#189 | November Q&A: Cholestasis; Growth Curve Worries; Petite-Women Birth Concerns; The McRobert's Position; Retained Placenta; Burping & Formula

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.

Do you ever wonder how many listeners we have that are not aware of our outtakes talked about that, literally since episode number. You guys one.

If you have missed a single outtake, you need to go back to Episode one and skip to the end and listen to the outtake of every single episode. If you're not hearing the outtakes, you're missing one of the best parts of the show

in some episodes is the best part of the show and others it's it's so boring. I'm just thinking I have a more interesting outtake. But we just weren't that funny that day or every now and then we just don't have a good one. My favorite ones are where you're mispronouncing things, there are lots of those.

Too many not mispronouncing where you're like fumbling over your fumbling over whether or not you never mispronounce.

There's definitely fumbling over words. Sometimes or making up words. Sometimes.

Oh, you've done it. making up words. Yeah. But I mean, that's fine. Go ahead, make them up.

We need to pay friends. It's Wednesday, Wednesday evening, Cynthia and I are recording this evening.

Specific Trisha, for which evening this this evening. Okay. A little differently.

Why is it different?

Because lately we've been doing it during the day for a while. Yeah, we've done some evenings before. This is not like brand new. It's always nice, but it's nice. We have quiet homes. People are out. I'm having a glass of wine.

We have husbands taking care of dinner.

Yes. Oh, I don't. coaching basketball. Oh, he usually does. Yes, not tonight.

Hi, Cynthia. And Trisha, my name is Megan, and I am about 33 and a half weeks pregnant. I love your show. It's completely changed the way I see birth. And I'm so thankful for that I'm actually in more of a functional field for holistic medicine. So my question is this, I keep my house quite cold in the winter. I actually keep my bedroom between 60 and 64 degrees Fahrenheit, because it really helps support my deep sleep that I track. So I'm due December 1 and the baby's obviously going to sleep in a bassinet in our room for the first few months. And my husband and I did a lot of research, but we couldn't find anything about how cold is too cold for a baby. I found more information on overheating. So could you tell me realistically how cool can we keep our bedroom with respect to the safety of our newborn? Thank you so much.

Another Megan.

She's like me who sleep with extremely cold bedrooms. I like it. It's good. It's healthy. And honestly, I can't tell you what the bottom line is for the temperature that's safe for your baby. But I can tell you that I slept. My bedroom is 6060 to 64 year round. Well, actually not year round. It's about 75 in the summer. I kind of like hot nights anyway, but hot summer nights. I don't mind it. Occasionally use the AC but I really shouldn't you turn it over to hot rather than cold. We're talking cold not easily you did that. Okay, nice try I get it all.

Okay, I do you know, I don't know you need your baby, you know, you don't want your baby to be too cold, obviously. But I don't know that there's a specific temperature most people would probably say, to keep the room around room temperature, which is 7272. I think 66 to 68 is probably fine, I wouldn't let it be in the 50s Depends on how many blankets and clothes your baby's wearing, how close they are sleeping to you, we're afraid of a baby what what could we also don't want uncomfortably cold, because then they're going to burn too many calories, they're going to wake more often I will say this, it is really important in the first few days that the temperature is higher than 70 degrees, because in those first few days, babies don't thermoregulate well. So when you first bring your baby home, you definitely don't want them in a 60 degree room, they need a little time to adapt post birth so that they can actually start to control their body temperature better. After a few days, maybe a week, go with whatever room temperature you're comfortable in. Because ultimately, if your baby's sleeping in your room, you need them to get comfortable with that. Make sure they're appropriately dressed and covered. And I think it will be fine. If you notice that your baby is feeling cold to the touch when you wake up. Like not their face, their face is exposed to their their face and their skin will feel a little colder to the touch. I'm talking core temperature, touch their chest, touch their body, see how they feel if they feel appropriately warm, when the temperature is fine. If they feel cold, turn it up a little bit. Great. And cosleeping would make a big difference. Either way with that, totally.

Hey, Trisha, and Cynthia, this is Jordan, for 1195 pounds very petite, did gymnastics for the majority of my life. I'm in my mid 20s. And my husband and I are about to start trying for a child as you can. Of course I put my height and weight in there because already I've had people approached me saying really disempowering statements about how I'm too small to birth naturally. They say oh, yeah, you're definitely going to need a C section. I even had my functional medicine doctor say that. He was worried about how small I was and how difficult pregnancy was going to be for me. So I can't imagine what this is going to look like going to my normal OB. If he tries to stay on too small for natural birth, should I try to work with him still and hire a doula? Or should I just try to seek out natural birth at a birthing center, which is really, really what I want to do. It's what I'm desiring. Please help me navigate this. And any insight you think would be helpful to me and some of your extra petite? viewers. Thank you guys. Love your show.

Bye bye. Do you have to say about this, I think it's a big red flag. If anyone ever looks at you and talks about your height, weight, or apparent pelvic size, because height and weight has nothing to do with how easily your birth your baby pelvic chain, the pelvis changes when you're giving birth, even to be under five feet tall, go back a million years and see how tall humans were. So I just I just think that we have to not succumb to this. And I do think it's a red flag. And it's a good reason to look for another provider for sure. I don't think a doula can protect you from a harmful provider.

I agree. I think that if that is going to be what we always say the fear of providers fear of the big baby is more dangerous than the big baby itself. And you know, a petite small woman is likely going to have a smaller baby, we generally grow babies that are appropriate for our size. Either way, take the opportunity to look for another provider when in doubt. Right. midwife try midwife.

Next, hi. I had a question. My OB told me that I can labor in any position I choose. However, when it comes to pushing, she told me that I have to be on my back because it was quote safer. When I asked what safer meant, she said in case they needed to do make Roberts maneuver were super pubic pressure. So look up what that maneuvers was. Which is your basic like on your back leg all the way up. And it's for shoulder dystocia. So couldn't I just get into that position? If Shoulder Dystocia dystocia occurs? Is it not realistic to have enough time or energy or the ability to reposition during the pushing phase? Thank you.

Okay. Well, if you've been following us on social media or following this podcast, you know how we feel about any provider forcing you into any position in birth, especially on your back. Because most of the time women do We are not choosing that position naturally we feel it's very important that you choose the position to birth your baby in based on what feels right to you in the moment. And it is your providers job to receive your baby in whatever position feels right to you should there be a problem with the birth of the baby requiring a McRoberts maneuver, which is correct that is, that is the position that is usually first line was so shoulder dystocia, then you can move on to your back and use that position. But Shoulder Dystocia is a lot less likely to happen if you are free to move in accordance with what your baby and your body are telling you throughout labor and when you're getting ready to push your baby out.

The best thing about the McRoberts position, if there's anything to say about it is that it shortens the birth path or the birth canal, just like squatting does. So if there's any merit to give it, it's that you're pulling up your knees, and you're shortening the distance that your baby has to traverse from the cervix to crowning.

It's also that you can apply super pubic pressure to the shoulder. So above the pubic bone, you can push down on the baby, when the shoulder is lodged against that pubic bone, you can push down and push that shoulder under the pubic bone, right, but I'm talking about a regular birth. So for the doctor to say, let's put you in a position that will serve us if your baby ends up with shoulder dystocia, which is absolutely unlikely, generally speaking, and there are other positions, if not better positions to address Shoulder Dystocia. Like a lunge position of runners lunge. For example, listen to episode seven of our podcast. And there are others for shoulder dystocia, where the women are forward leaning to say let's just have you in that position just in case remember that most women are not going to experience Shoulder Dystocia and to be on your back drives up the likelihood of fetal distress. So why should that be the default position, restricting your movement drives up the likelihood of a shoulder dystocia. So forget about that to end in that position to prevent it. Get into that position if you need to, because there's an issue. But don't be in that position as a preventative measure for it.

One thing I've noticed is that providers sometimes say, let's not take any chances. Let's do this just in case. But in fact, what they're recommending increases the likelihood of the adverse outcome. To begin with.

We need to go back to the fact that giving birth on your back with your legs up in the air is the easiest position for your practitioner to manage your birth. That gives them the straightest view that allows them to have the easiest access to do what they need to do if they want to cut in a Peasy army if they want to rotate the baby. If they want to use a vacuum, they want to use forceps if you're already in that position, all of this is much easier manage, they can do cervical checks easy, they can check the position of the baby's head easily. All of it is is about their convenience. And they don't know what to do. Many of them do not if they're not a practitioner who regularly supports physiologic birth, they are not comfortable when they can't see all that's going on and have that access. If you're on your hands and knees, if you're squatting, you're on your side. whatever position you're in, kneeling in the tub, they can't see and feel and touch and access the way that they can if you're on your back. And so this is about them.

And even if it were about them and their convenience, women want to know is that okay for my babies, can I still do that even if it's more convenient for my provider. And what you need to know is that position of being on your back is linked to a prolonged labor and B fetal distress. And those are the top two reasons for cesarean section in our country. So if we get women off their backs when they're giving birth, and potentially reserve that as one of the few positions several positions they can utilize. If there is shoulder dystocia, then they're going to be less likely to experience an adverse outcome in the first place.

I always add the caveat when we talk about giving birth on your back though that many women actually end up finding that they choose this position. And if you choose this position, by all means, if it feels right, go for it for they're tired, they want to just be in the bed, that's fine. If you choose that position, then that is your body telling you that this is the right position for you and that's fine. It is not a horrible thing to be on your back, but to be restricted throughout your labor to your back and forced to birth your baby in that position. That is or not okay with that. We often think of baby books as old fashioned scrapbooks that our moms made us but today's parents have more baby photos than ever, and it's easy to feel guilty and overwhelmed that we haven't organized Have those special memories. But now there is a fun, easy and super convenient way to capture your baby's special moments with baby notebook. Baby notebook is an app that allows you to save your photos and memories along the way. And it comes with the reminders for milestones and convenient features for uploading photos and telling your baby story. You can then print your entire book into a beautiful keepsake for your family. No more blank baby books are searching through 1000s of photos accumulating on your phone. Create a modern baby book the modern way The app is available in the US for iPhone and Android. And you can download the baby notebook app for free using the link in our show notes.

Hi, Cynthia and Trisha. Thanks for opening this hotline up. I really love the podcast, I just started listening. I'm about seven months pregnant. And actually in light of your recent episodes, with the Pitocin risks, I just found out that I have polio stasis and kind of freaking out about it my first child, I mean, told now I need to be induced at 37 weeks already high week high risk due to my age. And also, now I'll have to be doing the non stress testing and weekly biophysical for the baby. Any advice or guidance would be much appreciated. Thank you so much.

So here we have a mother who is seven months pregnant with coli stasis or ICP coli stasis is a condition of pregnancy that is a liver disease. And it usually presents with itching in the second and third trimester like excessive itching during pregnancy. It's diagnosed by lab tests, liver function tests and elevated bile acids and abnormal liver function tests are the and the itching at the key keys to diagnosis. It is a condition that definitely increases risk and pregnancy there's an increased risk of stillbirth for babies increased risk of meconium meconium aspiration, respiratory distress syndrome in babies. So it's always this balance of how severe is the cholestasis versus how far along you are in the pregnancy and the risk of preterm birth. So it's often recommended that if it can be managed up to about 37 weeks, then women are given the option to be induced at 3738 weeks to prevent the possibility of stillbirth really are problems with the baby later on. It's generally familial. So if somebody in your family had it, or you had it, you're more likely to have it in a subsequent pregnancy, but it's still quite rare. It's only about a point to 2.3% incidence. As far as her question around Pitocin and the risks of Pitocin in relation to this, I mean the risk of Pitocin or the risks of Pitocin. And they just are that but you have to weigh those risks. Along with the risks of staying pregnant with your color stasis, there is a medication that you can use to treat it. So if the treatment is working, you can buy yourself some Time, we know that we do want the baby's to be, ideally beyond 3738 weeks. You know, hopefully she doesn't have to be induced before that time, you certainly can still have a vaginal birth. But I think it's really just a week by week evaluation and determining how severe the condition becomes. And if you're responsive to treatment, then you can stay pregnant longer. So of course, in modern maternity care today, obstetrics, particularly, we're always, we're always labeling women who are older as being more high risk. Or she may be a little more high risk for coli stasis because of her age. But that doesn't mean that she is necessarily more at risk of having severe problems with the baby. They're the the main issue with the baby is the potential for stillbirth, which does occur at a rate of three to 4% with this condition, so it's, you know, it's three to four out of 100.

What's happening internally where the mom is itchy on the outside, the bile salts, the liver, the liver, they'll function and the bile salts building up in the bloodstream, okay, then that passes through the placenta and impacts the baby. Okay? So it's really it's not a black, it's not totally black and white, your provider may say it's black and white, you have this diagnosis, let's get you induced as soon as possible. But if you want to advocate for yourself and say, Hey, what are my bile acid levels? What are my liver function tests looking like? How's the baby looking? I'm asymptomatic, the medication is working. Maybe you stay pregnant longer. It's the kind of thing where it's, you know, it's a constant ongoing evaluation of are the risks of staying pregnant greater than the risk of induction?

Hi, I have a question. I am hopefully going to have an h back at the end of January. My midwife is not pressuring me, but she did talk about a ultrasound as far as figuring out where the placenta is to make sure it's not attaching in front or in front of the scar. She's worked with a lot of VBACs she says she doesn't need the ultrasound but I was originally good with not having one and now I'm second guessing myself. So what are your thoughts on an ultrasound? To find out where the placenta is for a VBAC? Thank you.

She's planning a HBAC.

Is this a thing? I mean, I know that there are so many people who support VBAC and they're not doing this. I haven't actually even heard about this. So it doesn't sound like a concern to me. But is it out there? Is this really looking at?

Oh, I don't think it's Tara actually terribly uncommon in her midwife was very sounded like her midwife was open. If you want to do it great. If you don't, I'm fine. The reason she might suggest doing it is because if the placenta is implanted right over the scar, you have a higher chance of placenta accreta, where the placenta is stuck basically in the uterus, and you have a higher risk of postpartum bleeding, postpartum hemorrhage.

So is this because the placenta has to attach by capillaries and it can't do that? Where there's a scar tissue so it attaches really inappropriately? Yeah, or it might partially release which is not what you want.

You don't want either one that it won't ever release and that it won't ever attach

or that or that it can't adapt or that it's not it's not it's not attached well enough that you could have abruption Are you put have partial, so it's like one of those clearance things. Let's just make sure it's not over the scar. Exactly. So that would be an anterior placenta. No.

Yes, it wouldn't be because the scar is on the front of the uterus. Yeah. Okay. So I think it's up to her. I mean, if you would feel better knowing that your placenta was not anywhere near the scar then you can not have that worry during your home birth.

What if a VBAC or H back mom does have an anterior placenta which isn't a big deal at all? It's quite it's very common. So it should anyone listening who's planning a VBAC? And knowing she has an anterior placenta be like, Oh my gosh, this is this could be over my scar I have to go to get this checked.

Well remember that most placentas implant in the top of the uterus, the scar is in the lower uterus. So the chances of the placenta implanting over your cesarean scar are pretty low.

And just for anyone who doesn't know yet H back is home birth after cesarean.

Okay, so we have Have a lot of quickies. Are you ready? I'm ready. Okay. Is it normal to feel a brief wave of nausea right before I let down? We're on three months of exclusive breastfeeding.

I had that in the first day or two. You're nodding, so I guess it can last longer.

But yeah, what do you what? Cause I mean, it's more it's hormones. And yeah, I mean, that's a long time for it. It's less but some people are more sensitive to it than others. It is still totally it is normal. It's annoying, but it's normal.

It's pretty awful.

Yeah. Yeah, it's not fun. I mean, there's some people who experienced some really uncomfortable feelings and breastfeeding not related to like nipple pain from latch but mood changes, nausea, really dis dis overwhelming feelings of dislike for breastfeeding. Some people stopped breastfeeding because of it.

So three months isn't a really long time.

I mean, it is but for her it may be going the entire duration of her breastfeeding. I don't know thinks it might get better after three months. A lot of things resolve after three months. That's true. Can the placenta become lodged in the birth canal during pregnancy like placenta previa what I think she means during birth

what? But that's not what placenta previa is. Okay, you know what? We can't do a quickie that doesn't make sense.

Okay. Okay, here's the second part of the question number actually, okay, can the placenta become lodged in the birth canal during pregnancy like placenta previa, but actually partially in the cervix? Not just sitting over it? DOC has told my friends this Oh, I see.

And how on earth what do they mean?

I think what she means is can if the placenta, the placenta previous the placenta, right over the cervix, can the placenta actually get grow down into the cervix and get lodged in the cervix? So then when your cervix opens, your placenta is going to be ripped from the sides of the

you why did why did anyone ask us this question? Because her doctor told her nightmare. Her doctor told her friend this I've never heard of such a bad six

I have not heard of this happening it would be extremely unlikely your cervix is meant to be sealed shut tight closed during pregnancy. So for a placenta even if it is a preview over the cervix for it to grow down into the cervix would be so unusual.

I just pictured the provider out there the doctor out there who says to the one woman like you know, we really need to be careful that your placenta doesn't end up in your lungs. This is the kind of thing I feel like we're dealing with next. Okay.

Is 40 Plus five too late to start evening primrose oil now get on it.

Yeah, get on it. We shared really good research on that in the August q&a Episode really good stuff.

If we you know, when we when we respond to this and Instagram, somebody sent back a screenshot of what to expect website would that talk all about the dangers of evening primrose oil and why you shouldn't do it.

And yet we shared the actual research on it. And there were no such dangerous, right? That's that website Asik. Now you cannot

All right. Is there a position in which a baby can't physically be born vaginally transverse? Yes, transverse and then somebody also pointed out face presentation or chin presentation. That can be another one that can be very difficult.

I mean, it happens the chin ideally is tucked. So this is the opposite of talked. It's like their neck is claimed.

Yeah, most providers would not do a vaginal birth that way because it can be dangerous, but it has happened but transverse is a no go low lying cervix during pregnancy. What do I need to know?

low lying? Where is the cervix? Exactly?

Oh LOLing cervix? I was thinking she meant placenta.

Does she mean like the center? There's no I think she must mean cervix. low lying placenta isn't on issue. If it's not over the cervix, she must mean the cervix because her provider has said we don't want you to have a low lying cervix. And then she What does that even mean? Right either way, it's fine. So if the survey, right, if the cervix is in the vagina, the baby's not much closer to crowning. I've never either I don't know, but I don't know. I might be legitimate. I don't know about it.

No, I mean, yeah, if you have like a little bit of a prolapse, it could be definitely lower. She didn't say prolapse. No, we need these doctors to stop saying weird stuff to all these women. So they stop asking weird questions that we don't know how to answer. I told you, one of my clients years ago said the doctor said he doesn't do delayed cord clamping because if the baby gets too much blood, he's going to have to drain the excess excess blood out of the baby. Anyway. All right, continue.

Should you burp your baby after every feed? No. Right? You certainly do not need to get a burp up after every feed and oftentimes burp Babies will burp regardless of whether you bourbon or not, they'll burp on the breast they'll burbling download burp sideline they'll spit up whatever the verb comes up. If they are acting particularly fussy after a feed or during a feed, you may want to take them off and put them up on your shoulder and try to get a burp out. But if they're not really indicating that they need to burp, they probably don't need to burp. How do I move my baby out of my ribs? This is very common in late pregnancy, as your baby is getting bigger and your uterus is really stretched to the max. And depending on your torso length, you may have your baby right up there in your ribs and it can cause a really uncomfortable burning sensation as the muscles and fascia stretch. So in olden, is midwives trick is to put ice right on that spot. And the baby tends to move away from it because the baby doesn't like to be cold. I guess.

It works. This precipitous labor menial tear beyond a superficial or first degree.

No, of course not. I had a precipitous labor and my first I didn't tear at all. I had a precipitous labor and my third I did not tear at all. So first of all precipitous labor is defined as a labor that is three hours or less from start to finish. So that's pretty fast. And usually when you have a precipitous labor, the babies are born quite quickly. If the baby is born too quickly, sometimes you can tear right? But you can tear a doesn't mean that you're gonna tear you can turn a very long labor to interfere in

any labor. Yeah, a lot of it has to do with your position and your baby's position more than more than the speed of the labor.

So absolutely not. I am postpartum and my wind wife says I don't have a cycle so I can't track it. track what her ovulation she must be talking about tracker cycle, so she knows when she's ovulating. So yes, if you're not menstruating if you if your cycle is not in its 28 day cycle, it is definitely more difficult to track. Some people still do ovulation test kits and might be able to catch the first ovulation before the cycle comes back. But for the most part, if you're not having a cycle, there's nothing to track. What do you suggest to process my homebirth that turned to emergency C section and I am traumatized. She can process her story with us.

You can process your birth story professionally, yes, with us or wherever else you can. At one end of pursuing this you can go to do EMDR therapy, which we highly recommend. And at an easier end, you can teach yourself to do Emotional Freedom Technique. All of these helped to release the emotions of trauma no matter what you're experiencing. Journal, talk to the right audience. Sometimes your family members are not the right audience because they just want to focus on the fact that you're healthy and the baby's healthy. You've got to go to people who understand and who recognize that you can feel disappointed, angry, resentful, regretful and you don't need the guilt on top of it when someone is reminding you that you're still alive at the end of it. Yeah, it's complicated. You need the right audience. That's why support groups are so powerful.

Support groups are great first step. And just talking about your story sharing, sharing with a supportive environment. That's that's that's how we heal. Alright, one more. One more can baby latch on before the placenta is out? Midwives wouldn't let that happen. What what your baby should latch on before the placenta is out? Especially if your headache or time getting knocked out? Yeah. Yeah, I don't know why they wouldn't allow that to happen. I mean, if your baby's not really eager to latch on, you don't need to rush it. That is another thing. Don't rush it.

The midwives didn't allow it. What are they doing? It facilitates the expulsion of the placenta. Don't second guess yourselves guys. Like if you if things are happening naturally between you and your baby and someone is standing there saying Wait, don't do that. Just ask yourself what any ancestor would have done for the past 3 million years. Don't allow people to make you second guess what's feeling instinctual. And there's no shortage of people who are going who are willing to do that. But wow, so disappointing. Coming from a birth professional. It's so sad.

Exactly the wrong advice. It's the opposite.

Unbelievable. There's as if there's any risk whatsoever to doing that. I just like It's so upsetting. Well, that's why we're here if I have a beautiful Wednesday, thank you for being here. Come hang out with us every month on Patreon. Oh yeah, that is where it is at.

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.