#184 | October Q&A: Evening Primrose; Breastmilk Storage; IUGR; Pumping the Second Side; Bacteria in Urine; Longer Gestations & Early Milestones; Postpartum Meals

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.

So, here we go. Hi. So I wanted to so I wanted to share, I wanted to share something to hopefully help other women. I had a VBAC in July after a 36 hour labor, it was pretty traumatic. It's a long story, and I'm happy to share it in full. But apparently the reason for my long and non progressing labor was a cervical scar tissue issue. I had a leap biopsy in my early 20s. I was never told it could affect my pregnancies and birth. But apparently scar tissue on the cervix from a leap or even an IUD can cause what I have very what I had very irregular contractions that do not progress. I spent 30 hours in labor with irregular waves lasting six hours of which were excruciating ly painful, and I only dilated to two centimeters. It wasn't until I was given an epidural and a Foley bulb that I went from two centimeters to seven centimeters so fast that I bred, bled profusely without my uterus ruptured until they realized it was the cervix rapidly opening. If you know about this, and you think it's happening, your provider can manually massage the cervix to help break up the scar tissue during labor or use a fully bowl. Anyway, I had never heard of this. And so I wanted to share in case knowing about it beforehand can help someone, maybe you've discussed it, I love your show so much and you do an amazing job at bringing stuff like this to light so women can hopefully know and avoid interventions. And then she sent us a bunch of nice links on cervical scar tissue and how it can affect pregnancy and birth. So I think the point of this is that when she was in her 20s Young went in for A regular Pap smear, found something on her cervix that needed to be addressed removed. It was never discussed with her that this could impact her pregnancy and birth by leaving scar tissue on the cervix.

What left it there?

What's the leap? You know, when you go for your Pap smears, you get screened for cervical lesions. And a leap is one of the procedures that's done when you have a cervical lesion that needs to be removed. And it's not always necessary. It's sometimes it's an option to wait and watch. And in this case, this woman wasn't informed of how it could impact her pregnancy in her birth experience, especially. And the fact that she was having this massive bleeding during labor could have led her down a whole different path, she could have had an emergency C section because they could have thought the uterus was ruptured or something like that, or the placental had a placenta had abrupted. Who knows, but I can't see why it would cause the slow dilation.

Because scar tissue in the cervix impacts how it stretches and opens and kind of provider that easily touch it and break it up just like that doesn't that take a lot of work and a lot of time with maybe a pelvic floor specialist or someone I think that she used the fully bulb and the power of her uterus eventually broke through the scar tissue. But that's why she suddenly dilated really rapidly it was when she potentially had irregular contractions. The point is more that about the informed consent that when she had this procedure in her 20s, nobody was talking to her about how this could impact her labor. And any procedure that's done that impacts your cervix can impact your labor.

All right. Let's get started on our first question.

Hello. I'm a Midwestern girl who is currently 36 weeks pregnant with our first I found your podcast just over a month ago and I completely fell in love with both of you during the first episode I listened to, which was the Pitocin episode. My question is about evening primrose oil. In my friend's birth plan, she had delayed cord clamping listed, the doctor went against her wishes and cut the cord immediately because her son came out smelling funny. Nothing else was wrong with him. And my friend thinks she came out smelling funny because she used evening primrose oil in the vagina in the weeks leading up to her birth. I'm wondering if there's any way to her theory. And if evening primrose oil can cause this to happen. Thank you so much for your time, and it would be a dream come true. Here my question answered on your shell. Thank you.

So that's an interesting one.

I just I just picture this, you know, we we shared the really, really compelling evidence on evening primrose oil, I think, in our August q&a episode. And I'm hearing that this woman had a vaginal birth, which you know, works well with that research because that's what it showed like you face very quickly. And the births in the studies were a lot quicker, but you don't picture the thing. I always tell my clients like we can't preempt everything you don't know what's you don't know what's going to happen in birth, no one pictures the moment where a doctor is going to see that baby and say it smells funny, and I'm taking it away. And washing it. It smells funny. How on earth is that a justification for taking the baby what of what are difficult to prove. situation to be in? It's so it's so random. If I'm trying to get I'm sure I'm trying to get in the head of this doctor and figure out what what he or she was thinking and the only thing I can think is that they maybe assumed that there was an infection then maybe they had been in a choreo or some type of infection that have gone on diagnosed, but it doesn't matter that the baby smelled if the baby is transitioning after birth absolutely fine. Why are you taking the baby away and even if the baby isn't transitioning, we believe that babies should be left intact the cord should be left intact and the baby should be left close to the mom and they can get the help they need transitioning right there on the mother but most providers don't practice that way. But smell the baby smelling is not a reason to cut and clamp the cord and take the baby away now evening primrose oil does have a smell. So it could be correct that it could be correct that the use of evening primrose oil in late pregnancy did result in a smelly vagina and therefore a smelly baby.

It looks like vitamin D in the capsules. What does it smell like?

I think it can have sort of like a little bit of a I'm gonna get one right now and have one I swear I do I hang on but it's also kind of how it interacts with your vaginal flora can change the odor. So Cynthia is going to do a evening primrose oil smell test for us.

I got a little sharp nice paper towel because I'm anticipating Having to really wash. Wash the smell off. If it's that bad. It looks like Okay, it looks like a Vitamin E capsule. Yeah, it's all right. I just ruptured it.

Okay, now sniff - I smaller, absolutely nothing.

Nothing. So sometimes oils change smells over time after they are exposed to oxygen.

But I don't smell like thing. It's like yeah, my eyes were closed. I would think there was nothing in front of me.

I think it may have to do with how it might, how it interacts with your vaginal flora.

Oh, there you go. I'm not doing that experiment. No, there's only so far I go I have my boundaries.

You know? It's the multiple dosing over time has absolutely no scent. Come on. Well, how much can it possibly mix with vaginal flora and change into something that's

well, have you? Have you ever had bacterial vaginosis?

No, I didn't talk about evening promos can have that effect.

It could possibly in some women. Yes. And I think that's what this doctor was picking up on. It's not

It sounds weird. If she hadn't used evening primrose oil. I wonder if this same thing would have happened.

I think it's just an excuse to be like, Oh, we gotta get this. Just like any smells funny. Hello? Yeah. Something doesn't seem right. Let's let's go evaluate the baby. Your baby doesn't smell right. What a thing to remember about the whole thing smells fishy to us.

Hi, ladies. My name is Dara. I'm from New York. Big fan of the show. You both change my pregnancy for the better. I'm currently three weeks postpartum, I'm still benefiting from the podcast. My question is for Trisha, do usually mention when talking about breast milk that the chart for breast milk storage is not true, that breast milk can be out for longer than four hours after a pump. My question is How long do you think breast milk can be looked out for? And also what makes breast milk go bad? Right. Thank you.

All right. Good question. Do you remember how long you ever left your breast milk out for?

I don't remember that. But I remember worrying about it. And then later, when I started offering breastfeeding workshops at my business, and hiring outstanding people like you to teach those classes I learned that under a microscope, breast milk is a living substance with enzymes and white blood cells. It's like got this it has this self cleansing property to it. So I think our question is a good one. When is too long when when is it too long?

Yes, it is alive food. And it is antimicrobial. And it is kind of it does keep itself in check the bacteria that can be harmful can build up. You can't leave breast milk out forever indefinitely. But you can leave it out for longer than Google will tell you. The CDC says four hours the Academy of breastfeeding Medicine says For optimal six to eight under clean conditions. And then various lactation consultants say 12 to 24. There are studies that do show that at 24 hours under clean conditions and a room temperature situation which is like 65 to 80 degrees, that at 24 hours, the bacterial count of the breast milk is still safe for a healthy newborn, not a preemie not a baby who has some underlying compromised immune condition or illness but a healthy baby. So what we're really talking about here is optimal versus Okay, so what's ideal, what's ideal is to feed your baby your milk directly from your breast. What's ideal after that is to feed your baby your pumped milk is as fresh as possible as soon as possible after you pump it for hours is the point where it does start to change a little bit and the longer it stays out the more bacteria that can build up in the milk. But it's still okay for many more hours than what the CDC says what Google says. You can always check your milk sometimes it can smell so be fishy or metallic and that does not mean your milk is rancid or gone bad that has to do with lipase activity in the milk. But if you taste your milk and it's sour or rancid, don't feed it to your baby.

So you will know by the time you can test it. Yeah. Okay, little shot glass.

Just a sip. Whatever. Sure. The takeaway is the sooner you feed your baby the fresh milk the better. But you don't have to immediately get your milk in the fridge and if you accidentally leave your milk out overnight or you slept a little bit longer, don't panic. Don't waste milk. It's still better than the alternative. Unless it's truly gone bad.

Hello lovely ladies over shape everything that you do. I'm learning so much, and I can't get enough. So thank you. And the question is, what is the best way to diagnose intrauterine growth restriction? A friend of a friend recently had a C section because of that reason, which got me thinking, considering how inaccurate ultrasounds can be. What are the diagnostic methods that should be used if that is a concern. Thank you very much, once again for your time.

So on October 12, we had episode 182 with Rachel Reed, PhD. And she has written a few books, but one of them is called Why induction matters. And she has a chapter in her book dedicated to this very topic. So I UGR is intrauterine growth restriction. And according to Rachel, women might sense that this is potentially going on because of decreased fetal movement. But the only way to actually diagnose it is to assess the function of the placenta, not the size of the baby, the function of the placenta. So that would be done with umbilical Doppler assessment via ultrasound. Very important question, because this sort of comment gets thrown around a lot. And, for example, in our episode number 150. With Rachel read, she talked about the rhetoric around calcified placentas and how it can imply that babies aren't going to get what they need from the moms. But often at the same time, they're trying to incite fear into those moms because of babies getting too big, and that just doesn't add up. So actual IUGR has to be diagnosed after doing an umbilical Doppler assessment via ultrasound.

Okay, think another important point to make on this is that IUGR is there is no, there is a lack of consensus regarding what I you gr actually is, what the etiology of it is, and what the diagnostic criteria are. And there's also uncertainty around if a baby is diagnosed with IUGR. Around the optimal timing of birth, is it better for the baby to stay in the uterus with IUGR another week, or to be induced and born and grow outside the uterus. This is why this is such a tough topic. And women are often told that their baby has IUGR. But there's all this lack of consensus about what that really is. And I think also it it can be diagnosed via placental sufficiency. But often it's not really confirmed until the baby is born. And then there are signs that they can see that the baby had malnutrition or poor growth in utero, that I think it's important to to understand. With IUGR, you have to get kind of to the root cause of what the underlying problem is the problem can originate in the baby. It can originate in the mother, or it can originate in the placenta. It can be behavioral habits of the mother such as smoking, drugs, alcohol, it can be chromosomal abnormalities in the baby, it can be related to a maternal infection. And then there can be some genetic things related to the placenta. So I also just want to point out because we talk a lot about how the placenta doesn't quit on your baby. The placenta doesn't have this aging out process that a lot of mothers are told that their placenta is are not doing their job anymore, that their placenta is getting old, their placenta is getting calcified. And they're told that the baby has IUGR. So placentas can have insufficiencies when there is an underlying condition, right? The placenta can not do its job effectively when there is an underlying condition. That is a true case of IUGR. And the placenta is not efficiently effectively growing the baby anymore. But just like you said, at the same time, that they're telling mothers that their babies are getting too big. They're saying that the placenta is not functioning properly. And that's just a illogical contradiction. And if you're told that your baby has IUGR, you really need to get to the underlying cause of what that is. And then again, there's no standard practice for determining when the baby should be born versus whether the baby is benefits from staying in the uterus longer.

Did you see that message? We just got an Instagram this morning from a doula whose client was told her baby's head is measuring five days too small. That Come on. That's crazy.

Look at how it should grow at a certain rate. It's not really about the absolute size as much as it is about the rate of growth.

I thought it was the absolute size compared to the back to the body and proportion to the body. Yes, I don't trust ultrasound for any of that.

Ultrasound is not good at predicting fetal weight. We know that but bone bony measurements it is pretty accurate.

Hi, my question is do I have to pump at night to maintain my supply? I'm 16 weeks postpartum and lately I've been having vertigo at night. My doctor thinks it's hormones or dehydration or stress. I can manage to nurse at night. But I can't sit up long enough to the other side of closeness I get up. There's one side and on the other. But I can't when I'm just busy. I'm worried about needing a supply overnight if he goes to a progression. Thank you so much.

Trisha, do women normally have to pump the other side if they nursed the baby on one side? Sounds like a lot of work.

Yeah, the idea is that we want supply and demand to be online. So if the baby is only asking for one side, your body will adjust and down regulate production a little bit so that your breasts don't get uncomfortably full in between feeds and nurse from the other side at the next feeding. Now, as long as her baby is gaining weight normally, then that's fine if she is trying to increase her supply because she's been supplementing or her baby's not gaining weight normally then yes, she would technically need the pump but not necessarily. In the middle of the night. There's other ways to increase your supply. But if she's exclusively breastfeeding babies gaining weight well and the baby only wants one side in the night, then that's fine. You just nurse one side and the other breast will adjust to the longer interval between feeds.

So she wasn't asking our opinion on this. But did you have any comments on the vertigo she's experiencing?

Well, it could be two things. What could be multiple things, but two main things come to come to my mind. One is that sometimes women can early on in breastfeeding experience a little wave of nausea with the oxytocin let down. That happens Also, it's easy for moms who are breastfeeding exclusively to get low blood sugar and easily dehydrated and you can feel a little dizzy and Nasir Nasus, you can feel a little dizzy and nauseous from that. So she needs to make sure she's probably eating before she goes to bed. Maybe she's going too long without eating from dinner until middle of the night when she's waking up.

Hi, my name is Beth, I'm calling from Denver. I am currently 14 weeks pregnant with twins. And this is my will be my second birth. I have a seven year old boy, I really appreciate your podcast, it was referred to me by a friend. And it's been a wealth and a bank of knowledge for me. So thank you for what you're doing. My question is, then I went in for my first visit on my eight week appointment. My doctor then told me that I had bacteria in my urine from my first visit, and therefore I was going to need penicillin in my IV at delivery. I asked her if this was a non negotiable, because I didn't really understand why if I had time for the bacteria to subside, or if it was life threatening to the baby. And she did tell me it was pretty much a non negotiable. So I guess my question is, is there a chance that if I had bacteria in my urine at eight weeks that it can subside by 40 weeks? And is penicillin necessary in my IV to keep both of my babies safe? Thank you so much. And I appreciate all you guys do.

You want to kick this one off? GPA was a period in the urine while she did not specify GBs. She said she tested positive for bacteria in her urine at eight weeks and her doctors telling her that IV antibiotics are non negotiable in labor because she has bacteria in her urine. Why assume?

Yeah, so in this question, if in this question, she didn't actually say if it's GBS bacteria, but if we assume that it is. We do know from our GBS deepdyve. We do know that if GBS presents in a woman's urine in pregnancy, she definitely has a higher colonization benefit doesn't. And while I don't like the word non negotiable, it is reasonable to strongly consider antibiotics during labor if that is the case. What do you think, Trisha?

Well, I think the part about non negotiables really important. It is always negotiable. She can certainly decline the antibiotics even if she has GBS in her urine. But when you do listen to RGBs episode and we break down all the statistics of the you know chances of the worst case scenario if a mother has GBS and how it impacts her her newborn. And there is a difference between just having it in your vagina versus having it in the urine and it is more likely that your baby will be colonized if it's in the urine. So I think we'll leave it at that and the GBS episode. We'll explain it further. But first of all, she really needs to find out if this doctor is telling her this because she has GBS or just because she had bacteria in her urine, she could have different bacteria, she could have a UTI that just needs to be treated. That doesn't mean that you need antibiotics and labor.

And it is worth mentioning that the GPS episode, the deep dive episode that Trisha is referring to was last week's episode 183. And the deep deep dive content is available on our Patreon platform. So patreon.com/down to birth show for all of that information. And for downloadables to our deep dive episodes. So hopefully that's helpful. And again, if we we presumed it was GPS, if it wasn't GPS, then definitely get in touch with us and let us know what's going on. Because that was our our only assumption. Right? I don't know whether Yeah. If you said antibiotics and labor I'm I can't imagine it would be like a UTI or something.

Well, if it's a UTI, then she should be treated now, right?

So I can't imagine that it was anything else if it wasn't a urinary tract infection. All right. Let's go to the next one.

Hi, ladies, thank you so much for all you do. My question is regarding late birth and early milestones. My son was born at 41 and five days, and he's four and a half months now and is already rolling both ways. From stomach to back and back to stomach. He's sitting up unassisted and his starting movie started moving himself forward in the form of an army crawl, or getting to hands and knees and often consult forward over and over again. Have you ladies ever noticed a correlation between a baby staying utero longer and achieving milestones earlier? I'm honestly shocked that my baby is already doing all of these things with no pressure from us. The only thing I can say that we have done for him is not putting him in constraining contractions like bouncers or swings or things like that, and then giving him lots of floor time and tummy time from early on. Okay, thank you so much.

I can only I can already envision all the women listening to this just freaking out that their baby isn't early on the motor skills. And unless you're dealing with a very specific situation like a very premature baby, of course, they're going to take longer with motor skills. It just doesn't matter. My son was that child. He was born at 40 weeks and two days. And he was super, super early on motor skills. He was walking fully upright walking at eight months, the pediatrician said like, he's the first point on that curve. And it's easy to celebrate. When you're a parent thinks, Oh, good, my baby must be so healthy and their muscle tone is so good. They're just different. My daughter walked months and months and months later than her brother she talked months and months earlier than he it just doesn't matter. Babies are on their own curves. We do know from Episode 152 that we did with on track baby, the occupational therapist Sisters, we do know that it does serve you when you have your baby basically free on a blanket on the floor just naturally developing their own skills and not confined with the exception of slings, which they were totally supportive of. But I don't know, I don't think that there's research out there to show week by week if your baby is born at 40 weeks versus 41 weeks, I don't really think there's going to be a correlation out there.

I agree with everything you said.

Especially the part about not comparing and don't celebrate too much because your next baby two might be totally different. Right?

I think the I think the the best thing she said was that she has kept her baby out of restrictive devices. I think that's probably the most important part of this is that she's given her baby the opportunity to work on these skills earlier. And she may just have a baby who's inclined to develop earlier as well.

So don't look too much into it. You're doing great. No matter what. Especially if the baby is getting time to move their muscles and develop at their own pace.

I paid very little attention to milestones. I can't even I do remember My middle child walked on her first birthday because it was actually the day that 12 months. See that was on the lighter side. My daughter was my first was later than that. And I don't remember my third. Sorry, north. But that's how little you and I are both Trisha, you and I are both third children. We know that's how it goes. I'm sure my mom couldn't tell me when I walked. But I get my point is that I put so little emphasis on paying attention to those milestones that I actually don't really even remember them. It's just doesn't matter that much. They all develop in their own time.

I guess it's like, I guess it's like if you feel good, then then go ahead and feel good. You have every right to out about anything then otherwise, just like a COVID. And don't worry otherwise don't worry about Don't stress over it. That's and keep your baby out of all those plastic devices.

Cynthia and Trisha, I'm calling in because I have a question about Postpartum Support. So I'm not a mom yet and have not given birth. But I'm in the stage of life where a lot of my friends are starting to have children. I also have two sister in laws that are currently pregnant. And I want to be supportive and helpful, but I'm struggling to know how to do that without feeling intrusive. I also sometimes struggle with meal ideas for just me and my husband and I'm a bit terrified of the idea of cooking for someone else. Can you please just give some specific meal suggestions? What does a nutritious nutritious meal for postpartum mom even really consists of? Thank you both so much. By what does a post a nutritious postpartum meal consist of protein? Quiche always comes to mind for me. You can eat it for breakfast. You can eat it for lunch. You can eat it for dinner. It can last for days. It's easy. Yeah, or hearty foods.

Soups are great. Yeah, I know. You'd say soups, warming, warming foods, curries, wonderful.

So she can get creative. I think one thing that would be really fun would be before her friend has the baby asked the friend to send you like three of her favorite recipes. It takes all the guesswork out of it and it'd be fun for you to make a new one. Scipio feel like you're doing something great for her.

I love the idea also of giving the mother like non open ended questions not like what can I? What can I do for you? What can I bring, but to say, Listen, I'm going to the store, I'm picking up this, this and this, that. And the other thing, which one of these is the most helpful for me to bring to you? I put choices in front of her rather than leaving it so open ended, because when it's just like, What can I do for you? She's, most people are always gonna say nothing. I'm fine. No worries, thank you for the offer. It's hard. It's hard to ask for specific things. But if you give her specific things to choose from, she'll choose one.

That reminds me of a nice moment. I was visiting a postpartum woman. And I was I texted her a little while before I got there. And I said, I'm stopping at the store. Please tell me what I can get you. And she was like, oh, no, we're pretty much all set. And I said, Well, I'm getting a grocery bag, and I'm filling it. So you can either tell me what to put in it, or I'm going to pick things myself. And then suddenly, she said, Thank you so much, and listed a bunch of things. And I felt so great about it. And the other thing is drop things off and say it'll be at your door at this time. No need to get up. No need to say hello to me. It's just there for you. She's gonna take it and she's gonna be very happy about it. It is time for quickies. Shall I begin? Yeah, please. Okay. First one. Somebody suggested I drink a glass of wine to speed up labor. What is it with alcohol and labor exclamation point question mark, after being told to abstain for the whole pregnancy. Question mark. Question mark.

Yeah, that's weird.

I don't think it's actually it's not to speed up, right.

I always used to call nervous moms when they're told I think so. Yes. Sometimes in early labor, you might get the recommendation to have a glass of wine so that you can relax, calm down. Wait for labor to kind of kick into high gear, but I don't think alcohol speeds up labor.

And even if it did, you don't need alcohol to get going either way. Let's just avoid it

and have some chamomile tea. No. Okay. Next Best Thing for a baby if they have jaundice.

Sunlife breast milk? Yes, more breast milk from like, the jaundice is cleared by putting more through the digestive tract. So the more they eat, the faster it clears.

Now, the argument for formula comes in there because a lot of women are told to give the baby formula because it forces the baby to poop more and then get rid of the jaundice. But research actually doesn't support that. And colostrum and breast milk are what you just want to keep giving the baby.

Yes, it's really about feeding them more. And ideally, breast milk. Yes. thumb sucking versus pacifier. Do you have a preference? That's my preference on breast first. But if a baby naturally starts sucking their thumb and you want to encourage that, go for it. Okay. Next, one thing you should definitely have in a home birth. privacy.

Privacy. What a good answer.

Is it okay to have sex during the two week? Wait when trying to conceive?

So what Wait, is she talking about?

I think she's talking about the weight between ovulation and confirmation of pregnancy.

Do you mean ovulation? At which point they had sex already, and now they just can't stop having sex for the next two weeks. So they just want to they want permission to keep doing it. So it's going on?

I'm not sure we're having Yes, I can certainly have sex, you can have all the sex.

Yeah, go ahead. Have sex. Next. Is if waterbirth is safe, per the World Health Organization. Why do my midwives tell me I can't Why do my midwives tell me I can't receive my baby in the water? Because they're midwives because they practice in a hospital that has policies and protocols and won't allow them to?

She answered her own question. Right? Yeah, you can receive the baby and water. So nevermind. Anyway, what the agencies say let's go to the world experts in these things. And Barbara Harper of waterbirth International is the world expert. She's been on the podcast a couple of times, but episode 100 is the one you want, where she talks about how beneficial it is for a baby to be born into water. So if you're inclined to do that, definitely get the right education for it and go for it.

Next, last one, vaginal prolapse. How common is it? Will it go away? And can I have more kids if I have it? Well, I mean, we typically have bladder rectal uterine, that we like to end on a fun one. This is a more healthy process on into this.

Okay, wait, here's one. Here's one. Yes, you can have more kids and it will go away but You need assistance you need to see a pelvic floor specialist. Moving on. Does eating dates actually help or make a difference in labor?

Doesn't it? Yes, I say yes but has been have they researched it or do we just go it actually there's some good data on it six I believe it's six red dates a day in late pregnancy 37 weeks on is associated with faster shorter labors.

All right. Well, Trisha, in two minutes, you have a breastfeeding appointment, so we got to wrap it up. But thank you, everyone, for joining us on this q&a for extended episodes. Join us on patreon.com/down to birth show. You not only get all our extended episodes right there, but you also get downloadable crib sheets for our deep dive episodes. So check it out. I'll catch you all next week. I will see you and all right, we're teaching Alright, gotta prepare for that. See you guys!

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.