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.

We're live. Welcome to the July Q&A.

All right, so I wanted to tell you, but I figured I'd wait till we were recording, that I had my postpartum group yesterday, and a couple of the women just replayed, and/or played for the first time, the May Q&A episode where apparently I went on one of my rants about how important it is to get creative and to play, because that's my new thing now in my life. I was so happy to hear their responses, especially because these are postpartum women, and this is not normally the turn of the conversation, but it turns out many of them were very, very enthusiastic and inspired by that conversation.

Wonderful.

One of them took out her violin for the first time in 15 years or something like that, and she's been playing a little bit every day so happily. She said she can't believe what she's remembering. She's playing little nursery rhymes for her children.

Another one talked about how she, and she had done this before the May Q&A, but another one talked about her felting. So, in the Waldorf schools, they're really big on felting all the natural products. She's been doing felting, so she was sharing that she's doing felting.

Another one shared that she makes jewelry, and you know me, I love jewelry. So, she shared with me her website. She makes beautiful jewelry with crystals and gems and things, and has a wonderful Etsy page.

And then another one said that she was inspired, and she has started dipping her toe into the field of wedding planning, and she's on a complete high now, because now she's involved in wedding planning, and she's having the time of her life, like getting to know the local florists and all the parts of wedding planning, and it's the opposite of what her career was. She was lit up talking about this.

That's awesome.

It was so much fun. I was so happy to hear all this.

Yes, sometimes we just need a little kick in the butt, a little reminder to get back to ourselves, because we will just continue to let a ball in motion stay in motion, right? Momentum is the hardest force to change, and so we just keep doing the same thing until something steps in and says, "Oop, change course a little bit."

I thought that was called inertia. Isn't that inertia?

Yeah, that's very true. What you're saying, you know, when you are idle, it's much easier to stay idle. When you're taking action, it's easier to take action. But just watching them light up like that, and it is just a reminder to everyone that it's discouraging for some postpartum women to hear this conversation, because they're like, "Oh, please, when am I supposed to do anything?" They're not even feeling rested enough to exercise or even go for a walk some days, and it's just a reminder we're supposed to enjoy our lives. We're supposed to make it an intention to enjoy our lives and not to put absolutely everything off.

If everyone could just see how these women really lit up talking about these things, I just could have sat back listening to them forever talking about their hobbies. It was really, really fun and wonderful. So, I hope the conversation keeps happening and keeps women inspired.

And it's okay to start really small. The mind shift is the most important piece of it, because you know we're not asking you to take up a brand new hobby that takes six hours a day. This is something small. Just focus on the little thing that brings you a little bit of joy, and then find something that your partner or somebody else can help you with, and give yourself back a little bit of time so that you can actually start doing that thing.

It is just believing first that we deserve it and need it, that it's worth our time, that it's worth making a shift in our life, that it's worth shifting the inertia a little bit, and then suddenly your inertia is going in the right direction.

Yeah. Okay, good. So, well, I was trying to think of how we were going to open this Q&A today, and I decided to ask our community a hopefully silly question. I have no idea what people are responding to with this question, but the question of the day is: What is something you swore you would never do as a parent, but you now do regularly, or at least a little?

Do you want to start, or should I start with responses?

Do I want to start as far as answering for myself?

Yeah.

I couldn't think of anything. I was just frozen for a second, trying to think of something, and there must be an answer to that. But okay, at this point, I haven't thought of what that might be. I adhered pretty closely to the things I set out to do, that's coming to mind so far, but I'm sure somewhere along the lines there was something different. I just haven't thought of it yet. Okay, so what's coming?

Okay, let's see. Little bits of screen time. Fair. How can we not? I mean, I really have a lot of respect and admiration for the mothers who are able to keep screens away from their kids entirely. Who were we talking to the other day? They said they have no screens in their home, no TVs.

I don't remember.

I don't remember who that was either.

I always said, oh, here's my thing. I got it now, and I couldn't think of anything either, but now I know. I always said I will only ever have one TV in my home.

Oh, yeah.

That was one of mine, and one TV.

Kept it that way?

Nope. I have one, two, three, four. Really four. One in the guest room, one upstairs in the kids' sleepover room. No TVs in the... The one thing I did really stick to is no TVs in our bedrooms, our personal bedrooms.

Yeah, in the guest room is nice. You want your guests to be comfortable. That's a nice one.

Yep, so I did not stick to that.

Okay, co-sleeping, of course. Bed sharing and breastfeeding past two years. See, the thing is, once you open up the bed, that's not going away easily, right? It's not like just one night.

Definitely not.

Now you're down that path.

Sugar. But I love taking my daughter on ice cream dates.

Cute, fun, and ice cream is a really healthy sugar.

I do not consider ice cream to be much of a dessert. I almost consider it a meal. It practically is a meal, as far as density.

No, I don't consider it healthy, and it's my favorite dessert. I love it. I made four quarts of homemade ice cream last week and had an ice cream party. I love ice cream, but I would never call it healthy, and mine was homemade, organic. I don't kid myself. It's not healthy.

What's unhealthy about it?

Dairy, sugar.

Chocolate. I know that's unhealthy.

We don't need to get into that conversation.

How about giving pouches? I broke down with my second baby. That happens a lot with the second child. Those little, you know, food pouches on the go.

Those look so unappetizing to me. I have an adult friend who will keep them in the car and eat them, and I have to turn my head if she opens one of those things up to eat it. I can't imagine an adult eating one of those things.

Yeah, no. Could you eat one of those?

No, they gross me out so much. A packet of soft food. I could see the temptation, of course, when you have a child, you need to have food on hand. So I do understand the temptation with children, but for an adult to eat it, I truly can't even watch.

She gave them to her baby. She wasn't saying for herself, but yeah, they're just convenient. Your kid's hungry in the car.

I used to carry a banana everywhere, and a tiny little spoon. It's true.

Spoon for a banana?

Yeah, I would. When I had a baby, I would just use the spoon on the top of the banana, like scrape, scrape, scrape, and make it so that they could consume it easily before they could take big bites. Banana was my self-contained food of choice. That's the one I remember.

Good one. It's good.

One: using a pacifier. I used it for my third baby only. Yeah, sometimes we break down a little bit, and you need a little soothing, a little extra time. Those extra five minutes can really help.

Bribing. Oh, the bribes, lol.

That one I really can feel. Not that I relate, but I really feel that I had moments where we didn't do punishments or rewards, and I had moments where I was going to cave so hard. It's so hard sometimes with children when they're negotiating, and you refrain from taking something away or coming up with a creative... all the little words for it, consequences. It's all the same thing. And not doing rewards. Yeah, never.

Never rewarding your children? Like you never gave your children a reward for doing something?

I don't know how to answer that question. We followed Alfie Kohn, and it's one of the best decisions we ever made, and really it's about intrinsic rewards. So, for example, we never said, "If you get an A, you're going to get something for it," because getting an A feels so good. You want your children to learn the wonderful feeling of pride after working hard on something.

We didn't do rewards with potty training. We weren't like, "Oh, and you get a sticker, and five stickers." No, we never did that. Let me think of another example. We never did timeouts.

Also, when our children did something they weren't supposed to do, I wish I could think of an example, but I can't at the moment, we didn't punish them. We talked with them about it, but we weren't saying, "Now that you did that, we're going to take this away."

I feel like then the child has a reason to focus on you and why you're wrong, when they really just have to sit and experience whatever they did, whatever the thing was. I think it's more powerful than if you're like, "Now I'm going to do something that gets back at you." I love that we didn't do that.

Again, the guy's name is Alfie Kohn. He's the author of many books, and I've seen him speak publicly. If you had to pick a book, I'd pick Unconditional Parenting, but it is very powerful.

The goal is to raise children where there's a household of respect, of mutual respect. Not "you do as I say," but your children respect you, and that you respect them, and you're not raising them to just take orders. I mean, I wanted to raise children who were cooperative, not just taking orders. I wanted to raise children who, if they had a teacher doing something wrong, my children would speak up and not adhere to even what a teacher says.

I'll give a little anecdote. I know we're getting sidetracked, but I think it's probably very interesting to anyone listening. When my son was a baby, I had a very close friend named Robin, who had a lovely, intelligent eight-year-old son, very brilliantly intelligent. The teacher was honestly probably jealous of this kid. He's remarkable. He's grown to be remarkable. Has a PhD from Yale at the moment. But anyway, wonderful kid.

He helped a kid who got hurt on the playground. He helped the kid in and brought the child to the school nurse. It was a private school, and the teacher always kind of was competitive with him for some reason, and they had a quiz to take. She removed his chair, this was a private school, I think I just said that, she removed his chair and had him take an exam on his knees.

I was so outraged when my friend told me this story. She was nervous because she was about to speak to the principal about it, but I remember thinking, I damn well better raise kids who are going to say, "There's no way in hell I'm getting on my knees because you took my chair away."

This is wrong, and you have to find your values. You have to raise children who are, yes, respectful and cooperative, and yet will neither trample on other people nor be trampled on when an injustice is occurring.

So all of this can be tied in many ways to "Do as I say, because I'm your mother," punishments, rewards, "You'll get this if you listen to me," and "I'm going to hurt you if you don't listen to me." That's what, for generations, parents have been told to do, and I'm not saying there are easy alternatives.

Well, to me, that's authoritarian-style parenting. I definitely do not support that. I do not think that's a healthy way to parent. I think that teaches a lot of shame, and I think it teaches a lot of insecurity, but I think that's really different than positive reward for certain accomplishments.

What's an example? I might agree completely with you. We might just be thinking of different things, right? What's an example?

Okay, let's say you improve your grades. Let's say maybe your child's not doing great in middle school, you're not pleased with where they are. "Make improvements in those grades, and we'll go get that bike you've been wanting for six months."

Oh yeah, no, that's the kind of thing I might get the bike, and I would be very careful to make sure they don't think it's because of the grades, because that's the whole thing. The whole approach is let them experience the true joy and satisfaction of intrinsic rewards rather than extrinsic. So I might secretly think, "Oh, I'm going to get them that bike. I'm feeling so happy for them right now," but I wouldn't link it.

In the same vein, it's the absence of excessive praise, all the "good jobs."

Yeah, I agree with that, but how did you ever, how do you ever then give your kids a positive reward? Like when—

My children did really great things, I honestly, for me, and I'm not saying mine is the right way, this has worked. This has worked for us. I'm at peace with this. I spoke from the heart.

I mean, my son built a 3D printer, one of the world's fastest 3D printers, in high school. It's from scratch, not from a kit, from utter scratch. What I witnessed him doing was remarkable. I don't know if I said much about it other than watching him with my jaw dropped and maybe tears coming to my eyes. What's more memorable for my son?

I must have said, "Alex, you must be so proud of yourself that two years ago you got your own first 3D printer and modified it. Now you built your own."

But if he asks for the 3D printer, do you just automatically say yes, or is there a...

What do you mean if he asked for one?

So let's say before he got the 3D printer, it's like, "Hey, Mom, I want to get a 3D printer. Can I get a 3D printer?"

Well, he asked for one, and we gave it to him for Christmas. Then two years later he said, "I think I want to build my own," because he modified his to improve it, improve it, improve it. Then he came to me and my husband and said, "I actually think I want to build my own," which very few people have done.

I just remember genuinely being impressed and witnessing it, and that probably was enough for him. In fact, he doesn't love excessive praise. He doesn't love being stroked in that sense. Yeah, I'm sure I said to him, "You must be so proud of yourself. I don't understand how you did this."

Well, that's genuine. That's genuine. I mean, I think what you're talking about is excessive praise. And by the way, we don't need to keep going down this path, because we have a lot of other things to talk about today. But somebody did ask us to do a parenting series on Patreon, so maybe we can move this conversation over there and get more examples and talk through scenarios, because it is an interesting conversation, and I agree with you. I totally agree with you on what I said about authoritarian parenting and heavy praise, all that, like constantly, constantly giving your children that excessive praise. I'm definitely not into that, but I think the reward thing is interesting. We should talk more about it.

Well, my postpartum women love to pick my brain and talk about this stuff. So let's do a Patreon event. We'll get questions, because this is a fun topic, and everybody gets tired of it, you know.

I just want to also share, like, we were once hiking, and my family was hiking, and we saw a lovely little family coming down the trail, a boy who must have been about six or seven, with this couple, his parents. Right in front of us, the boy did the cutest thing ever that children do. He braced himself to leap over a little tiny stream or a big rock or something, or he jumped off a big rock and he just jumped over something. It was no big deal. It's the kind of moment that fills a child's heart.

And just as he landed, his mom went, "Good job," and that is exactly what I feel like. Let him have his moment, because any day now he's going to say, "Mom, enough." Like just, "Mom, Mom," because moms lose credibility really fast if they give too much praise, so they have to be very sincere with it.

Yes, totally agree with that.

Anyway, I love the topic. It's so much fun. There's no right or wrong way. The whole thing is a damn experiment. Then you have children with different personalities, so what was easy with one child is really hard with another.

I mean, that's completely... that's why I think it'd be really fun to talk through specific scenarios, and how would you handle this?

Let's do it. Yeah, and if it's popular, we can do it every two months or every three months. We'll just have a little parenting session. We'll just talk about it, because it's so much fun and so interesting. All right, so let's plan that for September. Let's do a Patreon in September on this topic. Let's lock it in, and we'll get questions and things people want to talk about.

Okay, I can't wait. What should we call it?

I don't know.

We'll have to think about it.

How to Not Be the Worst Parent?

No, you'd never want to put the phrase "worst parent" in anything.

I know.

No, it's not about that. It's just about parenting according to your values and your long-term goals. Most parents think in terms of short-term, like, "Don't embarrass me in front of people. I want you to behave a certain way. Behave, behave, behave." It's really about what kind of human being am I looking to... what are the characteristics of this being I'm looking to raise?

I agree. I agree completely.

You know what? We're going to put a link into this podcast description for the Patreon parenting event.

Okay.

Anyone can scroll down to the description, click the link, and sign up for the Patreon event.

Okay, so back to what you said you would never do as a parent, and you do frequently now, and this one's great: sniff my baby's breast milk poo diapers.

Wow. We're just going to keep that right in the episode and pray that people keep listening.

No, I cannot tell you how many women in their head right now are going, "Oh my God, yeah, me too."

Wow.

They smell like rising bread dough.

They definitely don't smell bad until you give them their first morsel of other food, and then, yes, breast milk—

It smells like your sourdough starter, which, you know, that's a great smell.

Okay, co-sleeping and so glad I do. Co-sleeping, co-sleeping. Let my toddler eat in the car. There's no way around that.

I mean, nice. Nice. That's a good example. That's a good example.

There's no way.

Oh, there is. Yeah, there's no way.

I mean, I would love to hear. I'd like to hear somebody who does not let their children ever eat in the car, how they do that. So, if that's you, please do share.

Occasionally giving red dye 40. I've been there, I'm sure. Definitely, my kids have had red dye 40 somewhere along the way.

Let them eat off the floor.

No big deal.

Let her watch TV when we're desperate. Understand. Oh, yes.

Formula feeding instead of breastfeeding. I mean, that's a complex one.

Understandable.

Of course, that was not an easy decision for that woman who had no intention ever to do it.

No, right. Of course.

I get this one. I relate to this one. Let my kid wear characters, Disney characters, but his excitement and smile is worth it. Mostly I don't like that because I just can't stand the fabrics, and I don't enjoy spending money on that stuff because I hate the material. But yes, my kids have worn... yes, yes, yes. North loved being Spider-Man.

Okay.

That's cute.

=========

And Lola loved princess dresses, so we did. Very cute.

My niece was like that. Very sweet.

But I've never taken my children to Disney World.

Oh, you haven't? Okay. You did other very cool things.

I did. If they didn't care, then it doesn't matter anyway.

They didn't. They didn't, and I'm thankful.

There's so much co-sleeping and pacifier.

Yes. Well, you know which one that probably every other woman could say and hasn't said? Cry it out. Every woman swears they're never going to do cry it out, and almost everyone has a moment where they just don't know what else to do, and they let the baby cry, at least for a few minutes, and start getting to them a little slower. If they're a certain age, a year old, standing up in the crib screaming and crying, there's a point where women are crying in the other room, just like, "I don't know what to do," and they feel so bad about it.

Yep. There is one cry it out in here. CIO, she wrote.

This is a good one: Eat the food my children have spit into my hand because I didn't want to get up to throw it away.

I could never. I could barely hear you say that. I could never do that. I've seen mothers do things like that, and I can't. There's something wrong with me. I've seen mothers wipe food off their children's lips, and I could never. Have you done that? You could do that?

No.

I can't. No. Okay.

I could not.

Ruby, my middle child, is always grabbing my water bottle and drinking out of my water bottle.

Every story is Ruby, by the way. You don't have to say anything else. Okay, she's always drinking out of your water bottle.

Yeah, and then I dump it out. I'm like, "No thanks. Just have the rest." I will not drink it.

Well, we're talking toddlers.

No, I know.

She's now—

I wouldn't do it when they were little.

I won't do it now.

Yeah, I feel you on that one.

Okay, let's see. I previously said I wouldn't ever even consider home birth, but after my C-section I had a HBAC, and I loved it.

Yep.

Okay.

There are lots of comments in here about bribing, using snacks as bribes, bribing, using my T-shirt to wipe their snotty nose when I have no tissue nearby. I definitely did that.

Yeah, that doesn't sound like a big deal to me.

Definitely did that.

Yep.

Believe it or not, that one doesn't.

Spanking for regular discipline.

Oh, okay. Address that in the parenting—

Yeah.

—conversation.

Yeah. All right.

Well, in there, I—

Yeah, yeah.

That's fun.

You just dropped my favorite conversation. I'm trying to end it now. My lips are sealed after this spanking comment. I'm like, well...

Because if we go down that path, you're right, we're going to be here for ten more minutes.

You're ready to get on with the questions. Got to get on it.

All right. So, should we play our first question?

Yes, we should.

Okay, let's do it.

Hi, Cynthia and Trisha. Love your show. This is Amy calling from New York. I had a question around what truly qualifies somebody as a high-risk pregnancy. There seems to be a lot of gray area between low risk and high risk, and when it starts to become indicated to do things like continuous fetal monitoring and other interventions that could be associated with a higher-risk pregnancy. What's the gray area there? What is considered low risk? What's considered high risk? I would love your thoughts. Thanks. Bye.

Okay, well, we could have an entire episode on this. This is the most important question, and a very difficult one to answer, because everyone's going to answer differently, and the information doesn't really exist to allow anyone a complete response to the question in the first place.

Theoretically, or generally speaking, a high-risk pregnancy is one that carries increased risk to the mother and baby over a regular pregnancy. The question then, and the reason it becomes complicated, is what constitutes increased risk? How much greater must the risk be? And what's the implication?

The whole implication becomes, well, should we intervene? Should we make this baby come out by induction now because of this? Then the assumption is that intervening is now a safer approach than leaving it alone, and that's where the whole problem lies.

So, to answer her question, it's just anything with increased risk.

One of the most interesting things I remember from Sarah Wickham when we had her on the podcast is that, yes, older moms over 40 have increased risk of certain things: genetic disorders, even a higher risk of stillbirth. All of that is true.

The fascinating takeaway that no one else wants to talk about is that inducing those women doesn't reduce the risk.

So even if you tell that woman, "Oh, you have increased risk because of your age," okay, what are we going to do about it? Because we know inducing doesn't reduce the risk.

So that's why I think the conversation goes awry all the time when it comes up with providers, because they always want to go down that path of intervention.

Well, what's high risk and what's low risk really depends on who you're talking to. It depends on if you're talking to an OB, a midwife, or a home birth midwife. It depends on what their circle of safety is. You hear me talk about the circle of safety a lot.

A midwife like, for example, somebody like Nancy Wainer, she considers almost no pregnancy high risk.

Is there any scenario where high risk is too high risk for her?

Yes. She has a few.

Very few.

Very few.

Very, very few.

Ina May Gaskin is another example of this. To her, twins are not high risk. To an OB, twins are high risk. A breech birth, not high risk. To Dr. Stu, breech birth is not high risk. Twin home birth, not high risk.

Look at VBAC. VBAC is considered very high risk for many providers and almost no risk to other providers.

So it completely depends on who you're talking to, and the challenge is when you are considered low risk but are seeing a more medicalized provider, you can very quickly go from low risk to high risk for what seem like unnecessary reasons.

Now, she asked specifically, if I'm high risk, am I going to need continuous electronic fetal monitoring, and what would make me high risk for requiring that?

If you are intervening in the physiologic process with a medication like Pitocin, an epidural, or Cytotec, then increased monitoring of the baby makes sense. It doesn't necessarily make you high risk, but it is a good reason to look more closely at what's going on with the baby because all of those things put the baby at increased risk.

If you have something like preeclampsia, I think that's a pretty obvious one. Preeclampsia is something that can go from zero to sixty pretty fast and cause pretty severe consequences, so that does put you in a more high-risk category.

But I can tell you that there are midwives who will still do home birth for a woman who is borderline preeclamptic or has early preeclampsia.

So this is completely subjective. It's like talking about safety in birth. It's relative and it's subjective.

There's no entirely safe birth, and there are different things that make birth safer or less safe. It has very much to do with the experience level and comfort level of the person who is taking care of you and how they label you. That's what it comes down to.

Yep. And just a fun fact about Nancy Wainer that is unbelievable: she's turned no one away. Of more than 2,800 women having home births with her, she refused no one. Not even obese women who've had three or four C-sections. She turns no one away.

So you're right. It comes down to the provider and whether there's a safer course of action. She remains convinced those women are safest in her hands rather than in a hospital.

That's not to say she was never in a hospital with women. She sometimes was. But she never turned them away as her client.

She said that she attended the birth of a woman who had had nine prior C-sections and then had a vaginal birth.

Right. She has all sorts of stories.

Who else on the planet is doing that?

Yep. All right, let's move on. Great question. Fun one. Impossible to answer.

Sorry. We could try to come up with a list, but women can hear the complexity of the question and why it is, in fact, a difficult one. Still worth listening to, though.

Okay, here we go.

Hi, ladies. First, I just want to say thank you so much for everything that you do. During my first pregnancy, I walked miles listening to your show and found it so informative, but also so entertaining and fun to listen to, so thank you.

My question stems from what happened during my first birth. We were planning a home birth, and everything was going wonderfully until, at 35 weeks, I developed preeclampsia and had to be induced, and it ended with a three-week NICU stay.

Everybody is fine now, but of course that was not what we wanted, and it was pretty awful. It was very disappointing because I'm a dietitian, and I feel like I was doing all the right things.

I am now pregnant again, and I'm still feeling like I'm doing the right things, getting help from our midwives because we're planning a home birth again and doing everything I can.

But I'm wondering if you have any advice on either mindset or even just the statistics around doing a home birth after something goes wrong the first time, especially something as sneaky and scary as preeclampsia.

I'm really struggling with whether we're making the right decision to plan a home birth, even though after my first experience, while I was very thankful for the medical intervention, it really made me double down on not wanting to have a baby in the hospital if at all possible.

So yes, I would just love any thoughts that you have about that. Thank you again so much.

Yes, she should plan a home birth until there's reason not to have a home birth. You should have a home birth if that's what you want.

I'm getting that anxious mom perspective, and you're hearing it as a clinician, which is good.

So here's what I tell her. This is what I say, because I understand my thinking.

What I want to tell that woman, and other women in a similar situation, is that when you plan a home birth early in your pregnancy, you're right, there are many things that can come up that would really make home birth not a great idea, or a less comfortable idea, even if statistically it would still be okay.

There are things that can come up because early in pregnancy, you don't know what's going to come up.

If you have Group B strep, your midwife might recommend intravenous antibiotics during your home birth. If you have a breech baby, you're going to have very difficult decisions to make. Preeclampsia—it might get ruled out altogether.

But as your pregnancy progresses, the way I view it is you keep checking things off the list, and hopefully by the end of pregnancy you can even check off, "Look at this. I've got a very well-positioned baby. I'm really in good shape for this home birth."

That's a confidence that comes over time as you rule out all these other conditions.

The second thing is, rather than always perceiving home birth as the risky choice—which we understand, because you're also making that decision because there's a part of you that views the hospital birth as the risky choice—when you are giving birth at home, you can make a list of what risks you're avoiding by avoiding the hospital, all those unnecessary interventions.

So if you think about it from that perspective, you're also probably going to increase your confidence in home birth.

It's not to say we would always recommend a home birth for everyone, but for this woman who's leaning toward it and is pulled toward it, that's my response to her.

Yeah, didn't she say that after the hospital birth experience, that made her double down on wanting to have a home birth?

Yeah. So it's just that confidence level is always tough to achieve because she's worried.

One, she said, "I'm a dietitian, and I felt like I was doing everything right," and she still got preeclampsia. So she should understand that it is not entirely related to diet, right?

Preeclampsia—there's still so much we're learning about preeclampsia. Diet is an element of it. It is not the whole story. You do not have total control over that, and it can get established early in pregnancy and not show up until late pregnancy.

So no matter how perfect you were throughout your pregnancy, it still can be there, no matter how well you ate. I don't want her to think that she is to blame for this or that she can do something differently to prevent it from happening again, because we don't know that you can do that either.

Her risk of recurring preeclampsia is slightly higher, but it's by no means a guarantee that she will develop preeclampsia in her second pregnancy. Many women go on to have subsequent pregnancies with no preeclampsia.

Also, we don't even know if she truly had it, because we know that many, many women are induced for pre-preeclampsia when they don't even actually meet the diagnostic criteria for it.

So that's why, to me, the answer was pretty simple. You want to have a home birth? Plan on having a home birth until something changes that tells you you can't, or you shouldn't, or you decide you don't want to because of what's developed in your pregnancy. Plan your home birth.

Hi, Trisha and Cynthia. My question is about manifesting the birth I want to have. This will be my third birth and my second home birth. My first birth was very long, at almost 30 hours, but my second birth was pretty short, maybe about eight hours, but probably more like four to five hours of active labor.

At my first appointment last week, I told my home birth midwife that I'm excited for my third birth and that I am going to manifest a short and low-pain, joyful birth.

Her reaction was not what I was expecting. Although I love how supportive she was last time, I thought it was a little odd. She told me that third babies can be a wild card, so it almost seems like she wanted me not to get too excited for a shorter birth experience, maybe to protect me from getting disappointed. I don't know.

But I just continue to choose to imagine the birth I want and stay positive. I find nothing productive in worrying about it being longer or anything going wrong.

This is most likely going to be my last birth, and I really just want it to be joyful.

So I would love to hear your thoughts on this. Am I being overly optimistic, or is it healthy to think like this? Thank you so much.

All right, so that comment about third babies being a wild card is rhetoric. That is a comment that is passed on from provider to provider to provider. I heard it when I was pregnant with my third. My midwife said it to me.

The reason I think providers say that is because it is almost a certainty that your second birth will be a little bit faster than your first birth, or similar to your first birth, but usually faster, usually not longer.

So then the thinking would be that your third birth would be shorter than your second birth. The reason I believe we've come to say it's a wild card, you don't know, is that it doesn't really work like that. It doesn't go from longest to shorter to shorter to shorter to shorter.

Sometimes the third birth is the same. Sometimes it's shorter. Sometimes it's longer. Generally not longer than the first, but maybe longer than the second.

So just explaining where that rhetoric comes from, from a provider's perspective.

She should absolutely continue to envision the birth that she believes in. You always should.

It sounds like they have some insight. "Oh, the third one's a wild card." Everyone's a wild card. You're pregnant for the first time, you've no idea how your birth is going to be. Pregnant for the second time, "Oh my gosh, this one was so different." Yeah, because it's another baby.

So you're going to have another baby, and it might be a third unique story. It certainly might be your quickest, easiest birth as well.

But to call it a wild card is such a cop-out, because you can call anything a wild card. You can call literally anything a wild card.

So ignore that.

The only thing I'm bummed about is I do wish she had a little more emotional intelligence. When you have a woman who's pregnant, who's coming to you and saying, "I'm really being positive, and I'm thinking this way," let her be.

Not to mention, the research is on her side. The neuroscience is on this woman's side.

You should be visualizing the birth you want, not the birth you want to avoid. You should be talking about planning and expecting the birth you want, not the birth you're afraid to have.

You're doing exactly everything right. Don't let this get to you. Don't let other people's comments get to you.

If she's the right provider, great. But don't go to her as your source of comfort.

And just for one additional thing to embolden you, to make this a little more practical: focus for your birth on the things you can control, because there are many things you can control.

There are things you can't. You cannot control what time of day labor is going to begin. You can't control, well, you can influence, but you can't control precisely the position of your baby. So do all that you can to influence it.

You actually can control how you will respond physiologically to whatever you do end up feeling.

So, "Oh, I hope I don't have back labor." Well, forget about it. Don't worry about that. But how will you respond if you have intense uterine contractions or back labor?

Put your focus where it will serve you.

You can even control your emotions and your thoughts if you dare to do the very hard work involved in that.

So if you can control your emotions, your thoughts, and your physiology, you're untouchable. This is going to be a great birth because you've got all those important things under control.

So put your focus on things you can control, and of course, be happy and anticipate a birth that you look forward to experiencing.

And one final thought. I am in agreement with her that I do believe her midwife was just doing her best, although she could do better, to try not to set her expectations too high. She made that comment not to criticize her or dismiss her, but she didn't want to misguide her into thinking that her third birth would definitely be faster than her second.

I agree with you. I just don't think it's our place in life to lower anyone's expectations about anything. That's just not our job.

If you have a friend who goes, "Oh my gosh, I had a positive pregnancy test yesterday," you don't go, "You know, I just want to prepare you that a very large percentage of women have really early miscarriages."

No, you don't do that.

You don't hug your friend on her wedding day and say, "Just don't be too disappointed if this ends in divorce, because a lot of couples get divorced."

It's not our job to lower expectations. We can trust people to handle their own disappointments if they come.

These are fun questions today.

Hi there. I am currently 40 weeks and 2 days, and I know you won't be able to get to this question before my birth, but I figured I'd pose the question anyway because it might help someone else.

I couldn't find any information on this on your podcast, but let me know if there is.

My home birth midwife is concerned about my baby's 99th-percentile abdominal circumference and is wanting to do some natural induction methods to induce labor, but they're not so natural.

She's suggesting Cytotec, a balloon catheter, membrane sweeps, and I know you've talked about membrane sweeps, but I don't remember hearing much about Cytotec or balloon catheters at all, especially in a home birth setting.

From my research, it seems like you might really want to monitor someone who's had Cytotec.

If you could talk a little bit about that, that would be helpful. Thanks.

Cytotec is about the opposite of a natural means of induction.

Yeah, there's some red flags all over this midwife.

How is that natural? That's as medical as it gets.

Well, first of all, the reason she hasn't heard us talk about this, or really could find much on it in her research as far as Cytotec at home birth, I would think, is because that's not really a thing.

I do not believe that midwives are using Cytotec to induce labor at home, and if they are, I'm a little concerned about that.

Some of them do.

And you're right, it's off-label. It's not FDA-approved for that usage. It's a very, very risky drug, but some of them do. I've met a couple.

For induction, or management of labor?

Induction. Yep. I can tell you for sure.

Okay.

Well, definitely Cytotec is in a midwife's bag, and it is used to manage postpartum hemorrhage, which makes sense, because if you're having a birth at home and you're hemorrhaging, you will do anything. We're not concerned at that point about the consequences of Cytotec induction. Completely different story.

I mean, when you give a woman Cytotec for induction of labor, you do need to be paying more attention to what's going on with the baby and increase monitoring because there are side effects. There are risks to Cytotec.

You can overstimulate the uterus. You can't take it out. Once you put it in, you can't take it out.

It'd be safer to give Pitocin at home than it would be to give Cytotec, because Pitocin you can turn off and it goes away quickly. Cytotec, once it's in, it's in. You can't stop it.

If it creates uterine hyperstimulation, then that's compromising the baby. It does increase the risk of uterine rupture, so that also is a thing.

But yeah, I'd be curious to talk to the midwives who are using Cytotec at home birth.

I'm just not sure why you're inducing. First of all, let's go back to that. Why are we inducing?

And if we are inducing with a medication that has some pretty big risks, then maybe home isn't the right place.

But why are we inducing for a baby with an abdomen in the 99th percentile?

Can you believe that? I can't believe this whole conversation was prompted by the size of the baby's abdomen. It's just unbelievable.

So we're talking about that baby alone. We have no risk factor here.

That's right.

For induction.

So this doesn't make sense on a lot of levels.

I'm definitely concerned about Cytotec for induction at home birth. I'd really be interested to hear from midwives who are doing that and what their experience is with it.

But if she were to go some route of natural induction, which Cytotec is not, then I'd feel a lot more comfortable with a balloon catheter than I would Cytotec, or a membrane sweep than I would Cytotec.

Cytotec, again, is irreversible once you put it in. It has a strong side-effect profile, and it is much higher risk than either of those other things.

Guess what time it is?

Quickie time.

Oh yeah, it's not quickie time. It's Quickie Time.

It's Quickie Time. All right.

Rule number one of Quickies is to be excited about a Quickie.

Okay, I'm still thinking about Cytotec. Sorry.

All right.

Yeah, I'm still thinking about Cytotec. I'm going to think on that after we get off this show, but for now it's Quickie Time.

Good.

All right, here we go.

Quickie number one: What's better, sunbathing your newborn or vitamin D drops for your newborn?

Sun.

I'm going to go with sun. I mean, neither of us used vitamin D for any of our babies, correct?

I didn't.

I didn't either.

I think it is important that the mother has sufficient vitamin D levels, though. So if she is deficient, she should take it.

But definitely get your baby outside.

Well, if there's sun, that's how she can get hers too.

Are any wearable pumps worth a crap?

Totally, yes. There are some good wearable pumps. BabyBuddha has made a good one lately. I've been getting good feedback about that.

There are some real advantages to wearable pumps, but not as an exclusive pump, especially if you're trying to build your milk supply.

How do you deal with in-laws that expect to babysit when you don't want them to?

Where did we just talk about this? Didn't we just have a whole conversation about this in our last Q&A?

I think we did. Yeah.

As a long-form question from a voicemail.

Yes.

The quick answer is: check out that last Q&A.

No, we talked about this at length in the June Q&A.

Okay.

Moving on.

Okay, let me think of a quickie. I guess you can get around it by staying home when they "babysit." Be like, "It would be great if you can come over and spend some time. I need to get some things done around the house."

Okay.

Good answer.

Supplements to take postpartum.

Spirulina, algae, EnergyBits. I love those things. Those are like the most nutrient-dense foods you can consume. They're better than any multivitamin you could take. So I would say that, and some vitamin D.

Are they as healthy as ice cream, Trisha?

I think they're quite a bit healthier than ice cream.

The odds that they're alkaline. Consider ice cream unhealthy.

I love ice cream. I wish I agreed.

Unless you're going to Carvel. That's unhealthy.

That's not ice cream. That's just food products, preservatives, and things. It won't stop me from eating it.

Tips for mastitis.

A quickie tip for mastitis: rest. That's it. Rest. You are going to quickly get over mastitis if you immediately stop doing everything and get in bed and rest with your baby.

And then there's a series of other things you need—anti-inflammatories—but it's a quickie, so I'm not going to go through it all.

Are early pregnancy cramps normal?

Yes.

Motherhood and PMS are incompatible. What do I do?

There are actually a lot of things you can do to help support PMS. That's usually an issue with how you're metabolizing your hormones and excess estrogen buildup, and there are some very good supplements that work for that.

What are your thoughts on ECV, external cephalic version, for a breech baby?

Do it at home.

You can.

Yeah, you can do it with a home birth midwife who's going to be more gentle. It's worth a shot if a C-section is the alternative.

Tips to conceive a girl.

No, there is a theory, and I think you know it's not a guarantee, but the male sperm swim faster, the female sperm live longer. So have sex at ovulation if you're looking for a boy. Have sex before, well before, three or four days before ovulation if you're looking for a girl. No guarantees, people.

This one just says "50-year-old sperm." I'm not sure what we're supposed to do with that. All it says is "50-year-old sperm."

Sounds gross.

What's the first thing that comes into your mind?

Tony Randall. Wasn't he having babies in his eighties?

I'm thinking she must mean a 50-year-old husband.

I'm thinking 50-year-old sperm, like on ice.

I know, I know, I know.

I think she meant a 50-year-old husband. And now I just added decades for kicks when I said Tony Randall and Robert De Niro.

Okay, fine.

Yeah, of course it's totally fine for men. It's so crazy.

Well, because they're always producing it. They just keep replenishing it.

Okay.

Do you believe in feeding schedules?

No.

Oh, finally, a quick quickie.

Right.

If you tear during your first two births, will you in your third?

No.

Another great quickie.

Thoughts on homeschooling.

No.

Just kidding.

Thoughts on homeschooling. We did a one-hour phenomenal Patreon event. We'll link it. We'll link it in the podcast description with a woman who homeschooled four children through high school. Remember? It was amazing.

Three of her four kids went to Ivy League colleges after she homeschooled them through 12th grade. They played instruments, sports, and she's brilliant. Honestly, one of my favorite people we've met.

It's fantastic if you're thinking of homeschooling. The information and ideas she had about creating annual curriculums for her kids...

Just get on Patreon and take advantage of this stuff. We've got such great things on there. Such a no-brainer. That's what we say. Go listen to it.

Sunbathing in pregnancy?

Why not?

Yeah, of course. It's good for you. We're of the earth. We're supposed to be in the sun. Sun is an essential nutrient.

You need it.

Oh, this is sweet.

You two are friendship goals. Give us advice on friendship in your thirties and beyond.

Meet at a birth.

Great question.

Meet at a birth, right? Let one of you be stark naked and in labor when you meet. Instant connection and intimacy.

That's right.

Just get naked at your first get-together.

Friendship in your... I'd like to know what you're saying to this, Trisha.

I have such unbelievable friends in my adult life. I can't even believe it. And they're all so different from each other. They really have different personalities, and they're all wonderful friends.

The one thing I feel like they have in common is just complete trust and respect, and really lovely boundaries. Deep, deep closeness. Absolute closeness. Nothing we wouldn't share closeness, but really nice, respectful boundaries.

I don't know how else to describe it. I just think it's a lifeline. It's a blessing. It's such a blessing in this life to have absolutely wonderful friends.

What do you think the secret is?

You don't need a lot of them. Don't be looking for a lot. You don't need twenty friends like that. You need a small handful. Even just a couple is enough.

Also, I think in your thirties, building friendships is really around your kids. It's the easiest way to meet new friends. If you're starting to build friendships in your thirties, it revolves a lot around your children.

That means you need to have similar values, I think, with parenting and lifestyle. If you find like-minded moms, it's much, much easier to connect and build that trust and respect.

Not that you can't be good friends with somebody who has totally different values, but then you really need good boundaries because you're going to butt heads about certain things.

Taking care of each other's young children and helping support each other is an incredible way to build really strong, deep friendship.

How else can you build so much trust with somebody than letting them really take care of your kids, and you do the same for them?

Yeah, which reminds me of another one that I think is really important.

Before I had my really, really, really close adult friends—when Eric and I were first married, or even the years before that—my social life comprised so much of nice dinners out. Like, "Oh, let's have dinner a week from Saturday." You spend a lot of money, and you talk for two to three hours, and it's lovely, and then you go home.

I think friendships just accelerate so much to such an incredible level when you hang out together and don't need a plan. You're willing to get together at four in the afternoon and not freak out about what you're going to do in an hour or two when you get hungry.

Be spontaneous.

Yeah. We are so spontaneous. I don't ring the bell or knock on the door of any of my friends' homes. The door is just open.

There's something different about when you don't have a plan and you just hang out.

Drop the pretense. Don't worry about whether your house is perfectly clean, or you've prepped the perfect meal, or you look your best.

Just be natural. Be authentic. Be willing to share your secrets. That's how you build trust: open, honest, deep conversations with people.

And if you have really, really, really interesting deep secrets, like Trisha does, and someone who loves to listen, like me—oh boy—really fast.

Now everybody thinks I have secrets.

Boy, did we have God knows how many hours of very close conversation before we launched this podcast. We were solid.

Well, I think that ends the Quickies for today. There were about fifty more in there, so we will soon put on a Patreon Quickies to answer the rest.

Please, please, people, if you have not yet taken the time to share an episode with a friend or give us a quick five-star review, if there is an episode you love, make a comment on Spotify, give it a five-star review on Apple. These things are super, super helpful in helping the show grow and getting others to see it.

So help us out.

Also, do know that you get early release of the episodes on Monday on Patreon.

In video format.

Cannot wait until every Wednesday? If you really need to see us on Mondays to make your week start off the best possible way it can, join Patreon. You get that at all levels. Six dollars to start.

You can see us on Mondays.

So go find it on Patreon or YouTube.

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.