#241 | November Q&A: Biophysical Profiles; Preventing PROM; Lacking Natural Birth Support; Declining Cervical Exams; Having Hashimoto's; Anemia

My question is how do I go about politely kind of defending myself without starting heated argument if they asked about my birth plan and choices which they clearly don't align with, I have Hashi motos, thyroiditis and they wanted growth scans because of this. And my baby turned out to be about 10th percentile. I was labeled IUGR. And they wanted to induce me at 38 weeks.

But what do you mean when, when who touches the baby's head.

So fetal scalp stimulation, you can go in and do a vaginal exam and you can actually scratch the baby's head with your fingers. We're not supposed to be in there. The baby is in the most sacred, private, intimate place that there is on earth inside another person's body. And we're like trying to climb our way in there and say, Are you okay? Does this bother you? Does that bother you? Right? It's so disrespectful to the baby. I mean, where does it end?

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.

Hey, Hey there. Welcome to the November q&a.

How's everyone?

How are we starting today? Trisha, do you have something?

I do have something something. I guess it's kind of like an anecdote story question.

An anecdote story. But you know, do you know in German, that would become a noun, anecdote story question. They would just make that one. Now with the word be. Well, German is known for like making up words.

Hi ladies. I have been an RN for four months now and work in labor and delivery. Although I work in a hospital where birth has medicalized I have done my own research outside of nursing school and wholeheartedly believe in holistic ways of life and believe that our bodies were created by God to birth naturally. I also have a dream of becoming a midwife someday. Recently at work we had a gap seven that means pregnant, eight times seven babies. A gap seven come in with a birth plan of having a natural birth with intermittent monitoring, no epidural, no Pitocin and only interventions if absolutely medically necessary. She knew her body she has had seven children who would by now and has birth naturally several times. She came in at 37 weeks one centimeter dilated with her water being broken for about five hours and said that the fluid was clear no odor had been feeling baby moving all day. We hooked her up to the monitor for 20 minutes and baby's heart rate was 130 to 150. Very normal. And the doctor ordered a biophysical profile because she was worried about how long her water had been broken. The ultrasound technician said that it was difficult to do the ultrasound and pick up movement and blamed it on the moms size. The score on the biophysical profile was six out of eight. Then the technician called us back and said it was four out of eight with the points off for fetal movement and tone. The doctor ordered As to prep her for C section just in case and came in to talk to the patient about what the biophysical profiles showed and how she felt would and how she felt it would be best to do a C section. She didn't quite understand because she had been feeling the baby move and its heart rate was good. The doctor checked her service again, it was three centimeters and applied a fetal scalp stimulation to get the baby excited. But baby didn't respond as she wanted her to. The doctor then did another ultrasound and determined that the baby still didn't have great movement or tone. So we quickly got her to see section. The baby came out with avatars of eight and nine and was perfectly fine. Since I'm new, and I do believe a bit differently than my co workers. I feel as though I will just get a generic answer if I ask if this was actually medically necessary. My question is, how necessary was the biophysical profile? Did this situation absolutely permit a C section? Or if we would have let her labor on her own? Could things possibly have turned out fine? I know these are million dollar questions, but in your opinion, how reliable is that? BPP. Thank you. Okay, so let's break this down. She was 37 weeks she was in labor labor, her water had been broken for five hours, which is perfectly appropriate, fine, nothing to be concerned about not a reason to order a biophysical profile, the baby's heartbeat was in the 130s to 150s, perfectly normal heart rate. The ultrasound tech had difficulty gathering information on the biophysical, biophysical profile for whatever reason. So how do we even how can we even say that the score of six out of eight, then dropped to a four out of eight was even valid if the ultrasound tech was not able to get a good scan on the mom, which we hear this? Yeah, we know that your things like well, we weren't able to test it. We weren't able to check it. So therefore, we have to assume, XYZ. Do you remember that story we shared? I wish I could remember the details. But I read it in one of the podcast episodes, I think. And it wasn't that long ago, but like a woman had. I think it was a singleton one baby. And they just maybe it was twins, but they couldn't see like one foot based on how the baby was positioned, and just the doctor was like, I'm going to feel a lot. I'm going to feel a lot better about this. When we can guarantee we know how that other foot is. And they just put her through like all this stuff as if there was going to be a problem with the foot. It's ridiculous. But this case, Didn't the doctor like change that number? While they say some fetal movement?

It does. They gave the biophysical profile score of six out of eight and then the technician called back and said it was a four out of eight. They based on points off for lack of fetal movement and tone. A ragin a rag doll, that's no tone. Got it. And then a healthy baby has good tone. And they observe this by watching it on ultrasound. Yeah, this is the this is like when we start over testing. This is where we start making things a lot less safe.

Well, so the whole point of this question is what did she actually need a biophysical profile just because her water had been broken for five hours and her baby we had been moving fine. And that's

a definite no, that's definite. No, no.

Why are we even doing a BPP and then to go straight to a C section. My without even giving this mom a chance to labor and see how the baby actually tolerates labor. And there was unless we're missing part of the story, there was no indication that baby wasn't tolerating labor. She did say she did fetal scalp stimulation. So when you touch a baby's head, you want to actually see that the heart rate increases.

But what do you mean when when who touches the baby's head. So fetal scalp stimulation, you can go in and do a vaginal exam and you can actually scratch the baby's head with your fingers. God, I can't hear anyone hitting me. When we get out of there. We're not supposed to be in there. The baby is in the most sacred private intimate place that there is on earth inside another person's body inside. And we're like trying to climb our way in there and say Are you okay? Does this bother you? Does that bother you? Right? It's so disrespectful to the baby I mean where does it end?

Maybe the you know okay for the baby was born with Apgar is eight and nine. So the baby obviously was doing fine. Maybe this baby was going maybe there were some other indicators of the baby was going not going to tolerate labor well over the long haul, but this woman was having her seventh baby. She probably was going to have a very fast labor and they didn't even give her a chance to labor. I'm surprised a seasoned mom like that wasn't more vocal. I want to say empowered, but I really don't know if she felt empowered or not. But I'm just surprised she wasn't saying this isn't adding up. I've done this many times before more than all of up people in the room put together. She probably did have more babies than all the people in the room put together. Yeah, I mean, there is no justification for the biophysical profile. I don't know, well, not based on her water being broke, and that's for sure there had to have been setting out

I'm talking about No, I don't agree there had to be something else. I think they just roped her into saying who you remember? Well,

I'm saying in order to, to justify a biophysical profile, there would need to be something else,

right? And then because she was willing to do that, they could now very easily say, and I'm not saying it wasn't correct and true, but they could very easily say, I don't like this tone. I'm not. I'm not thrilled with this fetal tone. Now ACOG says your membranes can release for days GBS negative, of course, because otherwise it's a another conversation. But you can have memories released for days. So it doesn't sound fair. I think this nurse is onto something. And she sounds like she cares. And I'm sure it's very frustrating for her in her job to be, you know, to be witness to these things. And ultimately, it's not to be the one making the decisions. I

think she should ask the questions. I think she should ask the questions of the doctor and get some answers from her, you know, get her to really justify her decisions, and explain why, why she felt that was really necessary because this woman didn't even get a chance to labor. Alright, that was a great letter to share. Thank you for that. Ready? Let's get on to our questions.

Hello, ladies. I've been a big fan of your podcasts lately. Ever since getting my positive pregnancy test. My husband and I had been trying to conceive for almost a whole year. But we're very excited to become first time parents. I have a great group of supportive friends whose views align with mine. But I also have a less supportive group of friends who I've known since I was little, they've recently expressed in conversation, how they'd never give birth out of their vagina and wanted to do a C section because recovery is a breeze. And it's easy. I'm sure you're speechless as I was, they begin to question me about what I would do if my baby was breech. It's almost like they wanted me to say that I'd have a C section at that point. I responded with something like I don't know. But I'd weigh out my options in that situation. Because I didn't really know about bending babies or other midwife guidance options back then. My question is, how do I go about politely kind of defending myself without starting heated argument if they asked about my birth plan and choices, which they clearly don't align with? This goes for any other old fat, old fashioned family member or friend that, that they will believe that I can do it naturally? Or support me with no epidural. I'm going to be telling these friends in the upcoming month, which I'm sure they'll honestly be really excited about. But I'm not really looking for their support in my decision, but I don't know how to answer their crazy, kind of like passive aggressive questions on the spot, I often look back at the conversations we've had. And I wish that I answered differently or advocated better, or just really didn't say anything at all, when they brought these subjects up. So thank you for your sites. Let me know what you think. What would you say in this kind of situation when you have those friends or family members that just aren't supportive? But they still want to dig, dig deep and kind of ask me these questions. Thank you so much for your endless contributions in this space. And I look forward to hearing from you and I hope you answer this question. Thank you for by.

Great question. I really enjoy this one. So many people deal with this. I dealt with this myself. I don't know about you, Trisha, it probably didn't affect your life. Because when you got pregnant the first time you're surrounded by midwives, and your entire community of friends and you're getting your your masters. But this is very real for a lot of us. Yeah, I think some family members of mine were not totally on board and supportive of what I was doing. But I just chose not to talk to them about it. I only talked to the people who were supportive and the people closest to me, like my own siblings, and my own parents were supportive enough. I mean, my mom did let me give birth in her house.

So that's pretty damn supportive. Trisha, pretty supportive. My my father showed up. So that was supportive. He was there at the birth. So So my answer, so my answers, only talk to the people who are going to support you and if you know they're not going to support you. All right, step aside here. Let me tell you how it really is for women. You can only choose to talk to the eye sounds perfect. I agree with you with almost everything in life. But now my situation I couldn't I couldn't avoid it because I was pregnant working in the corporate world and you can't even you can't show up to work and not talk about your pregnancy when you you know work. You don't have to tell them where you're giving birth. Oh my gosh, what happens at work is you're very close to some people. And we I mean, that people you're close to find out we had, you know, we were the we were the risk management team and we were very close group. have about 20 people. And yeah, no, but like my very close friends do. And it's like everyone was nice and supportive. But before you know, it's like the, you know, the woman from HR was walking by my office once and came in and said, I heard you're having a natural birth, like, let me just tell you, and you can't control it and stop it all the time people talk. And yes, your advice is perfect. It's just very difficult to pull off. Now with this woman, it probably is good advice, because she could avoid them, I guess. But here's the thing I noticed in what she said. She said, How do I politely defend myself? Who says you have to defend yourself? One thing that I find what? I think that's my point, you, you don't have to ignore people. It's not like you avoid those people. But when they bring it up, you don't have to defend yourself, you simply say, you either don't say you can say my birth, I'm not choosing to talk about where I'm giving birth. Or you can say I'm giving birth at home. And that's the end of the conversation. Look, if they're that interested, they can spend the hours that you spend listening to podcasts and reading and educating yourself. Clearly, they're not that interested because they are going to you for the information. Whatever it is you decide to do in your life, you just don't have to explain to anybody ever. Just keep them really at bay, back to what Trisha said. But keep in mind why you're not defending yourself.

I always, you know, one of my favorite lines. And it's not easy to put into practice. It's hard. It is a hard life skill to learn. But other people's opinions are none of your business. And if you just keep reminding yourself of that, your opinion is none of my business opinion is none of my business. It does not matter to me. If I do care about your opinion, I will ask you, right, if you're offering me your opinion, right? It's not my business. Keep it yourself, you just politely decline. And the worst thing to do is defend yourself. Because then you're engaging, change the subject, move on, say your decision very confidently. If my baby is breech, I will make decisions at that time, that best suit me and my baby. So you have to say, yeah, they won't know what to do with that. Just don't engage in the conversation. You say you say your piece and you end the discussion there.

Yeah. You say I'll get back to you.

Change the subject. Okay. Next.

Hi, there. I had a quick question about early labor. So my son was born at 37 weeks and three days, he was small, he's about six pounds, 14 ounces and didn't have a lot of fat on him. Otherwise, it's really healthy. My question, is there any chance or indication that my second labor, second baby could have another early labor or even premature labor, I just want to make sure there's nothing that I can be doing to prevent that, or anything I can be doing to not have a super early water break? A any insight or any tips would be greatly appreciated. Thank you.

I think there's an argument both for and against thinking that you might have a premature baby the next time because we don't know the conditions of it. Like I didn't know she was asking about having a small baby the next time, which can be in part genetics, though you also have women who have one really small baby and then another baby that's three pounds heavier. But when she mentioned membranes releasing that shifted the conversation in my mind, because if she went into labor after her membranes released, then that's a different story that was specific to the baby. The only factor of that that might not be specific to the baby, is that some women just like have much thicker membranes than than other women. And some research came out that I found very interesting that showed that natural sources of vitamin C and citrus which so many women Craven pregnancy makes very strong membranes, so even to form a positive belief like if your group B strep positive, or you had a premature baby and you're basically hoping your membranes don't release early. Just have a lemon a day. It's like the healthiest thing you can do and it makes for very strong membranes, and I think the rest is out of everyone's hands.

The chance of having premature rupture of membranes are preterm. Did she say print was her baby born preterm?

He was born on time 37 And three days and he was actually a good way she described him a small but he was almost seven pounds, which is pretty impressive for that. i It sounds like a good way to me for 37 weeks. Yeah, so you technically it wasn't premature. But if you do have premature birth, the chances of having premature birth are definitely higher than next time. But this is not that she just had proof she just had ruptured like brains her early, late, late preterm, so I would agree with you. Reducing infection infection is often the cause of premature rupture of membranes. So that could be vaginal infections, yeast infections, bacterial vaginosis. GBS might be part of that. STDs, anything like that can increase the risk of the bag of water breaking too soon. But nutrition plays an important role just like you said, integrity of the strength of your bag of water. Sometimes it's just happens and there is nothing we can do. So wouldn't have her focusing on this happening again.

The fetal movement can cause it No. Yeah. But if you have a stronger bag, it's less likely to break. No, exactly.

Yes. Yep. Okay. Moving right along, right along.

Hi, ladies, this is Makayla. Sorry, I'm a little bit emotional. I just got done with my 36 week appointment with my OB. And I just I don't know, it was quite an interesting experience. First of all, I was informed that I was going to get my group B strep done today, which I was feeling fully expecting. But as she walked in, she also said that she was going to do a cervical exam. And she did not ask me if we were if I wanted to do one, but she just told me that we were and I need to work on being more assertive and advocating for myself. But it's just hard when you're open. You're someone who's very pushy. And she really wasn't just pushy up until now I feel like But nonetheless, she told me that we were gonna do a cervical check, I made her know that I wasn't comfortable with that. And I didn't really see a need to do it, especially since it's so early. And she mentioned that she wanted to make sure the baby was headed down which, prior to the exam, she just said she noticed that the butt was up higher on my abdomen. So that kind of ruled out the whole need to do a circle check. Nevertheless, she did one anyway. And then I also definitely her how late to be comfortable with me going past my due date or death date. And she said 41 weeks typically, because the longer you wait past 39 weeks, the higher the chances of C section are. And I just was dumbfounded by that because because I know that's absolutely not the case. She also said we're we can do a flu shot next week, which I absolutely do not want to do, either. Just wanted to get your perspective and definitely looking into maybe changing providers and in the future working with a midwife for someone else. So thank you both so much for everything you do. Your work does not go on under appreciated.

Alright, this is total bullshit. I know where do you where to even begin, I wrote down so many notes listening to that just now.

The cervical exam is total bullshit that is so unnecessary. If the if the if the OB can't determine the baby's position abdominally, which she should be able to do, because that is a skill of being maternal health provider. But every one should have, then she could at least use an ultrasound if she was concerned, you don't need to go in there and stick your fingers inside her and confirm the head position. That way there is no benefit to the IQ and understand what her motivation is because it's not like you can charge more for that. Well, this is a very pushy midwife. She mentioned the flu shot, that's also none of the midwives business. It makes no sense at all. They haven't tested on pregnant women. I mean, it just it speaks volumes to how it's you know, she's just overstepping things. I feel I feel so bad when I hear a woman like this saying like, I should be better at asserting myself. My first thought is you just shouldn't have to be I'm all for us being assertive, you know that. But we shouldn't have to be, we shouldn't have to go through things where like, especially it's your body and like you have to assert yourself against whom exactly. Like how did you end up with a situation where someone is doing the stuff to you and you are blaming yourself for not being more assertive and saying stop. It just shouldn't be like this. There should be so much more respect and space and respect for that mother. I mean, anyway, I don't want to it should just be a simple No, thank you. There's no benefit to doing it. So I don't even understand why this provider is so pushy about it. It's like well, what is she getting out of doing it? Just power Wish I Knew role. Because there is nothing useful. There's enough money motivated. I always, you know, kind of go back to liability or money and it doesn't provide either of those.

No. So it might be what you were saying control or something like that. Just remember dynamic earnings statement of all is that she said This is so upsetting to me that she said this, this nonsense rhetoric, there's a higher chance for 39 It's just absolutely false. But here's what gets me like this. I remember years ago doing research on an on a PC Artemi and tearing, and I remember how many articles said like, this increases your likelihood of an episiotomy? I'm thinking, Am I going crazy? Is this just me, and a piece out of me is a conscious, intentional action. It doesn't just happen. Like I could see something increasing the likelihood of tearing because that spontaneous was increasing the risk of a PCI to me, like the whole article was like such and such. I don't remember like, if you do this, if you do that older moms have a higher risk of a PCI to me, I'm like, What are you talking about? Someone is cutting, choosing that doesn't graduate intervention. I mean, it's choosing and that's how this sounds like. It's what do you mean, after 41 weeks, there's a higher chance of C section. That's not how this works. See, sections don't just happen. And the vast majority of them are absolutely unnecessary, the vast majority that or else you wouldn't have midwives like ina may Gaskin, who's attended 1000s of births, and her average session rate was 14 women per 1000. So she would laugh at that and say, really, after 41 weeks, the odds are higher, almost 99% had vaginal births. And now we have these midwives, acting like this notion that we know when the baby should come out. See sections didn't used to happen like this, you know, for the whole first half of the 20th century into the into the 70s. They just didn't do. And they didn't use women out there 60. And they didn't induce women either. So more women went to 41 or 42 weeks. So more women went later and the C section was way lower than it is today. It's a it's a host of red flags. Yeah.

And it's just so it's the it's the fear mongering, that is just it's not a healthy conversation, a healthy conversation could be looked more like well, if you go past 41 weeks, you may you know, your chances of developing a pregnancy complication may increase. And therefore, I recommend if this is her position, have a C section at 39 weeks, and then the woman should be able to very politely say I decline. That's not the path. I want to date. That's not the birth I want to pursue and she should say, Okay, no problem. I support your decision. That's how it should work. Okay, so that's a wrap for the non extended version of this month's q&a. And if you'd like a little more of us, head on over to Patreon or Apple subscriptions where you can get more questions in the extended version of this episode. Let's get into our quickies. Are you ready? Let's see how quick we can do our quickies. Okay, today is the challenge. We're going to be quick. Okay, should it first one should do a stay after birth to help initiate breastfeeding? I think so. Somebody should. That's for sure. Nobody should be leaving until that baby has latched on for the first time or second time or third time. So yes, your doula probably should stay. How necessary are blackout curtains for baby naps?

Hmm. Babies get used to whatever conditions you create. That's, that's my quick answer.

They are not necessary. I've never used blackout curtains for anybody's naps. I did use them. And I made my life very difficult. Because the conditions had to be perfect and silent and dark for my for my firstborn to sleep. So if I can do it, I would go Trisha his way. No blackouts. All right. Get your vitamin D while you map. My mom used to put me outside in a little stroller. Yeah, to get some take my ad torn app. Yeah, that's a great way to nap a baby actually. Is it necessary for my midwife to take my blood pressure during labor? It is appropriate care to check blood pressure in labor.

I never take your blood pressure single time. I never had my blood pressure checked and labor really not even when they first got there? No.

And I mean, I sincerely believe now. I you know, I had I had low blood blood pressure at all my prenatals. So maybe they just didn't think about it. But I thought it was normal not to check blood pressure. No, it's definitely routine. To check blood pressure and labor. It's done every four hours in the hospital stung a lot less than homebirth. Usually at home, right? If you've had normal blood pressure throughout your pregnancy, you get one blood pressure check at the start of labor, maybe one throughout depending if you have a long labor afterwards. Yes, but so I would say the answer to this question is yes. But you can decline always. Next, why are my close friends and relatives so anti natural, unmedicated

birth, because you're special. They don't trust birth, because of their society and culture and because of Yeah, because that's why they have their fear. That's why they have their opinions. They have their non evidence based opinions. That's how most of us go through our lives. Have you been influenced by what's around us? With very limited critical thought? And we have to be aware of that. As we go through life?

Does baby get milk between let downs at the breast and what kind of milk? Is it?

A chocolate?

If it ain't chocolate, I don't want it. Yes, they get milk and they get breast milk. And you don't need to worry about what kind of milk it is beyond the fact that it's breast milk. And most women have an average of two to three letdowns per feeding. So, yes, babies getting milk in between. It's just the letdown is when the milk is coming faster. Do babies need to be burped after every feeding? What if you are co sleeping or dream feeding? Do you need still need to

burp your baby? That's a really quick quickie. That's a no, you do not need to burp your baby after every time they feed. If they need to burp, they'll burp when they go when they get up, right. If they're really relaxed and sleepy, you should be able to lay them down and they probably don't need to burp and if they need to burp they'll burbling down. Next, can prolapse be healed? Or do you just learn to manage the symptoms? Well, there can be various types of prolapse. Yes, it can be healed and you should seek pelvic floor support pelvic floor therapy to help heal it. You should not just endure the symptoms. Alright, that's it for quickies. It's the last quickie is a personal question. This is a funny one.

Oh, weather.

What old person things do each of you do? Oh, where should we begin? What old person thinks Okay. I should have a really good one to this.

I know mine. Here's the first thing that came to mind for me. I've definitely become a little bit of a birdwatcher. You have that's a real thing.

That's a real thing.

I didn't know you have that's so nice. My husband's always been into nature. And he's always known about birds since he was young. So I never thought of that as an old person thing.

I don't even know that much about birds. But I find myself looking for them and watching them and observing them a lot more than I ever did in my life. And I realized like, Oh, I must be getting old. I watch birds.

That is a completely, really correlation. Some people like nature at all ages.

I don't like nature at all ages, but I just didn't birdwatch. That's really funny. Okay, I thought of mine. Okay, all right. Do things I do that are traditionally things that old people are thought to do.

You put it so politely. What do you mean? What's what would be the just online way of putting when I said, this is my old person thing? Oh, yeah, things that are traditionally one of them actually feels that way to me, one doesn't work. So the first one is that I so but I've done that since I was 13. And I do counted cross stitch. And I absolutely love it. And I'm my daughter doesn't know, but I'm working on an amazing project for Christmas, if I can get it done. That's one thing I do. And I've always done. And the other one that I did take up this year in July that I have been religiously doing every Monday morning is Tai Chi. And I definitely bring down the average age in my Tai Chi class. Tai Chi is no older persons. My son predicted that when I went there, and he always thought Tai Chi was cool, but he was like you're going to be you're going to be the youngest person there. They're going to be all very old. And there's one or two, my age. And then there are a handful who are much older and our instructor is incredible. And she hosted us all to a beautiful lunch at her beautiful home this week. But Tai Chi is I used to kind of laugh at it in my mind because it looks so silly and you're standing and like waving your arms and it's nothing like I ever thought it's extremely complex. It totally engages the mind. It's very difficult. You have to know exactly which way you're like your hand is tilted, how much weight you're putting on one foot versus the other foot. It truly engages the mind and body and my instructor. She is Chinese. He's phenomenal. I'm digging it. Young people are missing out. It's very, very, very cool. So they're okay, that's it. I'd be much more concerned. She said what young people habits do you have? I

Oh, yeah, you were so good about that. You're so good about going to bed early. That's so good. Alright, so that's it for today. That's it for this month. If you haven't joined our book club yet, you're really missing out book club.

Yes. Join our book clubs. Keep your young, fresh and healthy by joining our book club. Yeah,

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