#289 | October Q&A: Placenta Previa, Nipple Sensitivity, Home Birth Transfers, Uterine Rupture Risk, Cholestasis, Gentle Sleep Support, Caffeine

Welcome to the October Q&A with Cynthia & Trisha. What's the most absurd thing that you've ever heard said to a woman in labor or to you? Today, we kick it off by sharing your anecdotes and our responses.  In our regular episode, we answer:

If I am planning a free birth how do I know if I have a placenta previa and what should I do?
 
I am twelve weeks pregnant and have extremely sensitive nipples while breastfeeding my toddler. Will this get better or should I stop breastfeeding?

How often do home births transfer to the hospital?

Why do so many women planning unmedicated hospital births end up choosing to get pain medications?

In the extended version available on Patreon and Apple Subscriptions (always ad-free) we address the risk of uterine rupture after a VBAC for a planned home birth, what, if anything, can be done to avoid induction if you have Cholestasis of pregnancy, what gentle sleep training (or support) means, and if you can decline induction with well-controlled gestational diabetes.

In our Quickies segment: Is body odor postpartum is it normal? Why is a VBAC called a TOLAC? Should home birth midwives always carry oxygen? Plus caffeine in pregnancy, postpartum dryness, birthing the placenta in the tub, leaking and letdowns, infant percentiles, and how we take our coffee plus whether our own children appreciate the work we do in the world.

Ep #229 The Risk of Risk-Based Approach with Sara Wickham

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Transcript

Hi, Cynthia and Trisha. My name is Heidi. I'm calling from Alberta, Canada, and my question has to do with uterine rupture and a Z back. So I'm currently calling because I love your show, and I do have a question about gestational diabetes for moms that are controlling it with diet. What is the indication for induction? My mom was told pre puberty, when she was quite young, but she was too small, and they felt that she would never be able to go into labor. I've got this all figured out. Yep, no, you're right. It's just what they have a little voice. And I'm saying, You think you're so great, you think you're so great, you think you're better than me, and then they try to knock it out. Oh, so you want a trophy. That's how great you think you are. You think you get a trophy. And the woman is simply looking to feel peace.

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.

Happy October. Happy October. Welcome to the Q and A so I heard you have an opener for us related to some stories that you did and well, it had to do with obstetricians or something. Yes, so I heard, and I don't remember where I heard this, but I did a post on Instagram called overheard on L and D, and it's some of the crazy things that obstetricians or midwives or nurses say to mothers in labor. So I wanted to share a few so I did this post. And then, of course, our community has a lot to say about things like this and have great stories. So they wrote in with all kinds of comments that you know they have heard or comments that have actually been said to them. So the comment that I posted was an obstetrician saying to a woman when she was pushing and struggling with her pushing, do you want to be a baby, or do you want to have a baby?

Well, so of course, that got a lot of fire from our community, and I don't understand why anyone talks down to women like this. Why is this happening to grown women if they're being spoken to this way? All right, what else? What else is there before we go down? So anyway, that set off a fury of comments, and so I thought I would just share a few. Because, you know, I know we, we usually have a some good things to say about things like this. Okay, so let me just kind of scroll through and find a few of the best ones.

One woman wrote that her OB said, you have 30 minutes to push out this baby. Which is it going to be? Vacuum, forceps or surgery? Okay, so vaginal birth wasn't even an option there. Just, you know, what am I going to do to help this baby get out in the 30 minutes? Why 30 minutes? Who cares? Why 30 minutes? What's special about 30 minutes? Nothing. The way, it implies that those are her only choices. I want to remind women that they don't have to answer questions that are asked of them. I think it's really powerful to remember. It's really hard. It's like almost impossible for me not to answer a question. I you know, I don't like to even ignore a confirming text message that doesn't require a response. I don't like to ignore anything. But when someone presents you with three options and you feel trapped like you have to answer it, who is compelling you to answer the question you have? You can retain your power in many ways. You can take on the fight. You can tell them, I want a fourth option. I want a vaginal birth. You also just don't even have to answer it. Just tune it out. Put on that pink eye mask. Remember that great birth story from a few months ago, the best, best birth tips ever. It's a it's an analogy. It's an it's an analogy. Now I like it. No, everyone loves it, but it was she just put on this pink eye mask and tuned everyone out. If you don't have a pink eye mask, you can do it anyway. To psychological barrier where you're saying, I don't need to answer this. I can stay in my birth space. What else is there? I'm sure you have, all right, the hospital midwife, who kept doing cervical checks every hour on me, told my OB that there was no way I could handle birthing vaginally because I screamed every time her fat fingers gave me a cervical check. Wow. That is infuriating that she declared that she couldn't have a baby vaginally, and talked about it that way, and talked about screaming in that way, keep your fingers out of her vagina, and she will birth her baby just fine. So many women say that a vaginal exam is harder than giving birth. So many women say that because so many.

I mean, have an aversion to vaginal exams, because you know that it's not the physiologic process. It's something going up and in when things are supposed to be coming down and out, right? That's Nancy Weiner's thing. I was just gonna say that. That's exactly it. Nothing is meant to go up and in only this nurse said to this woman, oh, pain is relative, honey, when she told her that the Pitocin was making her contractions too strong. Honey, honey, honey. By the way, back to the last one. I don't know if you remember my friend Rhonda, but I'll never forget when she was talking about not wanting vaginal exams. She said that. She said to her midwife, I like two things in my vagina, penises and babies.

That's it. That's great. I can't stand the word honey. To be honest, I actually said it one time to my daughter, and she was like, um, Mom, what? I've never heard you say that before. Like, I don't, I don't, I don't like that word. I don't like calling people that word. Yeah, I don't know why. Well, I think because I always hear it being used very superficially. I feel like people use it very insincerely, right and in this case, obviously disrespectfully, right. Now, my challenge is to call you honey one of these days in just the right moment, and you're gonna, you're gonna feel it as affection, rather than someone talking down to you. So out of character, my challenge. Okay, yeah, it's gonna make me laugh, because I know, well, still be prepared. I'm gonna do it sometime between now and Christmas. Okay, okay, well, we'll, we'll report back when that happens.

Let's see what else do we have here? While I was in between pushing, the nurse looked at me and said, Oh, you're not going skin to skin. Your baby is immediately going to the NICU. Let's push now. One, exclamation point two, exclamation point three, hold your breath. And then when I started crying, she told me to calm down, wow, and hold your breath. Yeah. Nice, terrible. All the wrong things. All the wrong things. So much ego and arrogance, so many people in the wrong line of work. This one said, you don't get a trophy for doing it without pain relief. The trophy line come up with something more original than that. I know. Stop it. Stop it. You like, nobody's asking for a trophy in birth anyway. Where did that even come from? Because women who don't have physiologic births, or the providers, the providers who resent that women seek and achieve physiologic birth are somehow, on some deep level, feeling inadequate because either they didn't, which is silly, because their birth has nothing to do with another woman's birth, or they feel not needed as a provider. So they have this little voice in them. I've got this all figured out. Yeah, you're right. It's just what they have a little voice in them saying, You think you're so great, you think you're so great, you think you're better than me. And then they they try to knock it out. Oh, so you want a trophy. That's how great you think you are. You think you get a trophy. And the woman is simply looking to feel peace with the most important mental, emotional and physiological experience of her life. That's all she is. Looking to have a natural experience than that is inherently rewarded. But it also comes from other women. It also comes from the women who are feeling a deep down dissatisfaction with their birth experience. Who are, you know, working to try to make themselves feel better about their birth experience, which ultimately they most likely are dissatisfied with their birth experience, not, of course, because they were incapable, but because they were forced into a corner in their birth they were not given the options that you know could have allowed and supported them to have an inherently rewarding birth experience as well. So exactly anyway, all right, this one says my nurse told me to stop making that face, stop making that face. Oh my gosh. Are you kidding me? Like do as you wish I was scrunching my face while pushing because she told me to push as hard as I could, but I had an epidural so I couldn't feel anything. She said, You shouldn't have to make all of that face squishing because you can't feel anything. All other bursts from then on have been in the comfort of my own home. Good job. My hospital midwife, dismissively said, If you'd let me break your water, this would go a lot faster.

Not true. Read, gay guidelines. 15 studies show that isn't true. Never mind all the side effects. Exactly. This is why we do the work. You're gonna love this one.

An L and D nurse said to an acquaintance when she was loud during labor, stop it. I bet you didn't scream like that when you were making it.

I just, I don't know that I can hear many more of these. This is so what right do you have to say something like that to a person like That's none of your business. I cannot believe this, and I hope you were screaming like that when you made it because then you were probably having a good time. Yeah, right, made conception happen. But it's when you when you pair this with the fact that our culture insists that childbirth is the most.

Painful, excruciating thing anyone will ever experience, which is so not even remotely true, in my personal opinion, you pair that with stop it and don't make that face and did it, and you're being a baby and, well, look, they both can't be true. Either it is equivalent to torture, and you get to make a face and react, or we can all agree that it's an individual experience like I just, I never mind that woman was probably making her get over it crunched up uncomfortable face because she was just wanting to get that nurse out of her face. I made faces like that in labor. I was You do whatever it feels right when your eyes shut. I mean, I remember the effort worse. I mean, it's it's beautiful, great. Do what you're doing. I did that when I was birthing my baby coming out of my body. I mean, there's no right or wrong way, especially in that stage, when you get adrenaline, it's not about the oxytocin anymore and the dilating. You're getting adrenaline to give birth, you need that energy, and it has to manifest somewhere. I always tell people, the day after I gave birth to Alex, my biceps were sore, and I was like, Why are my biceps sore? And because for 45 minutes of pushing him, I was speaking this and squeezing my arms, and I didn't realize I was working out my biceps. But the energy has to go somewhere when it's done, when you're when you're working hard, you make faces. That's just how it is. Oh, yeah, it's not a yoga class. No. I mean, I mean, sometimes people don't make faces at all sometimes. I mean, think about, let's think about when we're again. Let's go back to sex. Do you make faces when you're having sex? I'm sure you do.

Well, I don't think the squeezing tense. I think when people are having sex, normally, the faces are relaxed and limp, which is ideal for when you're dilating, depends what you're doing when you're when you're in a deeply relaxing, when you're in a deeply relaxing oxytocin state, we tend to go limp. The lips get limp, the face gets limp, the eyes get softly, barely open. The body is really in a limp state, because that's what happens with oxytocin. Like when you're getting a massage, or you're, yes, having sex, or in that dilating stage we're looking for. But once you're 10 centimeters, you do get the surge of adrenaline. It's why we shake after we give birth. And of course, with that adrenaline, it's equivalent now to lifting weights and not a yoga class. So go lift some dumbbells and don't make a face that like, why should you Why shouldn't you be able to express that energy and that adrenaline however you need to, so you should do exactly what feels right in your body when the urge comes upon you. That's it, right, whether it's a relaxed face or a scrunched up face or, you know, tense shoulders temporarily. I mean, you do need to sometimes be reminded to get out of that tense space. Women can hold that tension for too long in birth, and you know that's the job at the doula or your partner or your midwife to remind you to take a break and relax. But this is not the technique. This is not the way the woman this nurse, conveyed the message is, is really wrong. All right, let's see if there's anything else that we must say, Okay, the last one, my OB was shaking his head in disappointment because I hadn't progressed a stage a half hour since I started pushing, and said, You have to actually work the same. OB said, I don't know why you don't want Pitocin. You're already have. You are already are not having a natural childbirth after getting an epidural. Also, he argued with me that Pitocin is not synthetic, and ultimately he caused me serious birth trauma. Wow, yeah.

Words matter. The way things are said to you in labor is unforgettable, right? I mean, we remember how we feel in these experiences, and we might misremember the words a little bit, but we remember the feeling that they imprint upon us, and words affect our thoughts, and that's why you're doing a crime against someone when you say words like that, because you're actually affecting how they think we always want to go down this pathway. Oh, words don't hurt you. They really change your thoughts. That's why some people have deep negative beliefs about themselves. Sometimes, when something is said to you from an important person like your care provider, you never forget it. Those words can replay in your head for years, for your lifetime.

Yep, so people need to think before they speak, and that's why you always say it's really important that we choose an emotionally intelligent provider. Yes, we want them to be skilled. Yes, we want them to have experience, but their level of emotional intelligence is a is as important as anything for exactly these reasons.

Okay, let's start with the risk question. Now, Hi, Cynthia and Trisha, my wife and I are preparing for my wife to conceive our first baby. We intend for her to breath at home without any licensed medical providers present, and we don't plan to have any quote routine testing done.

My way of preparing for my wife to conceive is that I've spent the past two plus years learning everything I can about healthy pregnancy and birth. So as a healthcare provider myself, I feel really comfortable with the idea of us and our trusted birth keepers moving through the kind of normal complications, but I know that there are a few things that are absolute contraindications for vaginal birth that we need to be attentive to and knowledgeable about, and the one that I know the least about is placenta previa. Are there any signs of placenta previa during pregnancy that might alert us to consider getting an ultrasound to check for it, or, you know, adjust our birth plans as needed.

Thank you so much for the information you share here and the beautiful community of empowered women you're nurturing so so grateful. Bye. So placenta previa is when the placenta actually attaches over the cervical opening. A lot of times, mothers are told that they have a placenta previa, but the placenta is actually on one side of the cervix and not covering the cervix, and as the uterus grows, the placenta moves away from the cervix, and then it is generally not a problem. So that's just a low lying placenta, but if your placenta is actually attached on both sides of the cervical opening, then that is an absolute contraindication to vaginal birth. There is no way around that, because as the cervix tries to open, the placenta is getting pulled from both sides, and the risk of bleeding is very high so and there's no way for the baby to get out, because the placenta is blocking the cervical opening, and then you could have an abruption, and that is very dangerous. So yes, there are signs of placenta previa. Typically, when previa is present, women will experience spotting throughout pregnancy. So if they're spotting in the pregnancy, that warrants an ultrasound. There's no spotting in pregnancy whatsoever. But during labor, suddenly you're having an unusual amount of bleeding, not like bloody show, which tends to be more of like a pinky, mucousy, bloody type of thing that usually just happens briefly and then passes. Although some women can have more, but more like, you know, bright red, continuous spotting, bleeding, trickling throughout labor would also be an indication of something like that, I think it's reasonable to consider a 20 week anatomy scan just to rule out something like that, or to make sure that the baby does not have any type of congenital anomaly that would make having birth at home unsafe, but that's their choice. Hey, Cynthia and Trisha. My name is Audrey. I'm from Minnesota. Long time listener. Love you girls. I have a question. I am 12 weeks pregnant and still nursing my 16 month old, but I'm just so sensitive now. Nursing is so incredibly painful.

I'm just wanting to quit, but it's only for me. I don't want to stop. For him, I want to keep going. I'm just wondering, sick, can I get better, or is it just going to be this way that you can tie your pregnancy? Let me know. Thank you so much for everything you do. Love you both. I mean, who can say for sure? Nobody can say for sure. The answer to this, typically, things do get a little bit more comfortable as pregnancy goes on, so her nipple sensitivity may improve, but it's this is a personal choice. This is just if it's bothering you and you're dreading nursing every time it's time for your son to latch on, you can at least reduce the amount of nursing sessions that you're doing. It depends if he's nursing five or six times a day. Maybe you try to drop that down to three or four or two or three, and then your nipple sensitivity will also improve. And you can try to give it a little bit more time and see if it gets better with fewer nursing sessions, and if it doesn't, toddlers often wean during pregnancy anyway, and it's okay to help facilitate that a little bit by giving your toddler some distractions and alternatives.

It's a normal time for a baby to transition off of breastfeeding. It's it's part of the biological process, and I think that we put a lot of pressure on ourselves and feel really guilty when we feel like the motivation for weaning is coming from us, but it helps to recognize that this is a developmentally appropriate time and space for a toddler to transition off of the breast. We just want to do it in a gentle way, and the easiest way to do that is to provide alternatives to the breast that are equally exciting to your toddler. Hi. My name is Megan Boyd, and I just wanted to submit a couple of questions. I was wondering if you could share how often that you see women attempt home births, but then are actually rushed to the hospital for a complication?

How often are people who set out to do home births actually able to stay with that and then a second question is, I often hear friends who.

Who intended to have a medicated hospital birth, and they changed their mind part way through, and I was wondering if that has to do with like pressure or just a lack of education on the situation coming, you know, from the hospitals, is it just part of that hospital atmosphere?

And then finally, my mom was told, pre-puberty when she was quite young, that she was too small, and they felt that she would never be able to go into labor. And I have no idea how they would have been able to determine that pre puberty, when she's that young. But as it turned out, she never did go into labor with me. It. She never even attempted. They took her, they took me C section, like very early, two weeks early, and then with my brother, they attempted to put her on pit, and her body didn't respond, and so they ended up taking him through C section as well. And I'm just wondering how they would have been able to know that she couldn't go into labor that early, or maybe Was it just the power of suggestion and the words spoken over her that resulted in her actually not being able to deliver naturally. I appreciate you guys and the information that you share, and I'm happy to learn and follow along.

Let's start with the last question and work backwards. So do you want to start with the last one, or do you want to start with I'll start with the last one. She was pre pubescent, and someone was their mind. Even being around that girl conceiving and having a baby? What the heck? Who said that to that girl? Was it a pediatrician who would say that to a girl? So the power of suggestion, I can't I would say normally, yes, but no, she was never given a chance to go into labor. In fact, the fact that the Pitocin didn't work in her second birth is evidence that she was not even anywhere near going into labor if it didn't have a response. So she was robbed. She was robbed of the opportunity to go into labor. I promise you your mother would have gone into labor with both babies. I promise you she would not still be pregnant with you after all this time.

I mean, the first baby was C section. Two weeks early, she wasn't even close to giving her body a chance. So yeah, that's just and now here we are passing it on another generation, giving her daughter doubt, because this became the story that these words were planted, the mother repeated it because part of her life story, I'm too small to give birth. I promise you your mother is larger than probably 100 million women who've lived and given birth before her. In this world, no matter how small she is, there have been millions of women who are under five feet tall and four foot something, and they all gave birth. This doesn't have to do with size. And the whole notion of saying something pre puberty is just it's absolutely ludicrous. I should never say it, but yes, it's so ludicrous, it's creepy. It is.

The middle question was about changing course from an unmedicated birth in the hospital to a medicated birth, which is quite common, and I think that is a result of being in the environment where you are constantly being presented with pain relief. I think it's that, and I think it's a few things. I think that's obviously a big one. You're facing a tidal wave of pressure, in most cases, and false information. We just heard in the beginning of this episode, a whole bunch of examples of what that environment can be like. I do think that, you know, I remember once sitting at a with a yoga instructor who owned a local yoga studio who took my class, and she was telling a pregnant yoga practitioner about me and my classes, and she was raving about and she's saying, honestly, I tell people like you have to take her class, because how will you know how to give birth? How will you know? And I said to her, I disagree with that. And I looked at the woman and said, You were born knowing how to give birth, you already know how to give birth. I don't want you to ever believe you need me or anyone to tell you how to give birth. You're already prepared.

However, that was me 1516, years ago. I would like to add to that, what we're not prepared for is giving birth in this day and age. This is not like if you were born 500 years ago. Yes, you're ready to give birth, but we're giving birth under such weird circumstances, leaving our home bright light strangers. So there's no way to pinpoint, but I'm coming back to the fact that I do think some women who are very strong make up their mind to have a physiologic birth, and they really don't think that they need to prepare. It is helpful, just as picking up yoga in your life is immensely helpful, and meditation, it is helpful. Learning to focus, learning to make.

Your body go limp when there's chaos around you. That is the game changing stuff that happens that that increases the odds of physiologic birth. So I think it's the environment. But I also think the that women can do a lot to prepare in advance. I am most impressed by the women who have unmedicated births in the hospital. I'm impressed by all women who give birth, but I think that is the most challenging circumstance, because you are up against constant disruption, and your natural endorphins have a harder time kicking in and working and supporting you when you are constantly being disrupted, interrupted, even if you think you feel safe in a hospital, because many people do. Many people believe that they are safer in a hospital. There is something in your physiology that feels unsafe in a hospital, just by nature of the beeps, the sounds, the strangers, the coldness, it is not the same as being at home. So intellectually, yes, you feel safer in a hospital, and that's great, and you should give birth where you feel the safest. But we cannot underestimate still, that our physiology is impacted by that environment, and so therefore it's harder for the physiology to work the way it's supposed to in that environment. And when somebody on top of that is constantly presenting you with an option, because they usually don't leave you alone. Usually they do keep coming in and asking you, if you want something. Can we get you something? Are you sure you don't want that epidural? Can we get you a little of this? Can we get you a little of that? Stop making that face, stop being basically having dessert sitting in front of you all night and like, just, you know, having to sit there and deny it over and over and over again, like, that's very difficult to do so anyway. And they encourage, you know, they they'll say things like, you just need to go get a little bit of rest, and your labor has stalled for whatever reason, because you're in the hospital. And then sometimes the pain relief does help with the labor progressing. So it's very understandable that this happens. But if we could create a more physiologic environment in the hospital, let women labor in the dark, let women labor in the water, have the soft lighting, keep the strangers out. There would be a lot less of this happening. There would be a lot less of women intending to have an unmedicated birth, and then changing course mid birth. I want to add one more thing that might be helpful, because anyone listening, and especially if they don't know us extreme. I think our long time listeners know us very, very well, but I just want everyone to hear this that clearly we're proponents of physiologic birth, but that's because it's our deep understanding that this is the safest path toward having your baby and by far the most satisfying experience for you. With that said, I want to tell you what I tell my clients in my HypnoBirthing classes, the goal is not a physiologic birth. Is that optimal? Yes, and anyone who's saying it isn't optimal is not being honest. It is optimal. It's a noble thing to aspire toward, and that's the experience of the vast majority of the couples I've worked with. However, the goal is for the mother to be calm and in control when that becomes your goal and not the physiologic birth, you have permission to make all your decisions. We don't want a woman being hell bent on a vaginal physiologic birth and suffering through it and feeling tense and fighting her way through it. We would rather have a woman, gosh, okay, one friend comes to mind who took my class years ago. She was in labor for like, 20 hours. She was doing beautifully, she was calm, she was really it was doable, and finally, she just needed some sleep. She got an epidural for five hours, she took a nap, and here's a mom who stayed calm the whole time. It wasn't about proving anything. She wasn't hell bent, and I'm like, oh, like, chef's kiss, beautiful, because you used it as a tool. You weren't manipulated into it. You weren't scared. And said, Oh God, I can't do it. You mean it's gonna get worse? She just said, like, little white flag, wait a minute. I need a break. She used it as a tool that served her toward her goal of staying calm and in control. When that's the goal, we stop worrying about everything else. It's not like, oh, I tried to do that, but I couldn't. All that goes away. Did you stay calm and in control? Beautiful, because that served your baby. Your baby was born in a mother who felt safe, so your baby had all of those endorphins that so I just want women to think about it that way. Choice, yeah, it comes down to, is this something that you are choosing, or is this something that you feel you are having to accept? And that's a big difference. Okay, what was her first question about home? The first question then, was about home birth transfers. And she asked, how often mothers are transferred from home to hospital for, I think she said, for, like, emergency reasons. So we know that that transfer rate is very, very small. Less than 1% of birth emergencies are a reason for transfer from home birth things like cord prolapse or possibly.

Placenta previa, or placental abruption, or serious unresolving fetal distress. There's not a lot of fetal distress at home birth because there's no Pitocin at home birth, so and there's not a lot of maternal distress, true, right? Or in there's freedom of movement and position, so your baby generally does very well adapting to the normal stresses of birth. At home, however, you have about a 10% transfer rate for prolonged labor or maternal exhaustion, labor that's not progressing, which is usually a result of the mother being tired, dehydrated, possibly needing that epidural? That's, you know, exam, a great example of when an epidural can really benefit the progress of labor, when a when a mother is just too tired and needs rest. And because she asked this question, I just want to say that our other response to this question is be careful of making your decisions based on statistics that are applied to a whole population, these actually don't have anything to do with you. If you tell yourself, okay, a third of American women have C section, you fool yourself into believing you have a one in three chance of a C section and only a two in three chance of a vaginal birth. But there are many providers, like Ina, may Gaskin and Nancy Wehner, who've had years of their work for ina may Gaskin, it was every year for over 40 years, the C section rate didn't even reach 2% so if you birth with her instantly, you have a 98% chance of a vaginal birth. We're never just random statistics. So if you learn it's, it's 1% of the time, like Trisha said, that's, that's, you're looking at this risk based approach. So I want to point you to episode 229 with Sarah Wickham, and her whole point in that episode is the risk of the risk based approach, the risk of making your decisions based on these statistics that are floating out there, which, by the way, change all the time anyway, get informed. Get quiet. Let you, let your intuition guide you into what's right.

Because if, if every woman heard that statistic of 1% 100% of women would birth at home, and home birth isn't necessarily the right thing for 100% of women. Anyway. So anyway, be careful of getting into your analytic mind. Yes, stay in the right brain. Always everything related to conception, pregnancy, birth and breastfeeding is right brained. We use our left brain way too much in all of this, and that's what creates the stress. Because if you're using 90% of your left brain and 10% of your right brain, you're like you're imbalanced. Your thought, your decision making, is imbalanced. You have to get more into the intuitive right brain side, the trusting side, and let your decisions come from a more balanced place.

Not to mention all the other statistics you could layer on it, you're statistically less likely to have a C section, and we're not talking home birth transfer at the moment, but a C section if you have a midwife, you're statistically less likely. If you have a doula, if you take a HypnoBirthing class and learn the tools for staying relaxed, do those things move the needle and make you have a safer birth? It's like walking down the aisle to get married and saying, oh gosh, I have a one in two chance of divorce, as if you have no role in how your marriage is going to go. That's That's what's happening when we look at the risk based approach. And that's it for the regular portion of this episode. We are now moving on to the extended version, which is as easy as can be to have access to. If you're on Apple for less than $30 a year, you can click the subscribe button and instantly, without doing another thing, you will automatically receive the apple feed where you will never hear another ad, and you'll have automatic extended episodes every time we release another Q and A. And if you're on Patreon, of course, you get everything that we have to offer on any platform. So in the first tier on Patreon, you also get access to every extended Q A, and you get early release. That's right, you also, you know? So if you're hanging out with your down to birth homies, and you get to hear the Q A a day or two before them. I mean, you get to, you got Lego, it's a good flex. Oh, did you hear, did you hear that question on down to birth yesterday? Oh, right, you're not getting the extended ones. Oh, yeah. Okay. You can wait with the regular people and tell me when you hear it, so we can talk about it. Don't be a regular folk.

I bet not one listener is actually like that, but I know half of them are laughing right now. Okay, I hope so. Okay, and the other half just subscribed. You're like, Why did Cynthia say that? Why did why would she say such a thing. All right, here we go. Oh, wait. But for the rest of them, for the rest of you, let's let them know. Let's let them know what they're missing over there in the extended episode. Oh gosh, there were so many questions, and I don't even know if we're caught up here on them. Trisha, um, I wish we could let you guys know. We just fly by the seat of our pants. We do Q and A do fly by the seat of our.

Hands. All right, there's one on uterine rupture, there's one on cholestasis, there's something on a sleep question for babies, and there's another on just stational diabetes. I think, Okay, I think that's what's coming up in the queue. Okay, well, let's go find out. I think that's it.

All right, shall we move on to the Quickie segment. Let's do it everybody's favorite.

I just assume it's everybody's favorite. Maybe it's just your favorite. It's just my favorite. Okay, here we go.

Is it normal to have strong body odor at four to six months postpartum?

I don't recall any such thing. You're going to say it's normal, right? Totally, yes, yes, the hormones of breastfeeding definitely increased the body odor, not

everybody, not for everybody, but yes, it is normal.

Why are VBAC candidates referred to as trial of labor? Since they are largely successful and safe, to give women doubt.

Yes, no other reason.

Forget the trial of labor. Get that, get it out of your head. Use your language, not theirs.

Should a midwife always carry oxygen to birth?

Yes, yes, she should, not for the mom, but for the baby.

Is it safe to have caffeine in pregnancy? I feel like we've answered this one before, but well, you're gonna say, you're gonna say a little bit is fine, and I'm gonna say caffeine is really never great for anyone. So it's somewhere in between those two things, safe is relative, yeah. I mean, it was not there. It would have to be significant amount to actually cause harm. But the standard, the standard, you know, research that's always quoted and reported, basically says, if you have more than five cups of caffeine a day, then that's too much, and that there are implications for the baby. But nobody's looked at really, what happens if you have one cup a day. So my philosophy on these things is moderation. Like, if caffeine bothers you more in pregnancy, don't drink it. If you feel more hyper stimulated from caffeine in pregnancy, don't drink it. No, I think she likes it. I think she wants permission to have it. Yeah, if you want to have a little and you feel okay about it, go for it. You could have half calf to start or true, or just don't have caffeine. It's not a bad thing to give up. It's a hard thing to give up. There are a lot of benefits to caffeine, though not necessarily in pregnancy, but for health in general. Okay, let's not get into that. Okay.

Next, what helps postpartum dryness? I'm so itchy down there. First of all, I don't even like to say down there, your vagina is itchy, normal.

I don't like the term down there. Let's try not to use we've got to be mature. I hated I got I didn't want to say it. It was so annoying to me when Oprah was saying But JJ, I was just like, grow up. You're like, you have millions. You're an adult woman with millions and millions of young girls, teenagers and adults, listen to you. Can we please like I don't know that always bothered me, even when I was very young, I didn't like terms like that. So dryness postpartum totally normal. The hormones of breastfeeding especially results in more vaginal dryness, because your estrogen levels are extremely low, and estrogen is what makes our vaginas nice and moist. 

Nice. Nobody says nice and moist was they're talking about a cake. Okay. Anyway, so it is normal. I guess we'll just leave it at that. There are, there are creams that you can use if it's really bothersome, you can actually do a topical vaginal estrogen in a very low dose, and that is okay and safe, even when you're breastfeeding. So just keep that in mind, or even, or if you're not breastfeeding too, okay. How do you keep the ambience at a home birth, if you, if you have to get out of the tub to deliver the placenta. It's so cold, getting out of the water, you don't get out. You would birth the placenta in the tub, sure. Well, of course, you can birth the placenta in the tub. You don't have to get out to birth the placenta. I got out at my home birth when you were there. Yeah, I think a lot of midwives do ask mothers to get out, but you don't have to. And if you do for some reason, need to get out. The only time I would say that maybe you would need to is if your midwife thought you were bleeding more than she would like, and you know, needed to assess things better. I mean, make sure first of all, the room and you're giving home birth in should be warm enough that getting out of the water isn't a cold experience. Your room should be at least 74 degrees, and you should be covered in a nice, cozy robe. Well, both times I came out of the water into the into the bed they had, and you were there for my my home birth, but they had Chuck's pads on the bed. And as soon as I lay down, I was holding my baby. As soon as I lay back, holding my baby, they layered warmed, pre warmed towels over me, which really felt beautiful.

Lovely. I really like that. So it was mildly disruptive. I held my baby the whole time, so it really wasn't too disruptive at all. And it was nice to end up in the bed, because it's ultimately where you're going to be anyway, when you're bonding, so you've got to get there at some point. True. That's one really nice thing that they do do in the hospital, is they always give you a warm blanket. They do that in the hospital. Absolutely they do. They give you I had it at the birthing center, and then you guys did it for me at home. You can totally do it at home too. You just put blankets in between the heating pads. We do it with the baby blankets. You can do it with the adult blankets too, or towels. Is it weird to push the opposite nipple in to stop the flow of milk while breastfeeding? It feels like an off switch. It's not weird at all. It's actually totally normal instinctual thing to do that was highly effective at slowing down or stopping a letdown. You can stop your leaking by pressing into your breast when you're having a letdown. The you know, oxytocin is stimulating the milk ducts to contract, and if you press back against that, they will relax, and then you will stop leaking. So totally appropriate, not weird at all. How important are percentiles? If the baby is steadily gaining weight but still petite, not important. If your baby's maintaining their percentile curve, then don't worry about it. Okay. Last two are personal. Since we were already on the topic of coffee, how do you take your coffee ice? Latte? Always cold. Do you ever drink it hot? Virtually, I don't. I'm not really a coffee drinker, as hilarious as that is, because I love espresso, and I love iced lattes, and I like hot lattes sometimes, but I pretty much 11 months of the year go for the iced you know that if I get a coffee, I mean, I always see you, I always see you drinking it iced. But, yeah, it's I will never drink. I have to be cold to the bone to switch over to a hot and even on a 90 degree day, I will still choose hot coffee, black. I like to nurse a coffee. You know, an iced latte is also a larger drink. I don't want to just chug a dainty little hot latte, because as soon as it's not piping hot anymore, I just want to, like, chug it, like the way Italians drink espresso. I just feel like I'm going to be like, down it, and then I'm not enjoying it. For me, I don't drink coffee because I need to. For me, it's like a treat and a dessert, and I like it to linger and last, and I like to nurse it slowly. So that's another reason I love ice lattes. Well, that is also exactly why I drink it black, because I taste terrible flavor. No, you don't want to drink it, and then you just drink it slowly. I want it so bad.

What you can't you can't even imagine a concept of not liking black coffee. I can't even imagine liking the good a good cup of black coffee is like a fine wine. It is so complex, inflated. It's a complexity, terrible, terrible things. You have not had a good coffee. Oh, my God, I I'm at your house and I use you, okay? You always, I always make it with milk. Here. You never have it black.

Well, I will have a sip black. Then I'll complain and ask for the half and half that I never have. Okay. One more, do your children appreciate your professional passion? Oh, gosh, who knows? Yes, I think so. I think mine are a little embarrassed by it, to be honest, no. But as they grow older, they will be less and less that way, and they will certainly be more and more appreciative.

I think my children do, and my son is 19, and increasingly in his birthday and Mother's Day cards, he talks about me teaching him to do what he loves. And you know, he and I both have business and a passion for entrepreneurialism in common, and just the qualities that it takes. It's kind of like when we were asked about we that someone wrote an article about us on being a podcaster, and I think she interviewed me, and I gave all the tips on creating a podcast. And none of them are what you see out there. None of them were like, get good sound equipment. Make sure you count. Like I went into if you work with a person, this is what you're looking for in the relationship with a person. You want to be successful, you better work with the right person. And I think they're just these obvious things that are overlooked. So when my son and I talk about business, and my daughter, too is quite a budding entrepreneur. She's already had a few little of her own businesses as well. I talk about the qualities of how you know what your relationship with your clients looks like, and having ethics and how trust is the core of the relationship and and also not settling and not tolerating something that doesn't feel like a good partnership and all of it. So I think that they do, because it's all wrapped up in similar lessons to parenting. So I think they do, and they're definitely not embarrassed, because sometimes my my kids will be like, Oh, my teacher's pregnant and said she listens to your podcast, or my son used to be on the school bus, and people would talk about how they would Google my name, and my son would talk to them about it. I don't think they're embarrassed. Man, that would bug me if they were embarrassed by what? What about this? 

When I said that, I think I mean my, both of my daughters, at one point, followed our Instagram page, but have also unfollowed it and refilled it and unfold it, because sometimes I the content is overwhelming for them. That's all. They're just not quite ready to see that. So proud of you. I have no doubt about that. I have no doubt about that. I think it's just, it's, you know, they're teenage girls. Birth, the idea of birth is both exciting and scary to them, but more exciting as time goes on and my oldest, Lola, has asked me repeatedly to please do a podcast episode on teen pregnancies. So I my gosh, so obviously she's interested in, yeah, she she has suggested that topic. She said she thinks that it would be very informative and helpful, and that nobody talks about it. And those teenagers who are unexpectedly pregnant, which she is not, would really benefit from, you know, hearing other teens talk about how to navigate that. Well, I think that that was very sweet. It is. But given what we're all about, I think we already provide a teen what she would need, because we're all about her making decisions for herself, etc. But teen pregnancy is way too heavy and concerning a topic. I think it's not just like a Oh, yay. You're 15 and having a baby that this is, I don't think I could do it. There's too much I have too much concern around her and her life and her school and her family and her baby, for me to be able to sit and chit chat about giving birth. She can listen to the podcast about that, but I but a teen pregnancy, that's a big deal. That's, yeah, little kids are not supposed to be having babies. They're biologically able to, but you know this, the our society isn't set up for that anymore, and I just would have so many concerns. I have had a few 18 year olds take my class.

You know, one just hooked up with her friend, and he took the class with her. Actually, two, two of them did, and another one was pregnant, and her mom took the class with her, and unbelievably, her mother was pregnant at the same time.

Wow, that was strange. Wow, yeah, that's why. And she resented that. She was like, Yeah, my mom got pregnant a few months after me. And I was like, Isn't your mom? Like, my age? Like, her mom was like, nowhere near. And she was like,
so she felt her mom was stealing her show a little. It was just so complicated. But it's very hard to just have the conversation about like, here's how you Well, if you want to know how to go have your safest birth, listen to the podcast. We've already covered it.

So I want to know from Lola what her specific question and concern is, because I think she was just thinking of a supportive, a way of trying to help support teen moms through through education, but about them, really, it's such a one episode isn't going to do it. So I can't even imagine being able to can't even imagine they just need so much Lola, being provocative, making things challenging for us. She's going to be our person. She's going to be our person to say, what should we cover next?

Oh, I think she could be that. Yeah, future, yes, growing into that. So obviously she is proud of the podcast. Oh, I know she is. You can say they're not. They totally I know, and I definitely know my son thinks it's cool. Well, that's a wrap. That's a great episode, great questions as always, and that's a wrap on October as we head into the darker, colder season. Now in the northeast, clocks will have turned back before we do our next episode next week. Turn back this dark at four o'clock, bed at eight. Oh, wow. What's at four o'clock? It gets dark. It starts getting dark, 415 I know 415 Yeah, and my in my neck of the woods, all right, so we have to do more to keep our spirits lifted. More black coffee. More black coffee, more music,
 dancing? Should we go dancing? I love dancing. It's like, my favorite thing in the entire world. If I could do anything creative professionally, definitely. Should we take a dancing class? Yeah, I've taken dancing classes in my adult life. I love it. What kind would you want to do? Like, would you like line dance with me? Line dance? Oh, I've done that too. That was fun, too. No, I wouldn't want to take professional line dance, flamenco dancing. That would be my favorite choice. Let's go to Spain and get some flamenco dancing lessons. We've got a place to stay. Yes, we're doing it all right, okay, and we'll see you next time.

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.