#387 | September Q&A: Home Birth Reactions, Miscarriage Prevention, Short Umbilical Cords, Stalled Pushing, Postpartum Anxiety, Tandem Breastfeeding

I'm Cynthia Overgard, birth educator, advocate for informed consent, 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 Show. 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.

I saw the first leaf fall today, and I came home to about 2,000 pieces of firewood in my driveway. So I know fall is coming. Fire season is upon us.

So you got your first leaf today, and I live, what are we, like not even 20 miles apart, right? It's just such slow roads, 30 minutes exactly door to door, right? But it's like, what is it, 15 miles or something, do you think? And we have such a different climate because Westport is on the beach, and you guys are deep in the woods, and I think higher up, higher altitude.

Exactly.

So you get snow days when we don't get snow days and colorful leaves long before we do.

Definitely. It is like a different climate zone up here.

All right, I'll let you know when the first leaf falls.

It's probably happened. I'm sure that many had fallen before I saw it, but that's true. It just fell right in front of me, and I said, "Ah, here we go."

They're probably all around me, and I haven't even noticed, even though I just walked my dog. I was just outside. All right, we got a voicemail that was basically a little anecdote, and we love that. I just want to say we love your anecdotes. Call us and tell us your stories. It's really fun. I mean, we get messages all the time, but it's really fun to hear your voices and your stories. I also want to say, I told this to Trisha the other day, there's been a marked difference in the voice messages we've been receiving. I think I made a comment a few months ago complimenting someone. I said you could tell she wrote her question before calling in because it flowed so nicely and required, like, no cleanup, no editing, great sound quality. So now, like, virtually every voicemail message we're getting, it's just top quality. So thank you, ladies, because I know that takes effort before you call in. Thank you for that effort. It's really paying off, and it makes it easy for us to accept most of the questions that are coming in. So if we ever don't accept a question, it's either because of quality, or it's because it is a question we feel we recently answered in a Q&A or discussed in an episode, or it might have been timely. Like, you might leave a message, and we're hearing it a few weeks later, and like, "Oh, I'm due on Monday." We're not going to be able to get that out to you. Sometimes we respond privately, but those might not make the cut either. But we really do try to get them all in whenever possible, because we know it means a lot to you, and it means a lot to us that you call us. Are you going to add to that, Trisha? You're just going to smile?

I'm just smiling, listening to everything you say, and agreeing, nodding my head. Yes, yes, yes, yes, yes.

Trisha feels the same.

I feel the same.

I concur.

Okay, so we got a voicemail that I want you to hear, and then I did an Instagram story based on it. Okay, let me play this and we'll talk.

Hi, ladies. I just had to share this with you today because I need someone else to be flabbergasted with me. I'm 35 years old and 35 weeks pregnant, and I was shopping in a little boutique with my mom today. And the lady at the counter, we were talking about birth. I told her I was planning a home birth, and she looked over at my mom and said, "Mom, are you okay with this decision?" But I just didn't even know how to respond. I wanted to say, "Well, she'll supervise the birth in the same way that she supervised me getting into this situation," just to, like, make the lady realize what she was saying was ludicrous. But I'm curious how you guys respond. The worst part about planning a home birth so far has been other people's reaction, so much so that I've really stopped talking about it, which makes me sad because I'm so excited for the experience, and I wish more people would know how positive it can be. But anyway, curious on your thoughts and how you respond to those kinds of comments. Thanks. Bye.

Well, I wish she would have said that out loud. That would have been a great response to her. I'm super curious what her mother said.

Me too. I was wondering the same thing.

Yeah. I think it just catches you so off guard sometimes that you just, like, yeah. But, you know, it would have been great if she could have just, with, like, a totally deadpan face, said, "No, absolutely not." I mean, just why people think that it is okay to respond like that. Why people think that it is okay to even, I guess, you know, asking is friendly, I suppose, but it's really not your business.

Well, to say, "Are you okay with this?" I think was—

No. That is crossing—

Not okay.

Yeah. I'm just saying asking where she's giving birth is still not even her business, but I guess it's friendly. It's okay. It's certainly something people in the Midwest would do.

Oh, I think it's nice to. I think that's fine. But I think to make that comment was a little much. So I had an idea, and since I've been on Instagram promoting today's episode so much, because it's such a great one, the Roger McFillin episode from two weeks ago, I decided to ask our followers, if they were planning a home birth or already have had one, comments that people have said to them. And I have not had a chance to look at these, so you're gonna have to give me a second to skim them and read the ones that jump out.

Don't skim. Just start at the beginning and really—

Just read straight through?

Okay, yeah, see how many we can do. More fun like that.

There's a lot. Okay, first one says, "My mother-in-law said, 'Oh God, no.'" Okay, all right, off to a good start. The mother-in-law said, "Oh God, no," to the idea of a home birth. "Oh God, no." I mean, I get it. I don't judge people harshly for believing home birth is dangerous because I used to be one of those people. I judge them harshly for having an opinion on how someone else should make decisions around their baby. I just want to say there's been plenty of research between home birth and hospital births, and the largest study on it was sort of a wash. But you have to take a few things into account. One, the home birth stats always include unattended home births, which is a vast difference, you know, those compared to attended with a professional midwife. And then the second thing is, the largest study that compared home birth globally to hospital births was really interesting because the country that provided the most data points on home birth was Holland. They provided, I believe it was 560 or 570,000 data points, and the researchers just simply kept Holland out of the study. They were the number one safest place to give birth in the world at the time of the documentary that did this. They provided the most data points on home birth, and they just said, "Meh, we're not going to include Holland," and then it looked like a wash. Hospital birth presented risks that created adverse scenarios, but also the positive is that they are there when there is a genuine need for medical intervention. And home birth, of course, the default was, like, safe births that were not unnecessarily intervened, but it was harder to get access in the case of an emergency. It turned out to be a wash, but they left out Holland. So, for anyone who didn't know much about home birthing, that's a quick takeaway, that it's a wash, but there's those details, including—

Yeah. The important takeaway is that the good quality studies on home birth show that there really is no increased risk to mother or baby when home birth is done with an experienced birth attendant and a low-risk mother. So it's been shown over and over again.

Okay, so I'm going to continue reading these now, now that we have that baseline information that we can all agree upon, I hope. Okay. Quote: "That's the most dangerous thing you could do. Why would you ever put your baby in danger?" Well, no woman in her right mind wants to put her baby in danger. So at least we should assume this woman fully believes she's not putting her baby in danger. So why can't you just be curious instead and ask her?

I would like to suggest that the woman who's choosing home birth is actually trying to keep her baby safer.

Of course, yeah. Okay. Next one: "Oh, I would never do that." That is not polite. "That's so scary. I could never take a risk like that." Okay. Next one. "Someone asked if I was having a home birth. Before I could answer, my mother-in-law said, 'Absolutely not.' I did though." Good for her. "Use modern medicine; it's why it exists, and you don't get a prize for going through pain." I can't with that line about getting a prize, as though women seeking a physiologic, gentle birth have their ego driving this process. I mean, I cannot get over that. Okay. Oh wow. Oh gosh. You know what? I hate when the worst ones come. The only people—

The only people who say that are people who have unsettled business within themselves about how they managed their own discomfort in labor.

Or they're personally threatened. Like they feel like the other one. That's why they're going to want—

That's why they're personally threatened.

It's kind of like they're saying to that woman, "Oh, you think you're so great? You're gonna have a home birth. You think you're so great? You don't think I could do that?" I feel like you're just personally provoked somehow.

Because they are unsettled within themselves about how they did or did not birth.

Okay, next one. Some of the worst ones come from mothers, I'm afraid. I'm sorry to say, but that's because there's basically no boundary between most women and their mothers, and mothers and daughters tend to speak very freely to each other, as they should. Okay, this one says, "Just tell me where the ER is, since you'll end up there." Now, why would you ever say that? Why would you put out into the universe that which you don't want? Give me a break. Where is the EQ, people? Okay. "Don't you think that's a bit selfish?" What the—

Well, these are all comments clearly coming from people who are not educated around the risks of hospital birth.

She added—

Just birth.

Yeah. The risks of hospital birth. The risks of birthing in modern society.

She added in parentheses, "We live in a country with socialized healthcare." Unbelievable. Okay, next quote: "I'd never be brave enough." See now, it's okay to be like, "I'd never be blank enough," but brave enough implies that it's unsafe, and that wasn't a great choice of words. Like, "I'd never be confident enough. I'd never be trusting enough," but brave enough? Come on. Okay.

Well, brave—

Go ahead.

I mean, brave might be similar to confident, or just, you know, "I'm not sure I could handle it." A lot of women fear that they can't handle birthing outside of the hospital or without medication. They can. They absolutely can. They just don't know it yet.

True. Yeah. I just feel like brave is loaded. I think, you know, strong wouldn't be, or tough wouldn't be, but brave feels a little loaded to me. Maybe I'm reading too much into it. The next one, quote: "You won't go through with that. Birth needs to happen in the hospital." Okay. "Sometimes their face says more than words. My mother cringes out of fear when I talk about it." Next woman said, "I live in Nebraska, and so need provider signature for a birth certificate. Four postpartum clinic appointments with my family MD wouldn't sign the certificate paperwork or order newborn screening. 'I wasn't there. How do I know that's really your baby?'" Oh, come on! Oh, well, you know what? I dare you to report her for kidnapping. Go try. With the baby nursing at her breast, cord stump intact, said, "I'm a liability."

What was the comment about making sure that that is your own baby? I mean, isn't there a much bigger chance of potentially having a baby mix-up or the wrong baby if you're giving birth in the hospital than at home?

Yeah, of course. It's been known to happen, and I don't understand that comment.

I would bet that's never once happened at a home birth.

Of course. How could it?

The only baby.

I'm joking. That's unbelievable. Okay. "Careful, because midwives are arrogant and they think they know everything." And then this woman added, "That's doctors, ma'am." That's funny. Okay, quote: "You know, home birth babies are always missing fingers and toes. Do you want a deformed baby?" What? You plan a home birth and their fingers and toes are in jeopardy in utero? At least have an intelligent— That one's just laughable. I mean, I know. Like, you can't debate with everybody. You can't have an intelligent conversation with everybody. You shouldn't bother. Referring to hospital birth, quote: "I'd rather be safe than sorry." Lovely. That's not going to create a cloud hanging over that woman's head the rest of her pregnancy. "I'll tell your husband not to let you." "That is so dangerous." "I'll tell your husband not to let you." Let you. Quote: "Something could go wrong, and you or baby don't have time to get to the hospital to be saved." Well, that is the concern. You just shouldn't declare it to the woman. She's obviously thought about it. "Well, that's a choice, I guess." Heard another woman. A close relative asked, "Are you sure your midwife's trained?" And the next one, here's the word again. The next one says, "You're brave," and then the next one says, "I could never. It's too risky. Passive way to say you think I'm reckless." Good point. Okay. Oh, this is great. This is from Emily, our friend Emily. She's been on the podcast. She wrote to me privately with this one. I said, "Please put it in the story box because I want to read it." And she did. This is the quote: "I could just smack you across the face for having a home birth. What were you thinking? What were you thinking? What if you had had shoulder dystocia?" Me: "I did. I did runner's lunge. All good." Love her. She's adorable. Okay, next one. "Two home births, and I've only heard, 'Oh, you're so brave.'" There's that word again. Okay. "I was told I was crazy, and what am I trying to prove?" This woman says, "No, because we didn't tell anybody." Mic drop.

There you go. The thing about home birth is it just always comes down to education. All these responses and reactions, while inappropriate use of words and crossing boundaries, the fears behind them are not unexpected. Everybody feels this way about home birth until they become educated, and it takes a while. It takes a lot of kind of deep work to really understand the risks that you're taking when you give birth outside of your home. Nobody talks about that. Everybody just thinks that birth in the home is dangerous and birth outside the home is safe. That's what this entire podcast is about, right? And when you really start to understand it, you start to realize that sometimes the risks of birth outside your home outweigh the risks of birth in general, and that your birth is actually safer in an undisturbed, safe environment. That's the key.

And we are proponents of women giving birth wherever they feel safest. The statistics only matter so much. We always want to make our decisions based on statistics, but that doesn't really get us through anything. You know, that's like getting married and being scared of, like, the one-in-two divorce rate. It has nothing to do with whether you, in particular, are marrying the right person and you're going to have a healthy, fulfilling marriage. It's not, you know, that's not how birth goes either. You really have to ask yourself where you feel safest, and then pursue your safest birth, given the circumstances of your pregnancy, in that location.

And don't assume where you feel safest. Don't just assume that you're going to feel safest in a hospital because that's what your mother thinks you should do, or your husband thinks you should do, or all your friends did. Like, you do have to do the work to figure out where you're going to feel safest.

Right. And it can be different from birth to birth.

Absolutely. And it can be different from pregnancy to pregnancy because risk factors and various things play into this. This isn't just what I think; it's also what's going on in your body.

All right. Well, that was great. That was fun. All right. Let's get into our first official question for this Q&A.

Hi, ladies. What are your opinions on miscarriage prevention protocols? For context, I'm seven weeks pregnant, and my home birth midwife gave me a protocol that includes progesterone cream, supplements, and baby aspirin. This is following a miscarriage I had earlier this year at 12 weeks, where I hemorrhaged enough that I needed an ambulance transfer. So, just curious for your thoughts of, is this actually worth doing? It is making me a little bit nauseous to take, or should I just trust my gut and stick to just eating well and being healthy? Thanks so much.

Well, I think the first thing to mention is ACOG, the American College of Obstetricians and Gynecologists, does not recommend giving women aspirin for the sake of preventing miscarriage with no other factors at play. It's just not something that they recommend. It's happening all the time anyway. But there are a couple interesting things. There was a study on this of about 1,200 women who had experienced one or two prior losses, and it was called the EAGeR study, E-A-G-e-R, Effects of Aspirin in Gestation and Reproduction. And the result of the study was that aspirin did not prevent miscarriage. There was a group, a subgroup within this population, of women who had exactly one loss recently, and they defined recently as within the year. And for those women, reduction in miscarriage did not occur. One thing I really want to say is this woman mentioned hemorrhage, and aspirin inhibits platelet function, so we don't know why she hemorrhaged. But if that had anything to do with the hemorrhage, or if they don't know why she hemorrhaged, introducing aspirin is potentially increasing risk.

Aspirin in preventing miscarriage, the reason it doesn't work is because it would only prevent one type of miscarriage, right? So if you're having a miscarriage because of a blood-clotting issue, then aspirin might work in those scenarios. But to give aspirin routinely for miscarriage prevention is going to do nothing. Miscarriages happen for a lot of different reasons, which is why just giving somebody a standard protocol doesn't make sense either. So I'm not really in favor of this protocol. Now, we also don't know her history. We don't know if this is one miscarriage or her third in a row. So if somebody's having multiple miscarriages in a short period of time, then you better be doing the workup to try to figure out why that is. If she's just having one miscarriage, this is normal. It's completely normal. I wouldn't suggest any type of protocol after one miscarriage. This is what nature does. While having a miscarriage is painful, physically and emotionally, it can be a devastating thing for a woman who's been working really hard on trying to conceive or having difficulty conceiving. But we do also have to give some respect to nature and understand that certain pregnancies are not going to take for reasons that are right. It's not like a miscarriage means you had a perfectly healthy baby that just didn't make it. That's the whole point. Miscarriages happen because it's not a healthy conception. You want that to pass. It's a good thing, and I think we've gotten off track a little bit with miscarriage because, maybe because social media, probably people sharing their stories, and we need to, like, lower our expectations a little bit about conception, or maybe we find out too early that we're pregnant. We're tracking it too much. We're tracking it too aggressively. Many miscarriages happen before we even know we're pregnant. That's why it's not as hard to deal with because you didn't even know you were pregnant. I think we have to lower the expectations a little bit about when we conceive and how often it's going to, you know, develop into a full pregnancy because nature does have a plan. Now, that is different than a woman who's having multiple miscarriages. There's a reason for that. You need a genetic workup. If it's a genetic reason, of course the miscarriage is going to happen. That's just not going to work. If it's a progesterone deficiency, which is, like, the most common reason for miscarriage, then that's actually something you need to do to work on your own health and restoring your hormones in your system so that your body is actually producing enough progesterone to maintain a pregnancy. So luteal phase defects, low progesterone, or luteal phase defect, meaning your body's not producing enough progesterone in the second half of your cycle to maintain a pregnancy until the placenta takes over, is quite common. That happens when women have short periods. It happens when women have too low a body fat. It happens when women have thyroid issues. It happens when they're nutritionally depleted. It happens when they have babies too close together. It happens when they're not exercising enough. It happens when they have insulin issues. It happens when they have high blood sugar too often, or, you know, their insulin sensitivity is off. These are all things that, or they're not sleeping enough. They're sleep deprived. That's a huge reason. There's so many things that we can do to restore our healthy cycle that is going to help support a pregnancy, rather than just throwing progesterone at a woman who had a miscarriage. And yes, it does make you nauseous because progesterone is the hormone of pregnancy, and we get nauseous when we're pregnant, and so if you're taking progesterone, it does add to that, and you might not need it, especially if you've just had one. Again, if it's a recurring thing and you've been proven to have low progesterone in your pregnancies, then that's a different story. You can either take the time to really try to restore your body's own natural progesterone levels, or you can use progesterone to support your next conception. But to just put somebody on a routine miscarriage management protocol for one miscarriage, I would not agree with.

No, I mean, it's not supported by ACOG, and the women in the study did have more vaginal bleeding who were on the aspirin over the placebo group, which is exactly what this woman is looking to avoid next time. It's one of those, I think in your last breastfeeding Q&A, this came up. It's one of those situations where it seems like the provider is just throwing everything at it, and it must feel, you know, it must feel very satisfying for the provider. Like, okay, here you, oh, you had a miscarriage. Here's my, let's, yeah, let's get you on aspirin every day. I want you to take a progesterone cream. I'm going to give you these supplements. You could just say, "Oh yeah, I've had one too." Oh yes. Well, you'll find with the vast majority of women who have their families, when all is said and done, they have their story of at least one miscarriage. It's that common. And like you said, if they even knew about it. And these days we do, you know, everything. Time and conception. We're tracking pregnancy from the second we have sex.

Stop finding out you're pregnant so soon. That's what I would say. Stop taking a pregnancy test the day that you miss your period. Just trust the process a little bit more. Let that go a little bit. And also, let's not forget about the men. The sperm plays a big role in this too. It might not be the woman's issue at all. So now she's taking aspirin, a bunch of supplements, progesterone, feeling nauseous, and that's actually her husband's sperm that is the problem. So everybody needs to clean up their life, give their body time to be as healthy as possible, and try again in a little time and trust the process.

Hi, ladies. I am calling because I recently had my first baby back in May and had a beautiful, wonderful home birth. When she was born, her cord was pretty short. I remember I caught her and I pulled her up to my chest, and I could feel the tension of the cord down on my vagina. I could, like, feel it, and it was a little bit. And I felt like I had to work really hard to keep her face from going under the water because I had a water birth. But my question is, if I had a short cord with this pregnancy, is it likely that I will continue to have short cords? Is that something that, yeah, just might happen with future pregnancies? I am interested in the future in having a free birth, but I worry about having a short cord, maybe getting a little bit stuck around baby's neck, and then baby having a hard time coming out, if that makes sense. And so, yeah, I'm just curious to know if there is any rhetoric or evidence that one time having a shorter cord could mean that I would continue to have that in the future. Yep, thanks for everything. Love the show.

Kind of a fun question.

Yeah, not a big deal regardless, right? And not something that I would say is generally considered a risk in birth or a risk for subsequent birth. Although I will just say the one thing about variations in normal labor and free birth are that having somebody there, one of the benefits of having somebody there at a birth who understands what is happening is if there is a short cord, if that cord is wrapped around the baby's neck, if that cord needs to be slipped over the baby's head to help the baby be born, you know, that's a helpful thing to have. That's why having somebody at your birth is a good idea, and that's not to say that she shouldn't have a free birth. That's just to say that these are the scenarios. It's a great example of one of the scenarios where having a skilled attendant is a helpful part of the process.

Absolutely, absolutely. That's the biggest thing of what she said, even though I think the caller thinks it was the short cord. I think the bigger one is the decision to free birth. But I'm so surprised by this. Someone actually funded a study on this. I have no idea why. They must have had a good reason that I don't know. But they did do a study of 850,000 women in Norway. They defined a short cord as those in the lowest 10th percentile. So 10% of all those women, 85,000 of them, were identified as having short cords. They were just in the lowest decile, and they found—

What did they consider a short cord?

So the cutoff for the short cords, where it fell at that 10% mark, was 35 to 40 centimeters. That's how long it was, 14, 16 inches, something like that. Fourteen, 15, 16 inches. So that's where the cutoff naturally fell for that lowest decile. And what they found was that of the women who had a short cord the first time, they had a 2.4% higher likelihood of having a short cord the next time. That doesn't mean that much. It means of the likelihood, there's a 10% likelihood anyone is going to have a short cord. And for these women, it was like 24% the next time around, rather than 10%. Just again, we're splicing analyses. This doesn't matter. It's just fun. So for her, I guess the question would be: If she is planning a free birth, what's her plan if she has a short cord, and how is she going to manage that? I think that becomes the important question for anyone planning a free birth, frankly.

So the interesting thing about cord length is it is actually correlated with fetal movement. So sometimes it has to do with where the placenta implants and how much movement or not the baby has as they grow. So babies who move more tend to have longer cords, which is also why sometimes those cords are wrapped around them more because they're longer and they're moving around more and they get wrapped up in them. And babies who move a little bit less tend to have shorter cords. There's not much you can do about that, and, you know, I don't want a woman to take that to mean that she's tracking her baby's movement every day and wondering what that means for her baby's cord length. Cord length really does not correlate strongly with complications of birth. That's, I think, what's important to remember. Don't worry. Don't worry about this too much.

Exactly. Like, why would we be concerned? It's also more common, again, this is just like fun facts. This really doesn't matter. It's more common with female babies, smaller placentas, and abnormal cord insertions. It's interesting. I never really thought about it. I just pictured the whole cord length to be a random thing. They can go up to over three feet long. I just think it's funny. They can go from, like, one foot to three-plus feet long.

Yeah, there's quite a variation in cords. There's quite a variation in cord thickness too. I mean, sometimes you see these tiny little, thin, pencil-thin cords, and then other times you see cords that are, like, as thick as a hot dog. It's wild.

Okay, thick as a hot dog. All right, we got to use that phrase more. Good analogy. Got to use that as much as possible. I didn't know they could be thin like a pencil. That's really interesting.

They can be quite thin sometimes, and it also seems to correlate with placental size. So bigger placentas, thicker cords; smaller placentas, thinner cords.

Really interesting.

But most of it means nothing. That's, I think, the important thing here.

Women's brains, they're wired to keep scanning for what can go wrong. And after they have a baby, that really fires up even more. It's where we get the anxiety from, the intrusive thoughts, but we're just constantly scanning for what could go wrong. And sometimes you see how creative people get. Short cord, right? I mean, it's not really a concern. But the point you made about whether it has to pull over the head, I do feel that that's an important point. They had to do that with my daughter, but I thought my daughter had a long cord. I thought that was more likely to be wrapped. You said that earlier, didn't you?

Yes. So her worry was if the cord is so short and it is around the neck, the baby's actually not going to be able to be born because the cord is going to hold the baby back.

Right. That's a concern with any cord around the neck multiple times, especially if it's long. But it's less likely to be around the neck if it's short, is what you were saying.

Yes. Yep.

Yes. Okay. Next.

Hi, Cynthia and Trisha. I have a question about a birth that I was at recently. The mom had been pushing for a couple of hours. Contractions basically stopped. Baby had some caput but was otherwise not descending. She ended up transferring. I was not there in a doula capacity, and my question was: Is it a problem at that point, or would it be a problem at that point, to just let the mom rest? Yeah, I think she'd been pushing for maybe two, two and a half hours, and really wasn't making any progress. I'd love to hear your thoughts. Thanks. Love your show.

So, assuming this was a home birth mom who transferred to the hospital after two, two and a half hours of pushing, no progress, baby had some caput, meaning that the baby's head was developing some swelling, this is the perfect opportunity for me to tell the story again of the woman who I attended her birth, and she was fully dilated and pushing for 18 hours. And this baby's head was more molded than any head I have ever seen come out of a woman.

Was it shaped like a hot dog?

Almost.

I have just been waiting to use it again. I can't believe I so quickly found an opportunity. Go ahead.

Okay, not really, no. But it was incredibly molded, and it took that long for her baby's head to make its way through the pelvis, and the baby was fine. And the reason we stayed home was because there were no signs of distress. The mother was comfortable; she was resting. She was obviously tired and contracting for a very long second stage, but she was staying hydrated. She was eating. She didn't want to go to the hospital. She felt fine, and her baby was doing fine through the whole thing. So in this case, with this mother, could the mother have just waited and rested at home if she felt good about that? If that felt appealing to the mother, then absolutely yes. She could have just rested, waited. The baby probably needed to make some positional change, or the mom may have needed the rest to let her body get re-energized again to start building up a stronger contraction to help get that baby to come down. So she probably needed to eat. She probably needed to hydrate. She probably needed to rest. But the decision was made to transfer, which is also a reasonable decision. Just depends on how the mom felt.

Well, I have a question for you on this one. So, I believe ACOG defines greater than three hours of pushing as their—I'm not, I'm not, you know, I'm not into these taking this art and putting it into science—but I think they say, like, three hours of pushing for a first baby and two for a subsequent. I would throw that out the window personally. That is meaningless.

100% meaningless.

But what did get my attention, and I'd like your opinion on, Trisha, is she mentioned that contractions stopped, and I know they can take a pause. I know they can stop. That's a whole strategy in my class I've been teaching for years. It's common, but my question is, like, she mentioned not descending and the contraction thing. So, as a midwife, what are you looking for there? I mean, if there's no fetal distress and there are no contractions, but then not descending, do you—

Well, the reason the baby wasn't descending is because the contractions stopped. You have to have the contractions to get the baby to descend. So that's her body becoming fatigued. So she probably went and had some IV fluids, maybe got an epidural, maybe got some rest, and then her body was able to pick up contractions again. Well, she probably got Pitocin too. So, without those interventions, without the ability to do an IV, which you actually can do at home birth, sometimes giving a woman an IV at home birth is exactly what turns her labor around and picks up her contractions again. But if you didn't have that option, you would hydrate with water. You would eat some food. You would take a nap. You would rest, and you would see if the contractions picked back up. You would do some nipple stimulation. You would do some other oxytocin-building things to help get her body back in a contraction pattern, and then see if the baby would descend. So, you know, true failure of descent, you can't really give that diagnosis. That's the term. It's not a good term because failure to progress and failure to descend means failure to do something else, failure to just create the environment in which the baby can actually make progress and the woman's contractions can pick back up. So without contractions, you're not going to expect the baby to move down. Nobody would have ever let that woman go 18 hours anywhere else. The only reason that baby was born vaginally was because we gave the woman the time and the space for the baby to make its way through the pelvis. So these terms are used prematurely, and yes, sometimes it is worth having a baby being born by C-section, but really only if the baby is telling you that needs to happen. You know, when you get to a point where there's distress in the baby and the baby is no longer safe in labor, then that's when we move to C-section for failure to progress or failure to descend.

All right, guess what?

Quickie time.

Well, let's see what came in.

You're doing them today.

Oh, good. That's fine. I never did hear. I know, role reversal.

Because I'm usually not able to access Instagram.

You're back.

Well, I'm back. Yeah, and boy, have I wasted time on this thing. But sometimes it's necessary to get on and do work. Okay, so let's see. All right. Oof. Okay. "Have you seen the trend of FTMs realizing they hate their pets once they have a baby?"

Full-time moms?

FTMs.

First-time moms.

Oh, I don't know. I thought someone who's home all day. Okay, first-time maybe.

I guess could be either.

Okay, we're very familiar with how stressful animals can be when you have a baby. You're angry at them for their nails clicking on the floor, for barking, for having needs, for crying to go out, for barking at people. I don't know how to say this. It is incredibly distressing. It is critical that you treat your animal well. It's critical that you get your animal's needs met. They're not more important than your baby, but that doesn't mean to take care of your baby and let this other being that you're responsible for suffer. And I don't say that to make any woman feel guilty. I say that you and your partner need to have a serious conversation about how the pet is going to get cared for. And I had a client in my postpartum group—I know it's a quickie—who felt so guilty sharing that they were thinking of rehoming their pet. I didn't think that was a terrible thing. I said if you can't meet the needs of your pet and you find a loving home, that's a beautifully responsible thing to do. They found a wonderful person for their dog. Actually, it was like the universe lined it up. It was truly an older woman who lost her dog, who fell in love with their dog, wasn't far from them. I mean, this was such a happy story. That is a legitimate thing to do, but it's not legitimate to treat your dog badly. I know we're dealing with moms who are already stressed and sleep deprived. So I really feel for animals. But it is normal. I feel—

Frustrated. It is normal.

—podcasting when my dogs bark. It is stressful. So what you feel must be separated from what you do. And the word hate just worries me here, but no, I haven't seen the trend, and I prefer not to.

But it is a thing.

Yeah, it sure is. Yeah, and I don't think it's something we should take too lightly. It's an important conversation. Okay. "Did either of you ever consider homeschooling your kids?"

Yeah, I considered it after the fact. Darn it!

After the fact. I considered before sending my son to kindergarten.

I was working. I couldn't. I was so thankful for school because I was working. But after the fact, definitely, yeah. If I were having a baby today, I'd do it differently.

I would have taken on elementary school gladly. It's like by the time they're learning things in middle school or high school, I just cannot imagine giving them as adequate an education, and then kids learning from their own parents. But I have women in my postpartum group doing it, and it's awesome. And we did that great Patreon event with Ro Labry, who I just thought was phenomenal.

That was excellent. So anyone who's thinking about homeschool, on the fence, want to learn more, definitely listen to that because that will convince you.

Oh, that will convince you. It was amazing.

Yeah, wonderful. Yeah, we have that in our Patreon shop, Patreon.com/DownToBirthShow/shop. It's in there, isn't it? So if you're not a Patreon member, you can—

In Patreon somewhere.

You can download it. We have to make sure it's in the shop. We'll check the shop. That's a really good one. I recommend it all the time, and women in my postpartum group have watched it. "Tandem feeding, three-year-old and newborn. Do I designate one breast per child?"

No, no. I mean, it depends on where you—

I could have said no to that. I don't know why. I just could have said no to that because—

A newborn needs both breasts in the beginning, usually, and the three-year-old doesn't need a full breast. Your newborn might need both. It kind of depends. It is a little specific to the scenario and how old the baby is. But don't do that as a strict rule. No. If you're doing twins, that makes more sense. Babies of the same age.

Okay. "What's the normal milk supply—" Oh, you're gonna love this. "What's the normal milk supply amount pumped in ounces at four weeks, six weeks, eight weeks?" Trisha, data, please. Data, data.

Okay, actually, I can give you some data on this, even though you're not really supposed to think about this and know these numbers. But the thing is, a full milk supply is on average 24 ounces in 24 hours. That would mean if you pump eight times a day, which is typically what people do, every three hours, you would get about three ounces every three hours, one ounce per hour. If you pumped after two hours, you'd get two ounces. If you pumped after four hours, you would get four ounces. A typical rate of milk production is one ounce per hour. You are not supposed to think about this. You are not supposed to know this. You're just supposed to feed your baby at the breast. But the rate, the actual amount, doesn't change at four, six, and eight weeks. It remains the same from two weeks through three to four months. Your breast milk composition changes to meet your baby's growth needs.

Very interesting. "Do you recommend giving a pacifier?" I don't.

Depends.

Sometimes. Why? Tell us why.

Quickly. The quick answer is sometimes. The quick answer is generally not in the first three weeks if your goal is to breastfeed your baby, and after that, if your goal is to exclusively breastfeed your baby, limited pacifier use, like when you are in the shower, when you're changing the baby's diaper, when you are in the car, only at times when you can't give your baby your breast. Then there's a whole other set of scenarios where sometimes a pacifier is needed for bottle-feeding babies or suck training and things like that. But I'm not getting into all that.

Okay. "Would you recommend a C-section to avoid the trauma from a shoulder dystocia birth?"

Oof, I would not.

I would say no. Except we did have a case where we talked about a woman who had had multiple shoulder dystocias. In that case, we said her decision to have a C-section seemed warranted.

Absolutely. One shoulder dystocia, no. It has so much more to do with the position you were in and whether or not you even actually had a shoulder dystocia. We don't know how severe this is. It depends on your level of trauma. It depends on how severe the shoulder dystocia was and what happened in the moment of birth.

And my opinion on it is, if you have trauma, you need to address the trauma. So this isn't about whether you have enough trauma to avoid a vaginal birth. It's what are you going to do to release yourself of the trauma? So processing the birth, EMDR therapy. You need to address the trauma and then make a decision about how to birth, but we don't want you to take this trauma, suppress it, avoid it, have a C-section, and then end up with compounded trauma because you had a C-section, and on top of it, then the guilt that that was your conscious decision rather than an emergency situation. So I would say it might be complicating things for you if you go that route. Just face the trauma, process the trauma. You can release that trauma, and I would make that the intention.

And really try to understand if your baby actually had a true shoulder dystocia, because many, many are misdiagnosed.

I feel for this one. Look at this one. Look at where we are in human history. This one says, "Measuring three days behind at my first scan, seven weeks, but sure of my dates. I'm worried." She is afraid at seven weeks. So her baby's had a heartbeat for, like, a week and a half. The stupid ultrasound is showing she's three days behind the day she knows she conceived, and now she's afraid the baby isn't growing. God help us! This is where we are with technology. Like, we are, it's honestly unreal.

There is absolutely nothing to worry about to this woman. I hope she hears this. There's absolutely nothing to worry about in that scenario.

You know. Okay. Next one says, "I'm miscarrying twins at seven weeks. Heartbroken. When can we try again?" Oh, that poor woman. She's miscarrying twins. My God. All right, at seven weeks. So she just conceived as well, just a few weeks ago. It's the most common time to miscarry, right around then, a little bit before then too. So when can we try again?

As soon as she feels ready. Honestly, you don't need to wait if you don't want to.

So really, do you feel differently about this? I think this is stating the obvious. You feel very differently about this, Trisha, than when you're asked to opine on whether women should conceive again after having a full pregnancy and birth. You do feel strongly that women need to replenish, but a miscarriage doesn't fall into that category whatsoever, right?

Absolutely not.

No. Okay. Fourteen months. There are three more, and if they're all good, it's just three. If they're not all good, we'll just have one or two more. "Fourteen months postpartum and exclusively pumping, weaned to two pumps per day, but only getting two ounces per pump. Done?" She's exclusively pumping. She's only pumping twice a day. She's only getting two ounces per pump. That's so—

Okay, she's pumping four ounces a day. She can probably go at least—she probably can go all day and pump just the next day a little bit. I mean, she's only making four ounces a day. Her breasts can hold way more than four ounces. So, yeah, she's basically done. When she gets uncomfortable next, when her breasts start to feel a little full and uncomfortable, then you just do a little pump, maybe just two or three ounces, and then the next day it'll be less, and then the next day it'll be less. And you're done. Does that make sense?

Yeah. It's just she, I think she thinks she's already done. She's not expecting the milk to go down to zero before she's done. So she's wondering if she's about there.

She's about there, but she's going to hit a point where her breasts are going to get full again. So they're just going to start to feel a little full, and she's going to have to release a little milk because she's still making milk. It's just a gradual going away from here, but she doesn't need to pump twice a day.

So we got some postpartum ones I want to answer. We don't do a lot of postpartum quickies, so let's see what I can do from this category. "True or false? You need to prioritize things like showering every day when newly postpartum." False. Well, this is loaded here. I mean, if you're talking the first few days and you're just staying in bed, who cares? If you're talking two, three months out and you're so low that you're not sure that you're showering, brushing your teeth, maintenance, just general maintenance, uncleanliness in your home, forgetting to eat breakfast, these are definitely concerns where we need to get your partner involved, and we have to do check-ins to make sure that you are functioning. You do need to shower. So top priority, like urgently and before your baby's needs, no. But if you're going two, three days without a shower, this is not normal anymore.

Low priority in the first two weeks, though.

Yeah, if this is just the first two weeks, then I would say this is a non-issue. But if we're talking months out and you think an emotional thing is getting in the way of caring for yourself, it's definitely something to be looked at for sure. And anyone can contact me. This is something, you know, please, like, I can do a session with you. I can do a session with you and your partner. You can be in my postpartum support group. Just please, there aren't a ton of resources in this area, but I am one of them. It's not difficult to get back on track when you really have a little bit of support. Okay. "Is there a science behind my postpartum anxiety steeply dropping around nine months postpartum?"

It's probably related to prolactin levels, probably, possibly.

Okay. "Why do midwives stop postpartum visits after a loss? I never had postpartum checkups. That hurt deeply." So this woman lost her baby at a stillbirth, and she's feeling— Yeah, I mean, I can understand why providers who are paid for their clinical work don't continue to do that. But I would like to see them reach out, out of just love and friendship, and check in and have a relationship with you.

Actually, that should be a paid service that they get. They should do that, number one, and they should get paid to do it, number two, because that is very important and necessary.

Right.

It's healthcare.

"A postpartum mom has 30 minutes alone." Sounds like a riddle. "Should she get sleep, exercise, or sunlight?" Oh gosh, we'll always start with sunlight. It's just so easy. There's no reason not to do that, even in all climates.

But there's a way to get both. There's a way to get two at a time.

Take a nap outside.

Absolutely.

Really?

Lay in the sun and close your eyes.

Yeah, I mean, yes. I don't want to prioritize these things. How could I say whether someone needs sleep versus exercise? If you're sleep deprived, the last thing you can do is exercise. But sunlight is something we deeply need, even in all climates, and that's an easy one. But I like the way you're thinking, self-care, and just do something for your self-care. First thing is get away from your phone. Okay. "What do you do if the husband has postpartum depression or anxiety?" Yes, and she's not the only woman who wrote in with this. Another woman with dads and their anxiety. There's so little support for men, and there's so little knowledge that men also get postpartum depression. So they need what women need. They need community. They need support. They need to hang out with other dads. They need someone who understands what they're going through, and they can know this is a temporary experience of having a massive life change, and it will get easier and better. But again, I could talk privately offline with anyone about that. I've worked with also fathers who've had very severe anxiety. I'll do one or two more rapid-fire. "Quick, simple ways to ground yourself if you feel some panic and anxiety coming on." I would say get into the present. So do something. Trisha, you've talked about running your hands underwater, putting your bare feet on the ground. If you're inside, just focusing on your breath. But the next thing is focusing on your mind. What are the words and what are the thoughts going through your mind? And get control over that because your thoughts are not you, and you can control your thoughts, and that's what's causing the anxiety.

Put your back up against a tree.

Sounds handy. "How often do you see postpartum anxiety show up as general anxiety rather than worrying about the baby?" Sure, yes, that can happen. Common example, when women are in postpartum and they have postpartum anxiety, and I'm not doing that in a diagnosis because I don't think that matters. If you're suffering, you're suffering. So who cares about what we call it and how the label works? But I've seen women with anxiety worry terribly about something happening to their partners, or they themselves dying, or their partner losing their job, or them losing their job. Anxiety can show up as appearing general in this stage. And finally, "If I had postpartum depression with my first, am I likely to have it with subsequent?" Not necessarily. All things equal, if you're doing nothing differently, the odds are a little higher. Don't worry about risk factors like that. The key is what can you do, and there is so much you can do to prevent or diminish the likelihood of experiencing postpartum depression. Okay, I will stop there. There's so many. Goodness, that was a lot. Anything else?

That's—we covered a lot of ground in today's episode.

Yeah, lots of good stuff. Just, you know, if you have concerns, if this postpartum stuff is really bringing up a lot of thoughts, fears, worries, especially with everything that's been going on in the world, please make sure you listen to our episode that just released a couple weeks ago with Roger McFillin about this, as well as the postpartum psychosis information that is in Patreon.

Episode 385. You know what? Since I'm such a numbers person, do you know the first thought I had when I saw that his was episode 385 when we released it? Want to know the first thought I had?

No.

Yes.

No.

That his previous episode with us, 235, was exactly 150 episodes ago.

Oh wow!

I was like, oh my gosh! Exactly 150 episodes later, he's on the show again. That was my first thought when I saw that would be 385.

Nice.

So now, if I ever forget the episode number, I'll just have to add 150 to 235.

There you go.

All right. Thank you, everyone. Remember on your birthday, someone said what they love about you is how you always remember episode numbers, and I was like, okay, someone's got us.

That was definitely not me.

Trisha has many gifts, but that's not the one.

That is not my brain.

It sure is. I'll be the first to say it. It is. All right. Thank you, everyone. We'll see you next time.

All right. Bye-bye.

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.