#145 | January Q&A: Hypertension & Induction; Boundaries with In-Laws; Posterior Babies; Birth Centers; Distracted Breast Feeders; Limited Provider Options; The "Nurse Curse"; Quickies!

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.

Is it too early to say Happy New Year?

it's never too late to say Happy New Year. God I blew it.

You're still January.

So it counts. It counts. Did you ever see that? Seinfeld where Elaine was like I went Scout one in March.

Oops forgot about that person. Is it too late? Right? That might be too late.

That's definitely too late. Just please, let's live in the present for God's sake. Right. And let's jump right in. We're gonna do something new this week. We're very excited about we're gonna see how it goes. Trisha just broke the news to you that I had this brilliant idea. So brilliant it is. But we get so many questions for the q&a Now that we're going to we have the ones we've selected. And we are going to do game show style I suppose a rapid fire What did you want to call them cookies or cookies? That's what they are. That's that's not what a cookie is Trisha.

Questions go? It is.

As far as questions go. I'll give you that. At the end. We're gonna do quickies. We're gonna see how many we can answer. I don't know, in a few minutes in five minutes. I like it. Because we get a lot. So we'll see. So we're gonna start with the with the deeper dive questions in the beginning, and I have one for you to start off the episode. Are you ready?

I am ready. All right,

it says Hello, ladies. I'm currently pregnant with my third and love your podcast. In my second pregnancy, I developed hypertension toward the end of my third trimester and I was determined to have a natural birth. The doctors tried to convince me to be induced even though I never actually developed preeclampsia. I pushed it, I pushed off the induction and in the end was able to have an intervention free birth. With that said, I'm very curious about when the right time to induce with hypertension is I'm approaching the last two months of this pregnancy. And I'm trying to mentally prepare myself for this to happen again. Anyway, I love your show and would be very interested in hearing your thoughts.

Well, first of all, great job to her for pushing off the induction despite having hypertension, because that can be a tricky thing to manage. So obviously, having hypertension and late pregnancy is a warning sign and something that needs to be watched. And the threshold for when you should induce with hypertension really is determined by the clinical picture. There's no black and white answer to that ACOG would tell you that once your blood pressure is over about 140 over 90, you're in stage two hypertension, and that's concerning. And usually induction is going to be recommended. But of course a single blood pressure, a single elevated blood pressure does not mean that your blood pressure is chronically elevated. Nor does it mean that you have preeclampsia doesn't mean that you could develop preeclampsia, and you need to be monitored for that and your pregnancy should be you know, more closely monitored. Yes. But I don't think I can give a specific answer to when you should be induced with hypertension. You have to look at the entire clinical picture. How was the mother doing otherwise? What other labs are we looking at? How is the baby doing? What are your thoughts on that?

Well, I think that's true. There's just too many factors. is involved. I did do some reading about it over over time, because this is a pretty common situation that we see. Very, and I think the most succinct response that is maybe a little bit helpful is from the New England Journal of Medicine. And basically, what they were showing was, first of all, there isn't enough research on this. So that's why you don't have a more clear answer, having all the education and background that you have Trisha as a medical provider, and as a midwife, because there really hasn't been enough research on this. But it's trying to find the balance between inducing too early, which isn't great for the newborn and has a very high rate of sending newborns down to the NICU, and inducing too late, which is where the risk of hypertension can turn into preeclampsia, or something very seriously at risk for the mother and what the New England Journal of Medicine was trying to summarize, acknowledging there isn't enough research is that when you induce at 38 weeks, it is a higher risk to the baby, but you're protecting the mother more, you're minimizing the risk of what adverse outcome could potentially impact the mother. But when you are waiting until 39 weeks, it shifts, and it's less of a risk to the baby's wellness, and a little bit more to the mothers because you're putting her in that situation. And preeclampsia can develop rapidly. And that extra week is better for the babies but potentially a higher risk to the mom. So there is definitely no clear cut answer to this.

Right. It's determined based on how significant your your elevation in blood pressure is, how quickly is going up what level it reaches and where you are in your pregnancy, just like you said, based on, you know, whether it's safe for the baby to be induced or not. But the problem with this scenario is that pretty much it seems that a lot of moms are saying that when they get a high blood pressure and late pregnancy that they're being told they need to be induced because they have preeclampsia.

And just because like preeclampsia, is that exactly. That doesn't mean that and it nor does it mean that it is going to become preeclampsia. But but that's the concern. And that's why every situation is on a case by case scenario.

But how would a woman know if she's being told that this is preeclampsia? And it really technically isn't?

What is she there are definitive labs that tell you if you have it or not, then there are specific symptoms. And you have to have you have to have a certain number of the symptom symptoms and your labs can be the definitive answer. But if your blood pressure is high enough, then you know you could and you won't, you're only going to your OB appointments once a week. So the concern is in that week that you're not being checked. Could you develop additional symptoms or additional credit the disease progress into preeclampsia?

I see. Okay. All right.

Next one. How common is it for women who use HypnoBirthing to not feel early labor, I was really into my HypnoBirthing meditations with my first pregnancy and had my cervix checked and I was at six centimeters without feeling any contractions at all. At that point. My birth went really quick. And from that time on, I was checked in baby was born two years.

Two years later, I was checked and baby was born in two hours. I'm currently pregnant with my second and playing a home birth but nervous my midwives won't make it in time. How can I stay more in tune with my body about what's happening this time around? I was just super laid back and calm and had no idea my body was laboring. I'm curious if this one will be similar. Thank you, Megan.

Isn't this interesting? So for so many women, they're so afraid that from the first surge or contraction, it is going to be so intense, they'll be gripping like the back of their furniture and wincing, and oh my god deserting Oh, my God, just like they see in the movies. But for many women HypnoBirthing or not, you ease into labor and you actually spent hours standing around nighttime daytime thinking, I wonder if this is labor. I wonder if something is starting and Trisha no doubt as a homebirth midwife. You know, women, I'm sure have called you and said, I'm not really sure I'm in labor, I would hate for you to come out of your way if I'm not. Has that happened? Of course. Yeah. So what happens HypnoBirthing are not again, if you're relaxed, you're much less likely to feel something happening because tension and stress hormones play a really big role in labor if you experienced them. But if you don't experience them, labor might be quite mild, especially early labor. So when you ask whether it's common for women using HypnoBirthing, to not feel early labor, it's fairly common, I would say. I mean, I experienced that. I've seen lots of my own clients experience it, but it's not necessarily directly linked to HypnoBirthing. We don't know if your next labor will be some women have precipitous first births and they do spend that next pregnancy really wondering just how fast that second birth will be. And all I can say is we don't know. But if you had to choose, would you rather have the tension? That's a associated with feeling early labor or the relaxation that's more likely going to predispose you to not feeling it. You might feel labor happening the next time around, but and you might be more aware of it or not. But what choice do you have? You always want to opt for having endorphins rather than stress hormones, regardless, is a good problem to have. The only thing I would say is just don't be hesitant to alert your midwife at the first consideration, that you might be in labor. I mean, it's We would much rather know and have you on our radar as a possibility of being in labor than to have you be worried about disturbing us and, you know, wanting to wait until you're absolutely sure. Many births have been missed by homebirth midwives, when they don't get the call fast enough to first sign up labor, maybe you lose your mucus plug something like that, or you have any signs of contractions, it could be diarrhea, those are all early labor signs, and just let midwife know, the other thing. I mean, I think we've said this before on the podcast, that when babies come that quickly, there's rarely a problem. So it's also if you have precipitous birth history, it's not a bad idea to have, well, you're already having a home birth. So you have the kit there. But it's not a bad idea to know how you're going to manage the birth if you are unattended, because that's a definite possibility. I mean, my first birth was precipitous, and my second one was longer, but my second was still extremely quick for about five and a half hours from the moment I felt labor was being getting, but I have a friend, whose first birth was as precipitous as mine. It was three hours and for her second she woke up her husband at 4am. And the baby was born at home at 4:48am. She was planning on getting to the birthing center and thought she just had to go to the bathroom before leaving the house. And she went in the bathroom and was just hanging out on the toilet. And the husband called the doula and said we're heading up to the birthing center. And the doula was like, oh, where is she right now? She's in the bathroom. I'm Rob, just stay really calm. I want you to go in there and take a look at her. Anyway, long story short, he checked on our didn't think anything was happening. He left the room and back on the phone with the doula. And in that moment, Carrie just crawled herself off the toilet went on our hands and knees, just breathing things. She was in labor and her babies had slipped out the baby weighed more than 10 pounds. Wow. But the baby's head slipped out. And they declared the duration of labor as 48 minutes because they woke up at four the baby was born 4:48am. And she did have that faster second birth. Not everyone does. But there's just no way to know.

Well, even I as a midwife was that woman who was didn't want to bother the midwife at 3am and had an hour and a half birth and my midwife lived an hour away. And as you know, North was born with nobody there. Because I didn't want to bother her at 3am. I wasn't sure it was really labor.

I can't believe you just said the words with nobody there. No, you know, you're funny. Nobody asked me about it. I know. But you're everything. Forget that. We forget that nobody else. And you had your husband and you had your mother. I mean, it was that they were out of beautiful. Yeah, they were out of the room, though. Not during the video that you showed me? Yes,

Paul walked in right as a board and caught that on video. He went to get my mom that was the whole thing he left to get my mom who was just down the hall. And he walked back in the room. Caught North being born. Thank God that we have that great video and but my mom missed it.

Well, he didn't catch you caught north but he caught it on film. Yeah, that's fine. I mean, it is a beautiful video. It's a beautiful video on Instagram and show and I'm kidding. What? Sure we can do that. You wouldn't mind right now. Yes, pretty awesome. Trisha. way cooler than I am. Alright, so let's do the next one.

Okay, next one. I have passive aggressive in laws, any tips on how to set boundaries before the baby arrives? I wish we knew the details here.

I wish we knew the details and I wish we had the answer. So common, like common conversation in our Postpartum Support Group every week. I have a mom in our current Postpartum Support Group. She's been with us for months and she's wonderful and she has been hit very hard by postpartum with an incredibly unusually unsupportive husband off the charts on supportive. He moved into another floor of the house. He's insisting that like he just he's isolating himself. He's kind of created a little cave for himself and she's totally on her own. I've might have mentioned her before because she was afraid of stairs and was basically trapped on the second floor of the House and eating granola bars for a week. I remember never noticed it cheese and her his mother has been coming for months, three days a week and I've been thinking thank God because I'm so concerned about this woman being on her own. But the mother in law comes and makes a lot of passes. passive aggressive comments. And it's very painful to this woman. And she actually has discontinued her mother in law coming. So now the mother in law is without seeing the grandchild very much. And much more concerning is this mother with the baby who is totally isolated now. And I wish she didn't ask her not to combat this is what happens when somebody, when somebody, like in laws make passive aggressive comments, she's very critical of her, she has a lot to say about everything, how she dresses the baby, how the baby maps, whether she nurses, the baby to sleep. It's very painful for her and she's not emotionally available to her at all. I think the big question is whether your partner is supportive and understanding because they're, if they stay in the middle, you're going to feel totally unsupported. If they side with or justify the comments of their parents, you're going to feel very unsupportive, I don't think it would be wise of your partner to ever make that choice. And your big question is whether you speak to your in laws alone, or as a couple, but they have to be spoken to, and not in a way of reprimanding them and laying down the law. But saying, This is not good for our relationship, this isn't good for our child, you need to respect me as the mother of this child, these are the comments you make that hurt me, this is how I feel when I hear these comments. And all that can happen is we have to distance ourselves from you as a result, and we don't want that to happen. We don't want to distance ourselves. But that's what we'll have to do to manage the pain and the discomfort and the suffering that this is causing. And who knows where that's gonna get you? Because it depends on whether they can hear that or not. So only you know that yeah, that's the real question. Are they going to respond to it or not? I mean, I think that in the situation you just described, the mother's doing the right thing by not having the mother in law to the home anymore. At some point, you have to set that parameter. And as far as this person's question, any tips on how to set boundaries before the baby arrives? I think without knowing anything about her passive aggressive in laws, just establishing how much you're going to let them be in your space in those early weeks is the first invest boundary you can set. So for some people, that's nobody no, no in laws, no visitors for the first two weeks. For some, it's the first couple of days. For some it's the first month. But setting that upfront will help put those boundaries in place.

I do want to make one extra point on this. And I only make this because I've been doing what I've been doing for so long in the postpartum oral that I think it's worth pointing out it might be a minority of people. But this is really well worth pointing out. I've also had a lovely mom in our group, she's now returned to work and she's on the group anymore. But she was in our group every week for months. And she talked about her mother in law. Almost every time she ate, she shared anything. And she repeatedly said I love my mother in law. And she repeatedly said my mother in law loves me. And yet, she was really angry at her mother in law. And the example I remember the best right now is that she said when the baby was sleeping, and would wake up from a nap, she could sense from the mother in law, she wanted to be the one the baby saw first. And she would go make her way to the baby's room and pick up the baby and go hello and pick up the baby. And she said, Oh, I just know, she wants to be the first face that baby sees. And I get that I get that I understand that. I don't know what it is a feeling of insecurity, a feeling of competition, I understand. Once you become a mother for the first time wanting to claim your motherhood, wanting to claim the well I'm the parent, now you've had your turn, this is my baby. But in the grand scheme, the fact that she repeatedly said she loves her mother in law, her mother in law loves her. You also want to be a little careful that you don't burn any bridges right now with someone you know you love and who loves you. And yeah, your in laws might be thrilled and madly in love with your baby. And you have to just have a little bit of confidence that you're always the mother. And you don't want to hurt that relationship. I mean, it's still such a net positive that you have in laws who love you. So just be aware that you might be a little extra sensitive in those postpartum months. And you might be seeing things a little bit off. And you know, that's a good point. And that's where you really need to bounce these boundaries off with your that's where you need to really establish these boundaries with your partner, so that you have that sounding board to make sure that you're not being too influenced by being extra sensitive that you know, you have your partner's input on it as well.

Yeah, I mean, sometimes it just, you know, it's our own experience. I mean, Trisha, you and I now have teenagers and we our youngest is each in the preteen years but I remember being a little bit that way and my in laws I remember having a little bit of those feelings and My mother in law is, um, she's German and like, very fit Hardy. And I remember one day I brought my son over to hang out with them. And it was like 40 degrees. And she came out of the house and a T shirt. And I remember thinking, oh my gosh, she's wearing a t shirt, it's 40 degrees, and she whisked off the fleece he was wearing, so he was wearing a t shirt. And I remember having so many feelings around that, like he's going to be cold and look at how she's just whisking off his shirt. And I can't believe how many feelings I had around that. And fast forward 16 years now. It's like, they're aging, I love them. They've been wonderful grandparents, it's like, I just sometimes wish I could. It was my own anxiety, my own attachment that I felt I took something so hard. So only, you know, as the mother listen to this conversation where you fall in that. But sometimes we get a little bit, you know, you know, if you love your in laws, and if they love you, and if there are passive aggressive comments that is definitely not in the realm of, of a loving relationship. And it's worth talking about. But we also can be a little extra sensitive, in that period of life as well. And we have a long relationship ahead with in laws. And, you know, we really want to nurture that relationship to if they're good influences in our lives and generally loving people in our lives. It's complicated.

Relationships are complicated. It's complicated, especially postpartum, and they change you will not always have a baby with these in laws, you're gonna have an elementary student with these in laws, you're gonna have a teenager with these in laws, keeps changing and getting easier and easier. So good luck. Good luck there. That's complicated. Yeah, keep us posted. We'd love to hear the details, honestly. Let's go to the next one. All right. All right. This is for you. I gave birth to my son eight years ago by C section. I had all I've always been looking forward to giving birth literally since I was a child, and ending up at the surgery fueled the very scary postpartum depression and anxiety that I ended up with. I was told by my midwife in my last trimester that my son was sunny side up, also known as posterior. She explained to me that I could still give birth vaginally, but it would be quote longer and harder. She recommend this is good, she recommended spinning babies. In retrospect, I did not take the warning seriously enough. I ended up with a C section at six centimeters after being at the hospital for 28 hours. Failure to progress. Number one reason for a C section in this country. So here is my question, how can I prevent this? At the time I had a 40 hour work week that was most of the time sitting down today, I worked part time as a naturalist at a national park. That's very cool. And I'm much more active than I was. And I know this is in my favor. However, a doctor recently pointed out that I have a slight anterior pelvic tilt. That is, that's unbelievable. It's no big deal. That's nothing. That's normal. Right? So I'm trying to work on that. I'm trying to work on that because it can cause other body issues like knee pain. Okay, fair enough. But that doesn't have to do with the birth complication. Right? You'll comment. I'm wondering if my pelvic tilt caused my son's poor positioning in me. I will also do spinning babies and seek chiropractic care and stay active but ultimately is a posterior baby. The only way my anterior pelvis and petite body will carry a baby. And how can I learn to accept the outcome? If I wind up with another C section? I don't want to feel devastated again. Well, that's a whole separate question. Yeah, exactly. What do you want to say? Let's talk first about the anterior pelvic tilt.

Okay, well, first of all, just because you had a posterior baby, the first time does not mean you're going to have a posterior baby every time. That could simply be the nature of that pregnancy, which has a lot to do with your muscular skeletal structure, not just your bony structure. So yes, there are some women who have very specific pelvic types that are more prone to malposition of the baby or posterior babies. But remember, our pelvis is mobile, in labor, it stretches it moves, it softens. It's not fixed. So just because you have this interior, whatever this doctor said, interior tilted pelvis. That doesn't mean that the hormones of labor are not going to kick in and help your pelvis move and open the way it needs to for your baby to fit. It has a lot more to do probably with the fact that she was at a desk job for the entire first pregnancy that it does with her pelvic structure overall.

It also has a lot to do with the fact that she was in labor for 28 hours and if they had let her go to 30 or 34 or 38, she very well may have ended up with a vaginal birth and the reason for her long life may have been the baby's position, not anything to do with her pelvis. But an anterior pelvic tilt is typically what you want. And what you do see, in a normal healthy pregnancy, if you look at spinning babies, you do see a deeper curvature in the back of the spine, you do see an anterior pelvic tilt, and that does give the baby more space. So the fact that her doctor said it slight sounds spot on.

Right, she also said that she ended up with a C section at six centimeters, which is technically just the start of active labor. So really, she was not given a chance for her baby to complete descent, and you know, to have full dilation. So her baby may not have been posterior at the time of birth.

And this is always my top concern as a HypnoBirthing. Instructor. And I just had a call with a new client today who just signed up for my class starting on Sunday. It's the belief system, it's believing this is how my body is, this is why I needed a C section. I'm petite, I have an anterior tilt. This is just how I birth that is by far the biggest threat to a woman like this with the situation than anything else. And a petite frame has nothing to do with whether birth is going to be easy or difficult, absolutely nothing. It comes down to fetal positioning. Of course, you can have a vaginal birth no matter what your frame is. So spinning babies is the way to go. But careful what you're saying to yourself, and the providers are planting these thoughts there that's so hard to overcome. Right. It's just so hard to overcome.

I mean, I think it's great that she's doing the chiropractic care. So get those musculoskeletal issues worked out. And we do know that chiropractic care does help with getting your baby into the optimal position for your specific pelvic shape, type tow whatever it is. So what can I how can I learn to accept the outcome if I wind up with another C section?

I mean, I think the easiest way to accept the outcome is to do everything you can beforehand to educate yourself and prepare yourself. But again, recognize you're being influenced by negative comments by your providers. Even your midwife who said you're in for a longer harder labor, no doubt, no question was in your mind, through your labor. And those things really affect us your thoughts physiologically affect your birth, you can feel at peace when you have a provider you trust. When you prepare when you do all the right things for your body. And then it's time to surrender, you control what you can control and you surrender to the rest. That is the path to feeling at peace with any birth outcome. Easier said than done. But that is the path.

That's exactly what we were just discussing on Instagram the other day, we posted something that said we do not have to have 100% confidence that we will experience the exact birth we desire. Instead, we must set the intention, we must do the work. And then we must surrender to the rest. And the work is choosing the right provider, getting yourself in the right birth space with the right person doing the chiropractic work, doing the doing the different jobs that gets you off, you're out of your chair and up on your feet a little bit more doing the yoga and pregnancy whatever it is that you feel you need to do to help you have your best birth you do the work. And then you surrender to the process because we do not have 100% control over it.

Alright, let's go the next one. It says I had always thought a birth center made a lot of sense, given my desire for natural birth with no intervention. My one concern is they send you home within only a couple hours after birth. If everything with you and baby checks out. Of course, this is really common. I get this one all the time from clients but have but given that this is our first child, I'm worried this could be overwhelming so quickly after birth. Have you had anyone have similar concerns? And the answer is yes, almost everyone, her birth in a birthing center has this exact concern. My husband thinks it will actually be great for me to rest and recover at home. Given that that's where I'm most comfortable. But I'm worried given my lack of experience that I'll find it more difficult without the support. Thank you again for everything you do, Emily? Well, very common question. If there is the slightest reason to stay, they will keep you they will transfer you to their backup hospital. Most women are ready to go home after giving birth. And I don't know that if they're rushing you out. But they have that policy because normally you really are ready. If you're not they're not going to send you what are your thoughts?

Yeah, I think I think it's a normal concern to have that you're not going to feel ready to go home after birth. And I think most people will probably be surprised that they are more ready than they think. Obviously if mom and baby are stable, you physically are capable of you know, getting getting up and getting in the car and going and it's not the easiest thing to do and hopefully you don't have too far right Drive, that would be my main concern of somebody who's driven two hours to get to a birth center. That's maybe not ideal to have to do a two hour drive in the first 12 hours after having a baby. What's your What are your thinking? What's your thinking about that, I mean, that's just, you know, comfort sitting in a car for two hours on your, on your bottom that you know, could be a little sore and torn and swollen. So distance, I guess would be a factor for me. But ultimately, getting home and getting in your bed and eating your own food and being in your own space and having your own bathroom and having your own clothes is well worth it. Something you kind of have to go through if you give birth in a birth center, maybe just have a home birth instead. And it's a non issue. But I do think in the grand scheme of things, if a home birth is not an option, the difference between birthing and a hospital and a birthing center is so great, and so likely to dictate the outcome of the birth or to influence the outcome of the birth, that it's worth accepting this Yeah, no, you're not I agree I'm comfortable with it. I agree. To not birth in a birthing center simply because of this, I think is just not worth it. It's too big of a factor that can influence the outcome of your birth. Trisha Oh, boy, do I relate? Did I read what I have related to this years ago, any tips for a baby gets distracted while breastfeeding? Gosh, we always think it's just our baby. Now you realize it's everyone, right? There's a common Trisha, oh my gosh, what happens with every baby, it happens with every baby. And honestly, there's not that much you can do except ride it out. It's normal as part of a part of normal infant development that at some point, they're going to become very curious about the world around them. And they still want to feed but they're also very curious about who's in the room, if the dog is around, if the other kids are around what's happening over there. It's just part of it, you just kind of learn to work with it. If it's seriously a problem, I guess you can take your baby into a dark, quiet room. Some people do do that.

Especially if they'll nurse enough. If they did and they pull off, they will just just no more frequently,

it's annoying. It's like up with the shirt down with the shirt up with the shirt down with the shirt off on off on off on. You just kind of got to work through it. And it's a short window of time. They kind of do get past it. But write it out. This happens when babies are older. So at this point, your milk supply should be well established. This is not happening by the two week old baby. This is happening with a four month old baby five month old baby. And those babies are also becoming very efficient with feeding. I mean, even though it feels like they might only be feeding for three minutes in, they're distracted. You'd be surprised how much milk they can take in a couple minutes. At that age.

That's good to know. But they'll manage to get there. I mean, they'll come nurse again, when they're ready to be exact. I mean, that's the thing, you got a conscious decision they make they are compelled to come get more, they'll nurse more often.

Yeah, that's why it's so important to not be feeding on a schedule. So if you have a distracted baby who's only allowed to feed every three hours, then you might actually not be feeding them frequently enough. But if you just let them come to the breast as they want to when they want to, even though they're distracted, and it can be a little bit annoying. They will feed a feed enough.

Putting a baby on a breastfeeding schedule is an intervention.

Yes. Usually one that messes up breastfeeding.

Absolutely. It's an intervention but the natural supply and demand it would never have something like that imposed on it. So it'll all work out if you're breastfeeding on demand.

Exactly. All right, next one. Okay, I've heard you talk a lot on the podcast about finding the right provider. But what about when there aren't any options? Where I live, there's only one obstetric office with many doctors and only a handful of nurse midwives. And you may even get a different provider with each appointment. Who knows which provider will be there at the hospital when I give birth? There is no birthing center nearby. Is there anything to do in a situation like this?

I think this affects a lot more of our listeners than we sometimes realize. Mentioning all of your options is very important. I feel it's very important, even if some are not practical, even if some don't appeal to you. But it is an option sometimes to travel to a provider rent and Airbnb, of course, is an enormous cost and logistical factor involved. But it is an option that most people decline. They can travel to a provider somewhere else in the country. I've had clients who've flown in providers from the west coast to the East Coast because they wanted a breach homebirth and they found the right person to do it. It's a big deal. Most people don't want to do those things, but it's an option. I think what's the most important thing is to really educate yourself and trust yourself in the hands of any provider. I mean, yes, we love when it's a good partnership. Yes, the odds are great when you're really well aligned with your provider, but you are enough when you know your legal rights. When you're educated, when you're informed when you learn how to self advocate, you are enough to navigate your way through your birth. It's when we abdicate our consent, that we're really at risk. But when you really understand your rights to decline anything, and you're informed enough to know what options you have, and know what questions to ask, in any situation. You can trust yourself, to get yourself through birth, no matter what provider you're with, it's not ideal, but you are enough when you're really prepared. Especially.

I mean, that's the truth that ultimately, if you know, your own boundaries well enough and you know, what you are going to accept and not well enough, and you have the ability to stay no say no in stand in it, then it doesn't matter that much the provider you have, you let your you let your body do its thing. And you let your provider your provider is only there to catch your baby. I mean, they're only there to just monitor and receive. Now, that's not how they see it. But ultimately, you don't need them. As long as everything is going normally. And it's also empowering, to get yourself in a position of saying, you know, what, doesn't matter who's attending my birth, I know what I stand for, and my birth and I know how to advocate for myself. And it doesn't matter if it's an OB a midwife. Any one of these people attending my birth, because I'm just going to do me. Right? And they're just going to be there to receive.

And if you have yourself you have everything you need what's right,

you told me that at the start of the episode, when you when I said I had nobody, right? You had everything you need. I had I did.

And I didn't have everything I needed. That's good point. I mean, we forget that you are all you need.

You're not all you need to conceive a baby. By your by you are all you need to birth a baby. You're all you need to breastfeed a baby. Alright, let's go to the next one. All right.

I am a baby delivery nurse, not a labor nurse. I go in right before the baby's born and help deliver the baby and care for the baby in the two hours following the delivery and wonder where this person is from. As she says, I'm a baby delivery nurse, not a labor nurse. I go in right before the baby's born and help deliver the baby and care for the baby in the two hours following the delivery. You don't think that's normally a thing? No. So do you think she's in a metropolitan area or rural think she's in a different country? Oh, really? Yeah. That's where they have delivery nurses.

Okay, that's interesting. Well, I hope she's listening. And she'll give us the details on that. It's

interesting. I work in a very busy hospital and I'm very natural, my mindset and practice. I want to go natural with my birth. But the nurses I work with keep making comments about how painful delivery is and how I should know better than trying to go natural that I am and that is so upsetting to me when I hear this is painful.

They have also said that because I'm a nurse, I am likely to experience the nurse curse.

Oh my gosh, they have a term for it. Have you ever heard that? Yeah, I've heard of that. Just because it rhymes does it make people?

Ah, because I know what can go wrong. And I've seen so much that's basically within this curses. I do my best to speak positively about my labor and delivery. But how is the best way to heal from labor trauma when it's not even my own labor I'm traumatized from and there's too much birth trauma out there. There is and it's vicarious.

She's not even traumatized from her own birth experience. She's traumatized from watching birth and believing that she now has the nurse curse and is going to have a same similar traumatic birth.

That's right. She thinks you just said that. So matter of factly shemale. She held things she has the nurse curse. I can't even believe this expression is out there. It's so I'm so mad that those words rhyme and someone turns it into a thing. Because if they didn't rhyme, you know, no one would have ever thought of it. There is no such thing as the nurse curse. There is such a thing as providers and I have nurses in almost almost every time I teach I have a nurse in the class. They do have a little bit of a heavier head than most people taking the class because they have been influenced not only by the adverse outcomes or the anomalies they've seen, they've been heavily influenced by the misinformation has doctors in the United States. They aren't practicing expectant management of labor. They're practicing AML active management of labor. I don't know what other people say it doesn't matter but what you accept in your subconscious mind is going to influence your birth. And when you hear something enough in your conscious mind when it's repeated enough, your subconscious does take it in as a belief. So you've got work to do.

Well, we just did that great episode with Molly, who talked about the use of hypnosis. There's a lot of modalities out there, whether it's

it doesn't have to be hypnosis, but any type of trauma healing work, it could be EMDR, which we always talk about, it could be the tapping method. It could be Reiki, it could be chakra work. There are lots of different options. But first and foremost is getting the right mindset, as you said, about getting out of this mindset that just because you're a nurse, and you've seen birth trauma, that you're going to have the same experience, a belief has to change.

Yep. And one way to work on changing that belief is to identify your negative beliefs, which takes a little bit of work, but identify what it is and replace it and that takes conscious work. So if you have a belief that birth is inherently dangerous, you have to sit there and think well, what do I want my new belief to be? And you can say whatever you want, you can say, women have been birthing safely since the beginning of time, see what you like. But then you consciously have to work on replacing the old belief when it shows up in your mind with the new belief it takes conscious work its effort, like any method of focuses effort, but it pays off very big. That's how women are doing the work. I think it's time for a rapid fire round Trisha.

I was just gonna say we are at the end here and we need to hit up these quickies yet let's get to the quickies. Alright, so we are going to see how many questions we can answer in a very short period of time. All right, right. Okay. Speed wins here. Nothing but speed. Okay. Okay, stopwatch ready? On your mark, get set, go. Go. What do you recommend for post episiotomy care? I've never had mine looked at by anyone. First of all, we recommend no a PC Atomy that's for damn sure. Second of all, tearing or episiotomy see a pelvic floor specialist.

Third, get some herbs, get some herbs on your perineum, postpartum soothe. Next Weight gain During Pregnancy. How important is it?

Minimally, there's a wide range of normal weight gain, it could be 20 pounds, it could be 50 pounds. It's important that you gain some weight. It depends on where you're starting where your BMI is, when you're starting, if you're significantly overweight, you're going to gain less if you're underweight, you need to gain more.

Okay, next one says My friend is due next month and she hasn't done any research. She says she wants to go with the flow. I'm so worried she'll end up with a traumatic birth. I know we're thinking the same thing right now, Trisha? Are we? What? What are you gonna say?

Hopefully she just gets lucky goes with the flow. And it's not your work. It's not your life. If she isn't asking, it's not your responsibility. There's nothing you can do about that you can't save someone or rescue them or convince them or jump up and down and get their attention. Every woman has to take full responsibility for her own birth. You're available to her. We view this in our own line of work. Okay, we're here for the people who are recept receptive and seeking the knowledge and information and you can't speak to anyone else because they're not there for whatever reason. So you love her and it's difficult for you and yet you have to you have to relinquish and surrender to the birth that she has. Definitely. Feelings on taking progesterone versus trying to boost it naturally. What's this all about?

I don't know. Depends. Just from for. Okay. Yeah, you can definitely boost your progesterone naturally by lowering your overall cortisol levels. Cortisol, high cortisol, chronic cortisol, chronic stress steals from progesterone production. Okay, another reason to meditate, four month old needs to nurse to sleep and during the night needs to nurse back to sleep help, does sleep improve naturally? Eventually? Yes. And eventually is the answer. I mean, I did all of those mistakes, and my baby started sleeping really well by about a year old and you can hire a sleep professional to help you now at the four or five month mark, everyone's afraid it's going to mean cry it out. It doesn't mean cry it out. They're going to teach you strategies for getting in a good routine and basically extricating your breast from the method of getting your baby to sleep. So look into hiring a good sleep person and see if they can be of help to you. But yeah, it'll eventually happen. If you are willing to wait many more months, it will happen.

Yeah, four months old is still very, very natural and normal for that baby to want to nurse to sleep.

info on short cords. Do they snap easily?

Well, they would be more prone to it. But I would not say they snap easily.

But what does happen so the baby comes out the cord is attached the baby can't do the breast crawl so you wait till the placenta is born basically, yeah, you would just basically keep the baby lower on the abdomen still Skin to skin with a mom but you may not be able to get to baby all the way up to the chest.

How do you handle the endless opinions received by No at all friends and strangers about pregnancy and birth plans? One line I know what you're gonna say I love when you say this, your opinion is not of my business. You got it? Who has the nerve to say that Trisha, let's be honest, is in my hands. You do have to find your way of establishing a boundary. We just had a great episode a couple of weeks ago, where he was a guest host and the entire episode was about boundaries. So go check out that episode and see what ideas you get about establishing those boundaries. Very important. Next, okay, what natural options are there for contraception? Postpartum?

What about the women who want sex all the time? Trisha?

condoms.

Condoms? Yeah.

Not that then the lactational amenorrhea.

I mean, really, a really good one is just postpartum resentment.

See, abstinence back to my first one really,

really affects the sex life in a way that will. should you really be getting a sonogram at every appointment. I read that they aren't good for baby. You really shouldn't be getting one of every appointment. You

really should not be getting one at every appointment. That is a hard. No.

How can you stop your nipples from hurting when you are pregnant and breastfeeding? Oh my gosh, silver at cups. There you go. Right. even think about the I mean, I can't I can't think of anything better. Coconut oil is the best substance to put on them. Yeah, the

problem is that when you're pregnant, your nipples are more sensitive. So if you're pregnant and breastfeeding, some of that is just going to be par for

the course. Ah, pregnant and pregnant with your second breastfeeding her first.

Yeah, it's just because your nipples are, you know, there's heightened sensitivity during pregnancy.

Aging placenta told to induce at 39 weeks due to being 35 years old. Oh, my good lord. Now, that is not a reason for induction. That is not a reason for induction. Pitocin was not FDA approved for that purpose. Listen to our Pitocin episode in early November. And you will get an earful that will strengthen you with resolve when it comes to induction with Pitocin. Last question is second degree tear painful sex, any advice?

Pelvic Floor specialist will wait a little bit longer. You're probably having sex too soon.

Yeah, just chill out everyone with all the postpartum sex. You know, it's interesting. It's interesting, because, um, so many women feel guilty that they don't want to have sex for months, and they think everyone else is having sex all the time. Guess what? Right? They know, they really aren't the vast majority or not at all. But we just got two questions in a row that are gonna lead women to assume otherwise. So we assure you that is not the norm. But hey, if you're having postpartum sex, have fun.

But if it's painful, wait, well, that's not fun. Good. We did it. We got a lot of questions. And thank you everyone for the excellent questions. And we look forward to seeing you next Wednesday.

If you're not a subscriber yet. Please get on that. Keep up with us on Instagram. message us through the website. If you have questions, you might just get a quickie.

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.

Should I start a stopwatch? No a stopwatch for me has no role in a quickie so that's normally a really bad idea. But maybe we can get away with it.