after a week because of my history of having preterm birth with no real explanation for why my provider has advised that I get around a steroid injections at 30 weeks as a prophylactic measure just in case this baby is also preterm. Everything I found online has specified that the injections are for birth, imminent within the next week, not necessarily as a prophylactic measure, just in case. Are these injections a good idea? Would there be a reason not to do it? Thank you so much for your insight and advice of the show?

Well, that's an interesting question we have never come across before. So the benefit of getting steroid injections in pregnancy with a preterm birth are significant. They make a tremendous difference in a preterm babies ability to transition to X ray during life. They increase their overall rate of survival significantly. They increase their ability to you know use their lungs, they increase their ability, they decrease the chance of a spontaneous brain bleed. They decrease the risk of getting out have a condition called neck or neck necrotizing and pero colitis, which is a very severe infection of the gut. So there are a lot of benefits to getting the steroids. The question is Are there risks so she has had multiple preterm births. And now her OB is recommending that she gets this prophylactically at 30 weeks in case she gives birth too soon. Steroids are typically given in two doses, about 24 hours apart, that's like a considered a full dose, but even one dose can make a significant difference. Previously, it was believed that, that the intramuscular injection of steroids in the pregnant mother really had no adverse effects on the baby that it really just was beneficial, and there weren't any observable adverse effects in the mother. However, in April 2022, a study came out in JAMA, which said that the results of this recent study showed that exposure to a single course of antenatal corticosteroids was associated with a significantly lower risk of neuro developmental impairment in children with extremely preterm birth, but a significantly higher risk for adverse neurocognitive and or psychological outcomes in children with late preterm and full term birth.

Oh, man, another made up approximately half of those who have exposure to antenatal corticosteroids.

What do you think they mean by psychological? Neuro? I understand, but psychological. What are they referring to? What could they be talking about?

Well, emotional. Yeah.

But we're talking about babies.

I know, as they grow up, this was as they grew up, really this one? Yes. So the, the conclusion of I didn't get into the details of the study. But the conclusion of the study was very clear that the that we need to exert caution in administering antenatal corticosteroids. So the thing is, they're pretty fast acting. So if she goes into preterm labor, and it's determined that she might need it, her baby might need it, then you can you can give them but to get them prophylactically at 30 weeks, I would be very cautious with this recent information. What do you think?

I think that I can't believe how frequently women are put in this impossible decision that if they do something, it can bring them great benefits. And if it doesn't bring them great benefits, it does bring them great risk. It just it's, there's so many situations like this.

Yeah, it's tough because I think that most providers have and mothers have been under the impression for a lot of years that these steroid injections are really very safe. And there's really no downside. So I'm sure I don't know what it's currently like in practice, because that's not even something that as a midwife maybe I would be dealing with. So I'd be curious to know what people's experience with this is.

Hi, Cynthia. And Trisha, my name is Sydney and I am 13 weeks pregnant with my fourth baby. And I really feel strongly that I do not want a 20 week ultrasound. I know my baby's fine. I have never had any pregnancy complications. I've never had anything wrong with any of my babies. I've had healthy, Labor's everything's been fine. This will be my third home birth. So since I'm experienced, and I feel comfortable in my abilities, I'm okay having a less experienced midwife. But she really wants me to get a 20 week ultrasound, but I just in my gut, I don't want it. My first pregnancy, I had lots of ultrasounds and they found lots of things that they said to be issues that ended up being benign, and they all cleared themselves. I also don't want to find out the sex of my baby. And I really don't want anyone else knowing before I do. What are your opinions? And how can I approach her so that she can understand my choice and be okay with my choice? Thank you.

I think the important thing here is that she said she doesn't want it. I can tell in my gut that this is not what I want to do.

Yeah, it's it's so easy. The only thing is, do you I don't think I'm familiar with homebirth midwives who care one way or another if a woman gets a an anatomy scan, but is there an argument for the midwife to say, well, I need to know that so I can know whether I need to rescue out that again. I've never heard of such a thing and I it sounds to me that she absolutely should not get an ultrasound has she wouldn't be at peace with that decision. It's not the decision she wants. But what is the midwife going to say to that?

Well, the the reason that a midwife attending a home birth would want a mother or to have an anatomy scan, this is the 20 week ultrasound, the 18 to 20 week ultrasound, the anatomy scan is to basically determine that the baby has fully functioning organs and would survive a home birth. Because if your baby has some sort of congenital anomaly that is going to require them to have immediate life saving care. In your 45 minutes to an hour from a hospital, choosing a home birth is not the best choice. So that would be the midwives perspective. And that would be as we have talked about on the podcast before, if we were to recommend one and only one ultrasound in pregnancy, it would be the anatomy scan, because it just rules out some of those things. But if you are comfortable, and you feel confident, and your gut is telling, you know, you don't have to have that, of course you don't the chances of having something like that are very small. You said it rules things out. And it does. But in some cases, there are false positives. I've taught many cops Oh, yeah. With false positives, they spent months thinking the heart really wasn't properly constructed and all sorts of things. Totally. Yeah, it was quite traumatizing for them. So it looks like she already experienced that.

So my personal experience, I had three numbers, I chose to have an MRI scan at each one, that was the only ultrasound I ever had with any of them. You just have to know what you're gonna do with the information. If you get that information that says, Oh, your baby's measuring a little big already or your placenta looks a little close to the cervix. Or we might want to check on the heart again in a few weeks. I mean, we're talking about, there are a few conditions that would make giving birth at home incompatible with your baby's survival.

She also very few, she also doesn't even want anyone to see the gender before the baby is born. Yeah. And then have to respect that that's like a spiritual, emotional aspect that matters. Great. Yeah. So I think that most homebirth midwives would be fine with that. I never I certainly in my practice never forced anybody to have a ultrasound. Well, hopefully her midwife will respect her decision and be comfortable with it. Right?

So she asked, How do we convince her you just simply say this is my belief, and I don't want it. That should do the trick. Pugs should do the trick. And if your midwife says I can't care for you, she has the right to, she probably won't, but it could happen. Alright, so that's a wrap the regular version of this q&a episode. And if you're interested in the extended version of this episode, head on over to the description and you'll find the additional questions there.

Sounds good. Otherwise, we're moving on to quickies.

Okay, well, as always, we have a ton of quickies. We could not answer them all in this episode. But we thank everyone for sending in their quickies. Because they're always great, fun questions. So we will run through a bunch of them, beginning with Are there ways to help prevent loss of milk supply when getting pregnant again, so I think she's referring to, to breastfeeding and getting pregnant and the loss of milk supply that can happen because of pregnancy, you kind of just gotta let what happens happens in that situation, the hormones of pregnancy and what your body is going to do. It's kind of what it's going to do. I mean, you just keep breastfeeding your your baby through that. And if your milk supply starts to go down, then what happens is your baby usually starts to breastfeed a little bit less than that kind of sets off the cycle of it further decreasing. So you can certainly try to breastfeed more and maintain your milk supply but a little more of a fan of just sort of letting nature have its way with that process. Nothing particularly that you can do other than breastfeed more. That's the quick answer. Okay. Is it possible to not get induced if you have gestational diabetes and mild preeclampsia? I am 33 weeks and do not want to be induced? Well, I hope you're not getting induced to 33 weeks while I'm off. No, I don't think she is I think she's just thinking ahead. And for gestational diabetes, there really is not a strong argument there for mild preeclampsia, they should leave her alone as well. But if it becomes severe, then induction would make much more sense. It just depends I think on the preeclampsia numbers more than anything. And mild preeclampsia usually isn't preeclampsia at all. It's usually just high blood pressure. What does an especially high L H spike mean? LH is the luteinizing hormone. It's the hormone that spikes around ovulation. So she has a very high LH and it most likely means she's ovulating. However, if you have really erratic irregular periods or polycystic ovarian syndrome or something like that, you can get random elevated LH or can be persistently high but if you have a very distinct elevation in it, that's ovulation. What's good sign.

Okay, next, do you recommend buying a breast pump before the baby arrives? I kind of do. I think at some point in most breastfeeding journeys people need a pump that's point, whether you're going back to work or you want to just, you know, three, four or five, six months postpartum, you want to go out half a day with your friends, date night, whatever, you're probably going to need a pump. And sometimes mothers need them early on. And it's sort of nice to have it around and not have to worry about it in those first few days or weeks if you do need to, what is your best advice for someone who had a traumatic homebirth going on to have a second home birth to go to and for you? I think identifying the source of the trauma is where we'd have to begin. There's no point in keeping your trauma unresolved, and then rushing off to a hospital and banking on the hope that you're not going to have trauma at the hospital. So I just think whatever you decide, do a do some birth processing. I think that's the best thing to do. It depends on what caused the trauma. If she didn't feel safe at home, and that concern is what led to the trauma, then that is a stronger argument for not birthing at home. But we have to know more. So she's welcome to call in and give us the details or, or do a birth story processing session with us if she wants but she can just call in and tell us a little more speak for a minute or two on the voicemail. Mullen will will answer it with more detail. Good night, I'd love to hear more. Okay.

Help. I have clogged ducts, and I'm trying to prevent mastitis. What do I do? Call lactation consultant? Right? Don't Google how to how to manage a plug duct.

Then it is not about this in some good detail on Patreon and one of our then we just covered this Yeah, yeah, yes, we did the breast milk show at the breast physical therapy exercises. Yeah,

so if you're in Patreon with us patreon.com/down to birth show, then you can join and watch all of our videos. And they'll most recent one we did Trisha talks about this? The short answer is that plug ducts or treat are treated with anti inflammatory treatment like cold therapy, breast physical therapy and not heat and massage as previously recommended. What is the best prenatal vitamin you recommend?

Needed? We like it definitely use down to birth as your coupon good. But we sincerely take needed on a daily basis a company else we really there's so many of their products we like great company, prenatal, they have a fertility one, they have all sorts of cognitive.

Okay, my period suggests they do one due date. But my anatomy scan says it's two weeks later, which is more accurate.

The later one -- the later one oh yeah, the one we're taking the later one.

We're just gonna say take the later one. True. True will serve you more to say yeah, we're accurate. We can all sit around saying well, you know, ultrasound is most accurate in early early in pregnancy than later and but what's the difference? Just go with the later one. It'll it'll see ya there because women, regardless of whether it's accurate, take the later one. And typically, it's the other way around. Typically it gets pushed the other way. And the anatomy scan or the ultrasound will tell you an earlier date. And then I would say go with your LMP. And again, take the later one is always go for that. All right, last menstrual last menstrual period LMP. Yes.

Well, what are your thoughts on when to night wean? My thoughts on that are whenever you feel that you can no longer feed your baby in the night. And it's compromising your sanity and mental health. It's okay to Nightwing sometimes it's at the risk of your supply decreasing, that sleep deprivation is a real real deal. You know, I mean, you can't really Nightwing in the first few months if you're pretty committed to exclusive breastfeeding. But after that, you kind of gotta do what you got to do. What's the most embarrassing thing that has happened to you in public recently? recently?

I love it. I know so many embarrassing things happen. I can think of an embarrassing thing that happened to you. You can what? Yeah, you broke your glass water bottle a third time.

I know you know, it's so crazy about that. I've been using those glass water bottles for I don't know 10 years, seven years. Eight years nothing long time. I've broken three in the last six months. And you I don't think you would have sent me that one of them. The people are who is claiming now. I did clean up the one at the airport. Now Yeah, no that was that that recent breakage it wasn't really embarrassing for me. But it was very it seemed very embarrassing for the people around me. Really? They've pretty they were embarrassed they were you they seemed very embarrassed for me and one woman trying to give me her shoes. You just said I do this I became your shoes and you weren't embarrassed.

I just start cleaning it up. And then they there was like a bomb went off everybody like fleed the area flood the area. So I guess that I can think of something more embarrassing though. Can you think of anything genuinely embarrassing?

What embarrassing situation have I been in? If I had you know about it? I can't think of anything. I don't know. You never make mistakes. Me.

You disagree, but thank you. Um, the most genuinely embarrassing thing that's happened to me recently in the last couple of years involved a TSA agent. And I and my, my bag.

Oh my god, I can't believe you're sharing that. I cannot believe you're sharing that. Okay, take it out. I thought I was the only person you told no, we're leaving that in. Now take.

Okay. Well, Cynthia, our mission now is to get something embarrassing to happen to you. Oh, God, please. No. So I don't know what we're gonna do.

But your streak of breaking glass water bottles in public and I'm going to keep up my streak of not doing anything embarrassing in public. I'm just saying I'm not giving up glass and I know people people think I should use a silicone protector and all that but I just like the purity of a straight glass water bottle and I'm not changing.

What if you knew for a fact you would keep breaking one every two months for the rest of your life?

Unfortunately, they're cheap. I mean, what's the big deal? You just clean it up? It's just

a bunch of glass around the castle. What can go wrong? Okay. Oh, and by the way, by the way, just in case you are a fan of the Down to Earth podcast but you are not following the show. Don't forget on Apple podcast to hit that plus button and follow the show. That way you will never miss a download and we will always show up at 5am on Wednesday in your inbox that where it shows up. That's no it's not on your notifications. They know where their podcast episodes show up. It's like the people who say I'll be there there's like the people who still say after the beep leave a message I just want to know who's this before they hear a beep - that's so true. Who leaves messages anymore? Packs please don't leave a message send a text even those are too time consuming

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.

like Right, exactly. It's like yeah, finish your sentence. You just gonna stare at me? Just what's going on? We're supposed to finish my sentence. I was I had no idea. I was trying not to interrupt. So there we go. Okay, I have no idea what's going on.