#293 | Extended Q&A [Season 3 Reprise]: Miscarriage; Evening Primrose Oil; Safe Bed-Sharing; Failure to Descend; Pushing; High Blood Pressure

Announcement: Between now and year-end, we will be releasing a 50/50 mixture of new episodes interspersed with old-favorites, due to the sudden loss of Cynthia's husband in November. We have a new episode coming next week, and will be back to our usual production schedule by New Year's. If you'd like to donate a gift to the GoFundMe that was set up for Cynthia and her family, you may do so here. Thank you to everyone for your beautiful messages, gifts and prayers.

Please keep an eye out for new content and an expanded Down to Birth platform on Patreon, including a new Community feature where listeners can post questions for us and each other. To join and gain instant access to our entire library of video content, go to our Patreon and sign up.

Onto the show:

For this November Q&A, please enjoy the full, extended version of one of our top Q&As from season 3, where we discuss: 

Weight loss after having a baby--can you lose too much too fast? What tests should be done if you've had multiple miscarriages? Can you give us the scoop on Evening Primrose oil for getting labor started--is it helpful or hurtful, and what does the research show? How do I handle my mother-in-law who keeps giving me keepsakes for the baby that I don't want? Is there a way to safely bed-share with your baby without investing in extra contraptions? What is the best way to create a stash of breastmilk without causing oversupply? And one of everybody's favorite topics: pushing in labor--when should you and when should you not?

Also: Trisha gives one woman the lowdown on all the types of "pain relief" options in labor. Another moms is experiencing some unusual physical symptoms at six-months postpartum and wonders if it means her period is returning. We discuss "failure to descend" versus failure to progress because one listener had a c-section and had never heard of that diagnosis before. We discuss a pregnant woman's high blood pressure questions as she's preparing for her home birth, and Trisha responds to a question about newborn feeding schedules as far as whether there's a time and place for using an alarm. We also discuss short cords, and resources for evidence-based info on induction versus waiting. 

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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.

Hello from Ontario. Hello, Trisha. I'm stuck up here in Canada. You're at your camp, and you have a baseball cap turned around backwards on your head, which has been the theme of the whole summer that I've been overdressed for you, even when we had dinner a month ago.

Well, I'm in camp attire now. You know, it's a whole new set of it's a whole new wardrobe. That's right, that's all right. So we got a lot of first of all, we got great feedback on our new format of audio questions. So we want to thank everyone for calling in with your questions, and remember to do that. Our number is 802-438-3696.

That's 802-GET-DOWN.

I love it. You know, when we first, when we when we first got that phone number, it was like, Do people really still use the phone number? Ever? Do people even make phone calls anymore? And we didn't use it for the longest time, and now all of a sudden it's blowing up. So put us in your contacts. Call us anytime. 24/7 our voicemail will pick up, and we're going to get started right away with this month's questions.

Hi, Cynthia and Trisha. I am calling in because I had a question about gaining and or maintaining weight while breastfeeding. I just had my first baby at home

last week, actually, on the seventh, and it was an amazing home birth. Prior to getting pregnant, I was trying to gain weight. I've always been super petite. I'm five one. I was 102 pounds when I got pregnant, and 131 when I gave birth.

I'm quickly losing weight. I don't want to lose too much weight, so I was just curious as to how I can maintain my weight where it's at. I'm about 110 111 at this moment. So just curious what tips you had and any advice. Thanks. Bye. Bye.

What do you say?

Well, no doubt, breastfeeding takes a tremendous amount of energy from the body. If you're exclusively breastfeeding, it's actually more than pregnancy, so you have to continue to focus on eating sufficient amounts in breastfeeding, just like you do in pregnancy, but it's even more calories. So I usually recommend the same strategies that we talk about in pregnancy, small, frequent meals and an emphasis on protein and higher calories at each meal. Okay, that sounds good. I mean, here's my question, does she have a legitimate concern, like, should she actually be a little concerned about her weight falling back to her pre pregnancy weight so quickly? What's the what's the issue? Well, I think she's just worried about getting too thin, which can happen, and then, would that impact milk supply or something? Well, it just takes up all your reserves. You know, if you get too thin and your body is working with a lot less nutritional reserve. So I think it's more about just protecting her nutritional reserves, and she probably doesn't want to be too thin.

So I don't think it's about calorie counting at all. I would never suggest counting calories, but just being aware.

That those are the additional needs. And I think when people are breastfeeding, a lot of times, they're very worried about getting their pre pregnancy they're worried about getting back to their pre pregnancy weight. They're worried about shedding the pregnancy pounds. So they often eat less when they're breastfeeding, and that would be depleting. Very few people, yeah, it's depleting. I mean, breastfeeding takes a lot from your body, and so does pregnancy. So you have to continue to replenish sufficiently so that you don't get postnatal depletion, which is a real thing. Hello, Cynthia and Trisha. Thank you for your show. I'm wondering if you have any advice for women who have had multiple miscarriages, who are wanting to get pregnant, I have a fertility specialist appointment set up in the next couple of months to try to figure out what's going on with my own pregnancy losses. I've had a couple of losses before the seven week March,

and we've tested progesterone levels. I'm just not quite sure what's going on, and we'll be visiting a specialist to do some additional testing in the next few months. But just wanted to know if you had any thoughts on multiple miscarriages and how a person could further investigate those losses. Thank you.

My first thought is, my, my interpretation of her question is, she has had a couple of losses. So in my mind, that's two. So that's one assumption I'm making, that could be false and that she lost them before seven weeks. I mean, my, my honest feelings are, everyone takes and handles miscarriage so differently, and I've experienced miscarriage myself, and my honest feelings are it's so much more common than I think anyone recognizes. And I think experiencing a loss around the time of the heartbeat starting at five and a half or so weeks is really, really common. And so she said a couple before seven weeks. I personally don't view that as necessarily a problem. It's obviously very difficult to deal with. But my concern is any woman developing negative beliefs, like I have trouble conceiving, or I experience miscarriage, it is so common. I mean, I once remember sitting at a mom's night out with like nine or 10 women, and every single one of us that evening had at least one miscarriage story to share. So I always feel for women when it happens before they've ever had their first child, because they form these beliefs, and that's always my concern. So now she's having her hormones checked. And you know that can be such a rabbit hole of doubting the body, and my guess is she probably doesn't have a hormone problem at all, and she did conceive. And I don't really have any advice or thoughts other than in my own personal life. If I would want to make sure my hormones are in balance, my first thought is, is food like just going to a clean whole foods diet is probably the very best thing you can do for your hormones or for your body at large, in addition to getting good quality sleep. And those are my only thoughts. I don't have anything. I don't think more more valuable than those. What do you think Trisha?

I think those are great thoughts. I would agree with you that miscarriage is extremely common. It happens in probably one out of three pregnancies, often on, often unknown. Sometimes you just have a period and you didn't know that. You actually, you know could have been pregnant, or you have a late period, and it turns out to have been an early miscarriage. One out of five known pregnancies miscarry. I believe that's the accurate statistic. So that's 20% of pregnancies, but probably unknown. It's higher than that. But the good news is that the vast majority who have multiple miscarriages still go on to have a healthy pregnancy. So as you said, we don't want to form that belief there are certainly some underlying conditions that can predispose a woman to multiple miscarriages, such as thyroid imbalances, diabetes and blood sugar issues, autoimmune conditions. The genetic variant of the MTHFR gene is a common reason. So I would, I believe, in practice, it's usually standard, standard that if you've had three or more miscarriages, we start digging a little bit deeper into the Gen genetics and underlying conditions, just to do a tiny bit of math, because I, you know, I can't, I gotta be me Trisha. And if it is one in three pregnancies, that means there's an 11% chance that a woman will experience two miscarriages in her first two pregnancies. So there's a one in three chance for her first but there's an 11% chance that she'll have two miscarriages before her third pregnancy. So that's not out.

Of the realm of normal. It's quite common. 11% of women can have two miscarriages, if those initial statistics are correct about one in three, and I believe they are, especially when you include early losses like this. Well, if you include that number, includes pregnancies that are not known about. So that's the assumption. If you are if it's a known pregnancy, it's one in five, right, right? So like the women who maybe had a heavy period, or they got a late period and it was heavy, yeah, but I exactly, I tend to trust those statistics, because I do believe miscarriages are extremely common at the very, very beginning of pregnancy there. So just really quickly, a very simple thing that a woman can do, if she is worried about this or has had two miscarriages or even one and doesn't want to jump on to further testing, is just some herbs to support progesterone levels. That's one of the most common reasons people miscarry is low progesterone. So Vitex is a great herb. Maca is another one. You can even do a natural progesterone cream. If you're a little bit older in your perimenopausal years and progesterone might be an issue, you can work with a functional medicine practitioner or an herbalist to help with these things. Do you mean maca? Like that powder you can buy and put in smoothies that has a nice taste to it? I've put that in like chocolate, banana peanut butter smoothies, and quite enjoyed it.

So it's an excellent supplement for women's hormonal issues.

Hi, this is Meg from Southeastern Pennsylvania, and I have a question about evening primrose oil.

I have read mixed information about taking evening primrose oil in late pregnancy and 30 weeks now, I'll definitely be eating my dates. I'm already drinking raspberry leaf tea.

However, evening primrose oil seems to have mixed information out there. Some studies show that it can help ripen the cervix, and other studies show that women who take evening primers oil ends up with more interventions. What are your thoughts on this? I would love to know. I've been listening to the podcast for about six months every time I go on a drive, and I've learned so much. I was planning a home birth before this, but I just feel so much more informed. And I sent episodes to my boyfriend, my family members, so many people. So thanks for all the work that you do. Well. Thank you for that question, Meg, and it's interesting when the when women look up things and they say there's mixed information, because when you look into the mixed information, what you usually find is very little research on something, and then you find a whole lot of rhetoric that says, well, it's never been proved to help, and they say that about everything. I mean, I remember growing up and they were still saying that about vitamin C. Well, it's never it's just a myth. It's never been proved to help, but we know conclusively that vitamin C, it definitely fights viruses in the body like zinc does. But the fact of the matter is, there just isn't ever going to be a lot of money poured into such research, because who's really behind it and who would care to fund it? But there was a small study, I believe there were 86 participants, where they studied primrose oil, and I found this to be really interesting.

Primrose oil can be administered vaginally or orally, so that's an important first distinction to understand, and in a study where it was taken vaginally, so it's like basically a pill Trisha, that they dissolve near the cervix, right?

Well, it's an oil. Then you break open the capsule and apply the oil directly to the cervix, or insert it vaginally, and it dissolves, and the oil gets onto the cervix. So they did a randomized control trial that looked at the effects of administering evening primrose oil orally, and that didn't really show particularly strong results. There was like a little leaning toward some positive effects. But let me get into that with the one where they tested the inserts that are done vaginally, and it was a double blind study, so that means that neither the participants nor the researchers knew who had the actual primrose oil and who just had a random placebo that looked exactly like the primrose oil capsule.

All the participants were 38 weeks pregnant when they did this, and the evening primrose oil group received 1000 milligrams in a capsule daily that they took vaginally, and everyone in the study was told to lie down for two hours following the nightly capsule. That really surprised me. And then I realized they're just doing it before bed, right? Because who has the time?

How much they have to pay people to say, Take this and lie down for two hours afterwards, they probably just did a good nap, right? Yeah, seriously, quite the luxury. Then they evaluated the bishop score for each woman. Trisha. Why don't you first jump in and explain what the bishop score is. That's just an evaluation of the ripeness. Don't love that word, but that's how they define it, of your cervix. So is.

Far as its degree of openness, softness and effacement. So they're looking at all the factors that play a role in whether an induction is likely to be successful. When they do inductions, it's a specific scoring system that takes into account those three factors, how open the cervix is, how effaced it is, and where the baby station is that's and it based on that Bishop's score, your likelihood for a successful induction goes up or down. And I think that's something a lot of women don't understand. They think induction just happens. But the truth is, sometimes women are sent to the hospital for an induction for a good reason or a bad reason or no reason, and sometimes she's there all day long, and they are cranking it up, and it isn't really working, and they have to keep adding interventions. And you know, she has to understand that they really began that induction when her body was just nowhere near ready. And sometimes induction works very easily. They just do the slightest thing and it triggers labor. So that's what the bishop score. Does Trisha? Do you think it's a little off topic, but do you think they typically care to look at the bishop score when they're doing all these unnecessary inductions for women based on due dates? I mean, I've never heard of a woman being sent back home because her bishop score wasn't high enough. Well, what they'll do is they'll give you a cervical ripening agent as the first part of the induction, so the right fully catheter, you get the or you get the cervidal and that's why evening primrose oil is good, because it acts like cervidel. It acts like the prostaglandin in semen. That's why we always talk about having sex to try to help ripen your cervix and prepare your cervix. And midwives have been using evening primrose oil for ages. Yeah, midwife mid midwives have been using this forever, and they have been on to something. So in this in this study, the control group that had the placebo, their bishop score was just 4.46 but in the evening primrose oil group, it was 7.83, it was 4.46 versus 7.83, so the evening primrose group had significantly in addition to being having a higher Bishop score when they all went into labor naturally, they went in with their bodies much more primed and ready to go right into active labor. The Evening Primrose group also had, this is where it really got interesting, significantly shorter labors of just four to five hours compared to eight to nine hours. And the C section rate in the evening primrose group was 21% versus 47%
in the other group. And Pitocin use, which you always have to take this part with a grain of salt, because this is provider intervention here, but getting impatient and pushing labor along. So this is no surprise, but Pitocin use was 29% in the evening primrose group. You wonder why they used it at all, quite frankly, versus 62% in the control group. There was no difference in the length of active labor, postpartum hemorrhage or Apgar scores, and there were no side effects reported. So Meg, whatever information you're seeing out there, I think this is pretty compelling, and the fact that there are no side effects reported, my gosh, no brainer. Trisha, I can tell you that I personally use it in all three of my pregnancies, and always recommended women started around 37 weeks pregnancy. You're kidding if they wanted, if they wanted to, yeah, I had no idea you used it. I never used it. And I never, I never, I never used it. Do note these were all low risk women, and definitely check with your doctor if you're already on some kind of medication in your pregnancy. That was the only caveat.

Hi there, Trisha and Cynthia. I have a boundaries question. I'm hoping maybe you can guide me through. I have a wonderful mother in law who happens to have kept every single little thing from my husband's upbringing that she is now passing down to me.

We have the first grandson, and so we are getting inundated with cribs and blankets, and I mean, everything, down to the socks that my husband wore in his six month baby pictures. So she's just so excited for us to recreate my husband's upbringing, and I'm not sure what to do with it all. I'm I'm so grateful that she's wanting to help us out some of the things I can't wait to use, but I have a basement full of furniture and boxes and just so much stuff that I feel bad donating, because it's all sentimental to her. Obviously, she's kept it the last 40 years. Some of the things I've talked her into keeping at her house for when we visit, but a lot of it has already been delivered to me. So I'm hoping you can give me some insight, or maybe some tips on how.

To handle this situation like I said, she's a wonderful woman, and I love and cherish our relationship, so not wanting to step on any toes. I'm just also not wanting to have a basement full of 40 year old baby things. Thank you for everything you do. Love the show. Bye.

Well, first of all, let's have perspective here. You love your mother in law. I think we can assume she loves you. None of this is just stuff, and stuff doesn't matter. What matters is you have a relationship that you are both enjoying and you love each other. Don't worry about this stuff. I have a mother in law who did the exact same thing, whereas my mother throws everything out without a trace of guilt, and has assured me I can always do the same and not to get sentimental over over stuff, no matter what it is. My mother in law saved everything, and when we had a baby, I was really shocked. Some of it, I'm not kidding you, it was like stuffed animals. I mean, that stuff can have mites in it after years, some of it was little hard covered books published in the 60s, and we just, what can you do? You just have to get rid of it when you don't want it. It has nothing to do with your love for her. Hopefully she's not prepared to give you a guilt trip, but there's nothing to feel bad about. And if you need a really good, Stark perspective in the other direction, there are two books I recommend, highly recommend Kim John Payne's simplicity parenting. It is phenomenal. I think every parent should read it. It's just, it's such a great mindset. I don't think you're going to really get anywhere else. And if you want to go further, read um, Rita Marie Kondo is the life changing Magic of Tidying Up, because she does have a segment on not getting rid of stuff in order to give it to someone else. No matter what, when you're getting rid of your stuff, don't give it to someone, right? That's a big that's a big no no. That's actually like really putting a lot of burden on another person, to give them your other to give them your thing. So the bottom line is, be attached to people, not to stuff.

Hey, girls. My name is Mariah. I'm 22 years old, and I'm from Los Angeles, California. I'm 20 weeks pregnant with my first child, and your podcast has been such a lifesaver, especially since I'm planning on having you out of hospital birth, I've been doing a lot of research on bed sharing to help inform myself about the ways to do it safely. However, I can't seem to find the exact answer I'm looking for. I want to co sleep in a way that is easiest for me while breastfeeding and that also allows my baby to bond with Me. Is bed sharing an option for a newborn, and how can I do that safely with my husband sharing the bed as well? Or is getting a bassinet or bed attachment the best alternative, I want to do the least amount of moving around as possible at night, and the idea have of having an extra attachment next to the bed just seems like an unnecessary extra step. Thank you so much for your amazing, informative podcast, and please keep up the good work. Okay, bye. We haven't talked very much about closely being on the podcast. We touched on it, but I look forward to answering this.

So you go ahead start well, I mean, my I like her question. She sounds already like she's experienced in this, because she's thinking about how to do this without moving as much, with minimal movement and disturbance to herself. I just have a couple things to say. One, what I found was, in the early I don't remember anything now, like weeks, months in the early days of having a newborn, I definitely found it easier to lie with my baby, usually tucked in my arm. I believe the baby was off and on. I don't remember their back or their side, the baby was definitely safe, because I'm a very light sleeper, and that's normal, but there's a point where the baby starts to move and become very active, and they do disturb your sleep, and at one point I had a co sleeper. And the plus side is you can sprawl out freely, and you're not nervous about anyone bumping the baby or anything. But yeah, it is a real pain when the baby wakes up, and you do have to basically sit up, lean yourself, up, lift the baby, and bring the baby into the bed. So my feelings are, it's easiest to go sleep in the early weeks or months, and then easier to have the baby just nearby when they get active. I think Kelly mom is one of the best resources for this. There are ways to responsibly co sleep. If anyone tells you it's unsafe, it's linked to people who do it irresponsibly. They're drinking, they're doing drugs, they're falling asleep on couches. There are very important measures to take, and then it is very safe when you take those measures. And the fact of the matter is that even with parents who say they're not going to co sleep, more than half of them, if not three quarters of them end up co sleeping at some point, even if it's just a night here and there. So you might as well learn how to do it and understand how to do it safely. So the concern about the husband in the bed is simple. You simply can put the baby on the outside of.

The bed and put yourself in between the baby and your husband. Therefore you don't have to be worried at all about your husband being less attentive and attuned to the baby as you are. Sometimes people say, Well, what about the baby falling off the edge of the bed? Or what about rolling, rolling onto the baby? And I always remind mothers that you know they generally do not roll off the edge of their own bed, because we are really, actually a lot more aware when we're asleep than we realize. I mean, if we weren't, we would constantly be falling out of bed if we did not know where the borders were.

I never thought about that, right? No one falls off their own bed. I mean, now someone's gonna write it and say, I fell off the bed. No, but okay, occasionally, probably we also don't roll over onto our husbands or our partners in bed without intention, right? It doesn't typically happen. We are much more aware of our surroundings while we're sleeping. So as you mentioned, a few things that are really critical for safe co sleeping is that you are a non smoker, that you are not drinking. We are avoiding couches or reclining chairs, especially like big Lazy Boy type recliners. That is not a safe place to sleep with your baby. So a lot of people do do that, and that is considered unsafe co sleeping, the baby should be dressed lightly so that they don't overheat. They should be technically on their back or their side, preferably the back. According to the guidelines, you should limit how many blankets and excess excess pillows and things are in the bed, so that you can reduce any possible chance of suffocation. Exclusive formula feeding increases the risk of SIDS, and exclusive breastfeeding dramatically reduces it. So that's another really important point, and having the baby on the edge of the bed, by the way, there's a really good technique for safely doing that. There's a technique with like a square baby blanket, where you fold it, you have it open like a diamond, and you put your own body under one corner, you put the baby in it, and then you wrap it around the baby so the baby can't roll, because you end up tucking two sides under your own body. And that was that really gave me the peace of mind to allow me to sleep while the baby was on the edge, not the very edge, but the baby was on the end of the bed while my middle because I was worried about my husband moving around and not having the same awareness.

Of course, I mean that just the worry would have kept me awake. Oh yeah. One other thing I'll add is, if you are worried about that, you can do what's called the cuddle curl, where you sleep on your side and you kind of wrap your arm around the baby on the top and tuck your knees up, almost like you're spooning your baby, and that creates a little safe haven for your baby to be protected. And your baby can't roll. They're not going to roll off the bed, so it's as long as they're not too close to the edge that you're not going to, you know, accidentally, inadvertently push them off. But do read about it, because you wouldn't want the baby on the edge of a bed if the wall is there, because that actually is unsafe, and the baby could potentially get between the space of the bed and the wall. So do read up on it. We're just giving you some sense of what you'll discover when you read about it. Hi. This is Megan from Downingtown, Pennsylvania, and my question is about how to create a small breast milk stash without creating an oversupply issue. So I'll be taking four months off after I have my baby and I teach piano lessons, so I only work about an hour or two per day, maybe three hours. I want to have a small stash available for my husband to feed the baby while I'm gone at piano lessons. My studio is also pretty close by, so he could probably bring the baby to me during my little breaks. So I don't need a huge breast milk stash, because I'm not going back to work full time in any capacity. But I'm wondering how I can do this without creating oversupply. Thanks so much. So easy question.

First of all, she's correct that she does not want to create an oversupply, because oversupply can be equally or more problematic than low milk supply. In many cases, it's actually a lot harder to fix.

So what she wants to do, really is, in my experience, if you want to save and store a little bit of milk without creating oversupply. You can pump one time a day, generally, first thing in the morning, because we have a little bit of extra milk in the morning, if your baby didn't nurse as much overnight, we also tend to produce a little bit more milk between midnight and noon. So I recommend taking your your first morning feeding that you do where you're sort of up and out of bed, feed the baby, then pump just up to two ounces. So you may only get half an ounce, three quarters of an ounce, a quarter of an ounce, but over time, that will increase a little bit, and you can store up to two ounces per day if you go over two ounces, if you start over.

Over producing 3456, ounces a day, then we're in oversupplied territory. Hi. I saw your post on Instagram about questions about pushing, and I did actually have a question about it, and it has to do with when nurses are telling their patients not to push. I just wanted to know what your thoughts were on this. I've heard that a lot of nurses have said that, as you know, regarding if they're waiting on the doctor or, you know, I just wanted to get a little bit more information on this. And just kind of wanted to get an idea of why they say that, and what can happen if, if someone doesn't push or tries holding back. So yes, just wanted to get your thoughts on that. Thank you so much. So my thoughts on that are that if nurses are trained to say that to women whose babies are about to emerge, then they're trained to abuse women, because you cannot tell a woman whose baby is on its way out through with no through no force of her own doing, the natural expulsive reflex, or the fetal ejection reflex. She can't stop that, and to tell her to stop it is. It's something you don't need to listen to or obey. I've said to my own clients, if I were on the way to a facility and I felt that moment happening, the baby's coming out, my first thought would be, well, we're going to need a new car. There is no stopping this, and the thought of it is heartbreaking to me. I can't I hate that any woman has ever been told, close your legs. Wait. Why? So a doctor can be there and take credit later for delivering the baby that you're birthing. Sorry. This gets me really, really upset, because it sounds like human torture to me, and it's very upsetting. There's my opinion, in all my professionalism, go ahead, I'm with you. The best thing you can do when that's happening is let that baby come. Let it happen. Just be there, you know, to hope somebody's there to help you receive the baby. And if they're not, you're just going to receive the baby yourself, and that will be perfectly fine. More women through the history of the world have received their own babies into their own hands than not since the beginning of time. I'm pretty sure our instincts will kick in just fine, and we'll reach down and grab that baby and instinctively bring baby up to our chest and do all the right things to help them transition. And then when the doctor walks in a few minutes later, you can go it turns out I didn't need you, Doc, but I was really glad you were nearby, just in case I did.

Hi Trisha, hi Cynthia. I just had my baby on July 2, and was planning for a natural birth. My water broke before contraction started, so I didn't get to labor at home as long as I had planned, and once I got to the hospital, I had to be continuously monitored and it spelled out. After laboring without progress for hours, I agreed to cytotech and eventually Pitocin. I was in labor for 55 hours and pushed for three and a half before ultimately having a C section due to failure to defend I hadn't heard about failure to descend before. What are some of the causes and what are some of the things that can be done to prevent it? Well, failure to descend falls into the exact same category as failure to be patient. I mean, failure to progress, which is also failure to be patient. Okay, so they're not different. I mean, it can it be that a baby doesn't descend? I think it's rare. But isn't that also a thing in and of itself? Yeah, so failure to progress, typically is, I mean, if you want to get specific, failure to progress is referring more to the failure of the cervix to continue dilating. Failure to descend is the baby not coming down through the various stations to get out of the pelvis, but they kind of fall under the same category. You don't progress past a certain point, and I feel the same way about it as I do about failure to progress. It's typically related to time constraints, poor maternal and poor fetal positioning, so your baby is unable to descend through the pelvis, likely because baby never got into the optimal position throughout labor. That makes sense. I just feel, I just feel sorry that she went through 55 hours of labor, cytotech, Pitocin, C section. I mean, this is how, this is how motherhood began for this woman and for so many others, absolutely exhausted with a C section to recover from. I can't even imagine labor for 55 hours. It's just so much. It's so much to go through. And I hope she was induced for the right reason, and I hope she can be at peace with it, or it's just Anyway, that's all beside the point, but that's what, that's what I'm feeling right now.

Well, it's the kind of boat. We don't know the exact details of this case, but I would bet it falls into the category of the Cascade.

Interventions that create a difficult environment for mom and babies hormones to do the necessary job to get the baby into the best position to be born vaginally. I mean, it's feels like this, the source the story that we talk about all the time. One intervention leads to another, which prohibits the next, the next thing to happen in labor, to get the baby to properly position themselves to be birthed federally. And those interventions come with extremely serious risks, and they should not be administered unless it's counter, unless it's offsetting some greater risk, like preeclampsia or something. Also, I want women to remember, or to know that if they do find themselves in a situation like that and feel like, oh my gosh, how did I get myself into this? I let them talk me into induction because I hit, let's say 41 weeks, you can go home. You're not captive. You can go home say, I've changed my mind. I don't want this. Nothing is going on. And they can make sure there's no medical indication for intervention at that moment, go home and sleep and go back in the morning again. Well, the other thing to note here is that she did have 55 hours of labor, which is going to put her body into an extreme state of exhaustion. And when the body gets dehydrated and low on energy and fatigued, it's hard for the uterus to do the job that it needs to do, of pushing the baby out. And so when she's when she's at that point of three hours of pushing after 55 hours of labor, the body can only do so much. And on the bright side, she has very good odds. Should she decide to have another baby of a successful VBAC, because her body was in labor for so long. Hi, I am planning a home birth. I'm currently 36 and a half weeks pregnant, and my blood pressure, starting at around week 20, was low, 100 over 60, which feels a little bit low. And my midwives are saying that that's quote baseline. So they've been concerned that my blood pressure ever since week 32 has gradually been creeping up. It's never been preeclampsia level of 140, over 90, but it has fluctuated between, you know, the high one, teens over, you know, 80 all the way up to my highest reading, which was like 133 over 89 I don't have any of the other symptoms of preeclampsia, such as just, you know, visual disturbances or headaches. I guess I want to know, how can I continue to have my dream home birth, even though, you know, I have some mild hypertension and I don't want to go to a hospital for any reason. Thank you so much.

Well, the first concern is that she said her midwives are by the book. I don't love that, because that means that, you know, they're not really going to take the individual person into consideration and look at the holistic picture, they're going to basically just go off what the protocols and policies and guidelines say. So that's already a little bit of a red flag for this particular midwifery group. She may not have options. This may be her best option. So in that case, I guess just as far as the physiology goes, it is normal for your blood pressure to lower in pregnancy. So when her blood pressure was low, that's that's part of the physiologic process of pregnancy. We hit the tend to hit the lowest point of blood pressure around mid pregnancy, 20 to 25 weeks, and then it does start to go up again. And that's also normal. It's important that you know your baseline blood pressure pre pregnancy, because that's really what we want to compare it to, not what we were at the lowest point in our pregnancy. And she doesn't have any signs of preeclampsia. So high blood pressure alone at this level is still in my book, still okay.

We did just do a post on Instagram that showed increasing levels of vitamin D is very good at potentially combating preeclampsia. And I know of two very famous expert midwives who would also recommend reducing animal protein in the diet, because that can strip minerals from the body, and they believe, they theorize, that that could potentially also reduce the likelihood of preeclampsia. So take that if it feels useful, and ignore it if it doesn't. That's interesting that you said that, because one of the things that midwives have always said is a risk factor for preeclampsia is too little protein in the diet. Yes, animal protein is the key. That's the big key, because animal protein, unlike any other protein, and protein is in every single food we eat, does take minerals out of the body. So calcium reserves go down, magnesium reserves go down. Magnesium is what they give you if you have preeclampsia, it's the first thing they give you in a hospital. So I.

Want to put it out there. If it resonates. I know that food is very personal, but if that resonates, I think that it can be empowering information to someone who's very motivated to, you know, to try natural ways of avoiding this, since it's such a big concern for her.

Do you think that it has anything to do with the type of animal protein, like we're talking, you know, pasture raised cleaner proteins versus our conventional most people won't agree with me, and I'm not your average person, because I'm already pescetarian to begin with. And for me, if I have dairy, you know, it's just a dessert or a treat. It's not because I think it's a good source of calcium. I am kind of in line with like the China study or the pH miracle by Dr Robert Young. And basically, I don't really, yeah, I mean, if I ate meat, I would buy, like grass fed. But I'm always walking through the grocery store thinking they're supposed to eat grass. Y'all like they were never supposed to be eating corn, and even worse things than that, so just restoring cows to their normal diet is, is what we should have been doing all along. So there's no doubt I think that that's better. But again, I'm no, I'm no, I'm I'm not the final word on any of this. This is just, this is my angle on food, and this is what I think might be empowering to her for wanting to

find natural, safe ways to potentially reduce preeclampsia. And I think it's potentially very valuable information that may never get a drop of research, and we may never learn more about it other than these theories.

Hi, Trisha. Trisha and Cynthia. My name is Brianne. My question is about some symptoms I've been having just wondering if they're normal, and six months postpartum right now, and I still haven't gotten my period back. I know that amount of time can be still normal, but this past week, I've been having like, some spotting and also some menstrual like cramping. I also took a pregnancy test just to be sure, and it was negative, of course. But then within the same week, I've also had symptoms of ovulating as well, so I've just been kind of confused about what my body is doing right now. This is a little different than how everything went after my first baby. I got my period back much sooner after that. So thank you so much for taking the time to listen to my question. I appreciate you guys in your show. So much. Thank you. Have a great day.

So she didn't, she didn't specify whether or not she was breastfeeding. If she's breastfeeding, this is absolutely, perfectly common and normal. Most people don't get their periods back before six months. If she's not breastfeeding, it could still be it could still be normal, because she may have done some amount of breastfeeding. It sounds like she her body is kind of gearing up. If she's having some spotting and cramping,

she might be ready to get her first period, as long as there's really no other major indication of a problem. I don't see this as being problematic. Vitax is another great herb that she could start taking that is helpful when the hormones are trying to rebalance after having been on birth control or after having been breastfeeding or pregnant. So I don't think she has anything to worry about. And I think her period is probably on its way. Hi, my name is Sarah. I'm calling from Seattle. I'm currently 26 weeks pregnant and planning on a home birth, and I have a question for you about feeding schedules for a newborn. So I understand that in the early weeks, it's best to feed the baby as much as possible, and I'm wondering if I should plan to set alarm to be on a feeding schedule where I'm offering the breast at a certain interval, or can I count on the baby to let me know when he's hungry? And specifically, I'm wondering for in the night, when I go to sleep, should I set alarms to wake up at a certain interval, or will the baby wake me when he needs to eat?

I would love to hear from both of you. Thank you very much, and I love the show. Thank you.

So yes, with a brand new baby, that with the attention, the intention to be exclusive breastfeeding, it is really important to feed the baby frequently, and if they are not self waking. You do need to wake them up overnight. The maximum amount of time overnight for a brand new baby is three hours. One four hour stretch is reasonable, but otherwise you should be setting an alarm for three hours if they are not waking on their own, most of them will wake around that point. Though. Hi ladies, my name is Serena. I'm from Lancaster, Pennsylvania. I love your podcast so much. I'm so grateful for it. I probably refresh your page like three days a week just to see if you happen to release extra episodes. I love them so much, so I was really hoping for your advice or input.

On pain relief options during birth, so I'm hoping to have a natural labor. I'm due in October with my second and other than obviously positioning and all of the natural options for my first daughter, I asked my doctor if an epidural in any way affected your body's natural ability to produce oxytocin, and she told me no, and obviously, now I know that is not true, so I was just hoping for some reliable pros and cons of some of the different medical pain relief options. Thank you again. So much for everything you guys do. I appreciate it so much. So I would just say that, if I had to give my personal opinion on this, I think that narcotics are my least favorite option for medications and labor. Epidurals have a time and place, but I believe are way overused and used too early in labor, which can be problematic, used later in labor under the right circumstances, epidurals can sometimes be really helpful for actually getting a vaginal birth. So there is a time and place for it. I think nitrous oxide is a fabulous option for people. It has very, very few side effects, and it kind of just takes the edge off. So if you're somebody who just is having a little trouble going fully on. Medicated nitrous oxide is a great starting place, because it just kind of gives you a moment to tap out and then sterile water papules, which she also mentioned, are excellent for back labor. There's very, very few risks to them, but they have also a pretty specific purpose. They mostly just work if you're having pain in your low back. They actually just sort of numb all the nerve receptors in your low back. Hi Trisha and Cynthia. This is Megan from New Jersey. How can a short cord affect labor and delivery? My midwife said I had a short cord that may have contributed to my 60 hour labor. Any truth to that? Thanks.

Unfortunately, there does seem to be some truth to complicated labor and birth with truly short cords. Now, whether or not they just called it a short cord as sort of a write off for her difficult, long labor, I don't know, but truly, short cords, which are not terribly common under 35 centimeters in length, they do have a higher risk of retained placenta. They do have a higher risk of Cesarean birth and prolonged labor. There is something to that. But again, I don't know if that was actually truly the case for her or not, or if that was just sort of a excuse. And it's worth mentioning that cords can be anywhere from about 12 inches long, which I think is about the 35 centimeters you mentioned.

It's close to that, and and three feet or three plus feet long, so short would be in the area of one foot long. And I guess that makes some sense if there's tension on the placenta, or if there's the thing about it is that short cords are correlated there. They are often correlated with like, a small for gestational age baby, a baby who's not growing properly, intrauterine growth, growth restriction, underlying genetic issues, because the length of the cord is actually correlates with the activity level of your baby. So if your baby is very active in utero, you tend to have a longer cord. So it kind of makes sense that if you have a really short cord, that there may be something underlying in that development of the baby that contributed to more minimal activity. Interesting, very interesting. Not always, though, not always. So we can't assume that just because you have a short cord that there's a problem, because a short cord is also normal. Hi, ladies, I would love your input on if you have a reliable website or resource or someone that you go to for all of your evidence based birth statistics and articles, I would really like to specifically educate myself on how to safely go late term. I guess that's the only topic I don't feel fully equipped to handle. If I would go past 41 or 42 weeks, how to do it safely, and what the statistics are, what you're supposed to do, what you're supposed to watch for, like the hospital, I'm going to most, most likely, just suggest I be induced, and I don't want to be induced. So, yeah, I would just love to be more educated on that topic. Specifically. Thank you so much so when we look at the actual data around stillbirth, it goes from basically four out of 10,000 pregnancies at 39 weeks to seven out of 10,000 pregnancies at 40 weeks to 17 out of 10. 10,000 pregnancies at 41 weeks, and then it doubles from 17 to 32 out of 10,000 pregnancies at 42 weeks. So when people say the risk of stillbirth doubles after 41 weeks, yes, that's true, but we're still talking pretty relatively small numbers when we're talking about stillbirth, no, no. Number is small enough. So this is where it becomes a really a personal choice for the mother and her provider on what they feel, what they feel comfortable with. And you have to look at the whole picture of our mother and baby doing okay. Are there any signs of anything looking awry in the pregnancy? And I think you have to take it day by day at this point. You know there you can have biophysical profiles to look at how the baby's doing, and if everything is okay with the baby and the mother, it seems very reasonable to go another day or two, or a week, or whatever it is. So here's what makes the decision so difficult, that there is a risk every week of pregnancy, of loss. And statistics don't apply to the individual, you know, and it feels like it does, but it doesn't. We can think about statistics until we go crazy. I really encourage women to listen to their instinct, because what can we do with just sitting there and looking at a statistic? So at the 42 week mark, that 32 out of 10,000 means there's a 99.68% chance that it won't be a stillbirth, which doesn't ever sound good enough to us, right? 99.7 still doesn't sound great. But the reason this is a difficult decision for anyone is and then there's no easy answer is, they just simply don't take 10,000 women in a study induce them all in the name of trying to save those 32 babies, and really tell us whether they saved 32 babies. And then what was the effect of the side effects of those inductions? Because the side effects of inductions are very significant. So are there losses on those ends because of the problems caused by the induction? We never will have that information. So until we could have that information, women could say, Oh, I see it's a balanced risk on either side. One is a risk of doing nothing, one is the risk of intervening unnecessarily. But we don't have that information, and we never will. So what can you do? You have to get quiet. You have to listen to your instinct, because there is no wrong thing to do. There just isn't. We don't know where the risk lies for any individual. The other thing I just always have to go back to when somebody is hitting the 42 or even going past 42 weeks, is because it's really not very common, you know. So are your due dates? Is your due date correct?

Because it isn't always factored in. If you had a extra long cycle that month that you got pregnant, or if you didn't have an early ultrasound for dating, sometimes we have the wrong dates.

Okay? Wiki, time.

Why is that? Choir cookies so fun.

We'll talk about that in another episode. Trisha figure that out. I was talking about questions. Okay, I know.

What else could you possibly have been talking about? Okay, first one. Here we go. You ready? I've got them. I'm always ready. The sleeping on your back actually double your risk for stillbirth. So interesting, interesting that people think this. So I did actually look this up, because I didn't really realize that people actually thought that, because I've always talked about sleeping on your back is really not being

that problematic. So there was one study that showed that women who went to sleep on their backs had a higher rate of stillbirth in those babies. However, it was only for women who went to sleep on their back, if you wake up on your back in the morning that is not a risk, only if you actually fall asleep on your back. So women who choose to sleep on their backs are at greater risk than women who actually do. Women who start out the night on their backs, oh my gosh, that is such, right? It doesn't make any sense, okay? So what I always tell people is,

the reason that this is a risk is because when you're on your back, the weight of your this is not getting quick. The weight of your uterus reduces blood flow to the baby, right? But it also reduces blood flow to your brain, so you will generally feel it before your baby is going to be compromised, and you will instinctively, intuitively get off your back. Now, if you're on your back, you can always prop up your one of your butt cheeks. And if you just get a little bit off your back, just tiny little something under your butt, it doesn't have the same effect. It doesn't reduce the blood flow, so that's it. Go to sleep on your side. You wake up on your back. Don't stress, if I hire a midwife, do I still need an OB?

Oh, my goodness, people, I forget that our audience doesn't necessarily know the answer to this, as Trisha said, no, okay, why? Let's just be quick about it, your midwife is a medical caregiver, unlike a doula, unlike a childbirth educator, they are a medical caregiver. They don't do major surgery. So any midwife has a plan B, where there can be an OB to step in, should a C section be required. But midwives can suture most tears. They can administer, they can oversee the administration of Pitocin and all the rest. So no one of the best benefits is you don't need an OB ever again, even for your annual exams or anything, right? You only need an OB if you risk out of midwifery care. That would be the only reason, otherwise, your midwife is fully capable of managing every step of your pregnancy and birth. How do I combat early pregnancy headaches?

Combating headaches, I would say hydration. And for many people, it's cutting out gluten, whether you want to hear that or not, it's very effective and linked to cutting out gluten.

Well, the other thing is, in early pregnancy, we are very we are very prone to low blood sugar, so eating frequently, eating frequently, four to six small meals per day. So low blood sugar can trigger headaches. What is the best time to introduce solid foods for my baby? Is it four months or six months? It's neither. It's when they're reaching for your food. So Are you cool with people giving babies food at four months if they're reaching for it? No, I don't think a four month old does reach for it. Do you think they do? My son didn't reach for food till he was a year and a week old, and my daughter didn't until she was eight months old. So maybe my sample set is too small to four month olds reach for food. If so, I'd be very careful about what I have within reach. Yeah, I usually say the same thing that you just said, except not before six months. I think it's generally too early. They should still be exclusively on breast milk at that point. I agree. I never imagined any baby in the world reached before that point. But yeah, I guess it does happen. So I'm with you, yep. Okay, does a lot of vernix mean the baby came too early? No, certainly not. If there's a lot of vernix, it does indicate your baby might have been born on the earlier side of your guest date. And if your baby is born without vernix, it would indicate your baby was born on the later side of your guest date, because the verdicts already absorbed. But no, absolutely not too early by any means. My daughter was born at 39 weeks to the day, and it was absolutely caked on her. This is a tons and tons of rednecks. It's it's all good, no matter what, no matter when

I agree.

Do you support the use of Vitex to encourage ovulation? We were already talking about it twice in this episode, that Vitex is a great herb or adaptogen for trying to support progesterone, and particularly through supporting ovulation. So yes, 100% I support it. It supports the LH surge, which supports ovulation. And when you ovulate, you're more likely to have progesterone production. It's it's probably one of the most common herbs for women who are struggling with hormonal issues in their 30s and 40s. Here's a good one.

Is it possible to orgasm differently during and after pregnancy? Nope, it's always going to be the same orgasm. How do you answer questions? It never gets better. It never gets better, really, aren't they all really unique, ultimately, like, can we just say yes to that without really, without wondering if there's any other potential answer?

What is we want? Details. Explain exactly what you mean by orgasm, differently, different. How I mean, here's what different house, better, bigger, longer, more, more frequent. Multiples, louder, louder. Yes, it's definitely possible to have it be different. And pregnancy, the the high, high levels of estrogen in pregnancy make us more prone to more powerful orgasm. So I would say Pregnancy is a great time to have your best orgasm of your life, and it's all downhill orgasms from there.

That I would disagree with. I'm kidding. I just know the whole thing is hilarious. Um, all right, let's should we end on that one?

How do you top an orgasm? Of course, we end on that one. What are we gonna go to now? Like, spit up baby hair falling out, right? No, always end on the orgasm. It's like rule number one of podcasting. That's good.

Life advice, don't forget that ladies over and out. Everyone see you next time bye.

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.

I'm just thinking,

You look stunned.

I look stunned. I'm ready to go jump in the lake. I will see you. I don't know, maybe that first weekend we can grab dinner before you go to the shore. All right. All right, cool. I'll see you soon. Trisha, okay, bye, bye.

Transcribed by https://otter.ai