#16 | March Q&A: COVID-19 Update for Expecting Parents, Uterine Scars & Childbirth, When Your Partner's Birth Plan Differs from Yours, Taking Hot Baths & Sleep Positions in Pregnancy, Missing Out on the Golden Hour Postpartum

Before we get into our regular Q&A episode, we bring you the current information we have on COVID-19 and its impact on pregnancy and breastfeeding. After reviewing the information from the Centers for Disease Control (CDC) and the World Health Organization (WHO), what we know thus far is good news. Sigh of relief. Please tune in to hear more.

In this week's Q&A, we answer questions on uterine scars and the impact on vaginal birth versus cesarean section; what to do when your partner wants you to birth in a hospital and you want to birth at home or at a birth center to avoid unnecessary interventions; some of the most common pregnancy-related questions, such as "Can I take a hot bath in pregnancy" and "Is it unsafe to sleep on my back in pregnancy?"  And, don't miss our conversation on the "Golden Hour" after birth, in which we dispel the myth that this an irretrievable moment of bonding if circumstances of your birth interfere. And remember you can call us at 802-GET-DOWN to submit your own question.

Information from the CDC on COVID 19, Pregnancy & Breastfeeding

Q&A from the WHO on COVID-19, Pregnancy & Breastfeeding

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Between episodes, connect with us on Instagram @DownToBirthShow to see behind-the-scenes production clips and join the conversation by responding to our questions and polls related to pregnancy, childbirth and early motherhood. You can reach us at Contact@DownToBirthShow.com or call (802) 438-3696 (802-GET-DOWN). We are always happy to hear from you and will strive to feature your questions and comments on upcoming shows.

You can sign up for online and in-person HypnoBirthing childbirth classes for pregnant couples taught by Cynthia Overgard, as well as online breastfeeding classes and weekly postpartum support groups run by Cynthia & Trisha at HypnoBirthing of Connecticut. 

Please remember we don’t provide medical advice, and to speak with your licensed medical provider related to all your healthcare matters. Thanks so much for joining in the conversation, and see you next week!

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Transcript

Hi, everyone, this is Cynthia. And before we get into this month's q&a episode, I wanted to mention unfortunately we're not in person in our usual studio, but speaking via zoom, so we see each other's faces but we're not together, and we look forward to things returning to normalcy. You might notice the sound quality is different. So please bear with us until we're back in our studios. And second, we wanted to just give a few words to Coronavirus. And we know Trisha has gathered some thoughts on that. So Trisha, if you're ready to kick off a discussion, we just want to touch on that before we get into her our usual episode that we prepared for this month on q&a.

That sounds good. Cynthia, thank you. This is a tough time for women to be pregnant. There is no doubt about it. It's a tough time for all of us to be living through what is happening right now. But I think the level of anxiety and fear for women who are about to give birth or who are newly pregnant, I really feel for those women and the and the worries they might be having. So I wanted to just say what what we currently no. And while we really don't know all that much yet, because this is still so new, remember, this is a new virus. It's not something that we have ever seen exactly before. And it's rapidly evolving as it moves through the various countries. We're getting new, new information. And we don't really have much of our own data yet from the United States. But we do have a little bit of information from China. And the good news is the really good news is that women in general, and particularly younger women in the childbearing age seem to be protected from getting severe. sick from this illness, they certainly can catch it just the same as anyone. But they don't seem to get the severity of symptoms. I did recently actually read that women in general, don't seem to get as sick from it as men, which is really interesting. I didn't hear that. That's interesting. Yeah, it's new. I mean, new stuff is just coming out every day.

So before we go into any more detail on this, I just want to be sure that the main message that is getting across to our pregnant women is that the data we have so far seems to indicate that pregnant women fall into the same risk category is women in general in their age group. I will say however, that because when women who are pregnant are at higher risk of other respiratory illnesses like the flu, they should take extra precautions, they really should be taking this to the highest level of hygiene, self protection. The other thing that is important to mention, though, that women who are at higher risk who had a high risk pregnancy are definitely at higher risk of getting more severely sick from a Corona virus infection. So that would include women with asthma, diabetes, autoimmune disease, possibly hypertension, we really don't know. We don't have good statistics on this information yet. But women who do have underlying health conditions should consider themselves at high risk for this illness.

So Trisha, should pregnant moms cancel their prenatal appointments now to minimize exposure I don't think I would suggest that all pregnant mothers cancel their prenatal visits at this time. I think that there may be some practices who are delaying the interval between visits, it's still important to get your prenatal care. And certainly if you have a high risk pregnancy or complication of pregnancy, or you're having some sort of symptom of pregnancy that feels abnormal, you should definitely be seeing your care provider. I think a lot of practices are probably moving toward a telemedicine approach and doing some of their prenatal visits through a digital mode, which is great. It may be a worthwhile consideration to delay that appointment. But that really needs to be a decision that's made between the woman and her healthcare provider. I can't make a general recommendation on that.

So do you think it's a time for some women to consider home birth to avoid birthing in a hospital and minimizing the exposure?

That's an interesting question. I do know from a number of home birth midwives. That many women are looking to move toward having a home birth. I think that the hospital feels like a potentially scary place for pregnant women and a high risk of exposure. And I would say that that's probably true that the risk of exposure is higher. But I do believe that labor and delivery units are taking all the proper precautions to reduce women's exposure. And again, these pregnant women don't seem to be at higher risk of becoming severely sick from the illness. Nor do we see transmission of the virus in utero, from mother to baby at this point. It doesn't there aren't any cases documented of that at this point. And the good news also is that it doesn't seem to be transmitted in breast milk. If a mother is positive for Coronavirus, and we know that lots of people could be positive and not know it. There. Is the risk of transmitting it to their infant through normal close contact.

So even though we don't have much information about this right now, it is another opportunity just to recognize that nature does have all these mechanisms in place to keep us unusually healthy and safe and protected, particularly through pregnancy, childbirth, and that newborn stage and your baby benefits from all the antibodies you produce from every cold, every flu, anything you ever develop. So nature is always on a mission to make you healthy. Your thoughts matter trusting in your body matters. I know this can feel scary, but it is really important to be aware of the messages you tell yourself the thoughts that are in your head and do trust nature and your body to keep you as safe as possible while taking careful precautions through this unusual circumstance right now.

Yeah, so we will continue to keep you updated as we get new information and we increase You to follow us on our Instagram account @downtobirthshow where we have already posted some information and we'll continue to post the most recent information as we get it.

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.

Trisha, we've got a question. We got a bunch through Instagram.

I was recently told by nurse that if you've had surgeries within the uterus, you're automatically going to have a C section because you are at risk for a ruptured uterus. My next appointment with my doctor is in a couple of weeks, and I plan to ask her about this. I'm just curious, the nurse said it would be standard in her office. Any advice?

So the thing here is that it depends on the type of scar complex uterine scars are a relative contraindication to vaginal births. So what that means is that they're not an absolute contraindication It doesn't mean 100% no chance of vaginal birth, but it does mean that there is a strong possibility that you would have to have a sectarian birth depending on the type of scar. So we know that women who are given c sections today are given The type of scar that's transverse and low in the uterus. And that's the reason that we can have vaginal birth after cesarean. If you've had uterine surgery that's more complicated and involves a scar that is up and down in the uterus as opposed to transverse. That would be a potential reason for not being able to have a vaginal birth.

Do they do those anymore?

Yeah. So if you had to have let's say, you had to have large fiber, you know, sometimes they just they have to cut the way they have to cut that I'm not a surgeon. So I can't get into too much detail on that. But I would say that it is very worth having a conversation with your doctor about it. It's something that you need to discuss. It probably depends on your doctor depends on their experience depends on the type of scar the the length of the scar. So yeah, I definitely do know of cases of women who have had fibroids removed and are unable to Have a gentle birth.

I've known several who had fibroids removed and did have a vaginal birth as well. Does that surprise you? Okay, so, you know, it's really dependent on, I think the, the size of the scar, the placement of the scar, it's worthy of a lengthy conversation about risks and benefits. For sure. And of course, it's not all scars are the same. So it really does make a difference what type of return scar we're talking about. Let's, let's touch on the next one. I think this question is for you. So I'm going to read it. All right. I'm feeling a lot of stress around giving birth not because of the birth itself, but because of the location. Our original plan was to birth in a hospital, which I was fine with until I started listening to your podcast. caste and reading more about midwives. We've called the birth center near our home and had good conversations. And I'm very excited at the prospect of birthing there. The problem is my husband isn't fully on board. He's actually adamant about birthing in a hospital. I like the idea of medical apparatuses, nearby. But I'm worried that birthing with an OB in a hospital makes me more likely to end up with a C section. I'm especially concerned they're going to successfully manipulate me into agreeing to interventions. I know I don't want but if they tell me I'm putting my baby's life in danger, I know I would do whatever they want. I'm not sure exactly what I am asking. But we'd love to know if you have any thoughts. Sure, we have some thoughts on --

We definitely have some thoughts. So you, you get it started. Um

Let's break it down a little bit. I have to say now that you know, and presumably your husband knows that your physiology is driven by your thoughts. And your physiology has a direct impact on how this birth will go. For example, if you're calm and safe and relaxed, you will secrete more oxytocin, you will dilate more easily. Even though this is your baby as a couple, and you're equally responsible for the outcome of this birth, and you're equally responsible for the wellness of the baby, I do happen to have the opinion that the mother's choice should carry a little more weight. And I think both people in the partnership should respect that perspective, because we know for a fact that your thoughts and your feelings will have a direct physiologic impact on this birth. So it really in my opinion, is a must to choose the place where the mother feels safest. Now for her to have that place and not have the full support of her partner puts her in a state of stress. So that's counter productive. We definitely would like to get you to win this same page, the least, you should both do is really explore that option. So I once had a couple where the dad wanted to have a home birth, and the mom didn't. They were really at conflict with it because he was a chiropractor. He was like really informed a lot of things. And he really believed it was the safest and best best place for them. And she wasn't there emotionally at all. I had a talk with him one day, and I was like, Look, if she isn't going to feel safe at home, that's not going to bring you the results you're looking for. I don't know if it's worth mentioning. They did end up exploring home birth and having a really nice home birth. But typically, it's the mom who might want to explore a birthing center. And sometimes the father says Absolutely not. We're birthing in a hospital. A little more stock should go into what she wants. Whatever you do, tour the birthing center together bring all your questions that your husband asked everything that's concerning him because I'm sure he has a whole list of really legitimate questions. What do we do in the case of emergency? What if the baby has to get to a nick you If you want medical intervention or need medical intervention, how quickly can they get that for you? The other thing you mentioned was that sense that if you're birthing in a place where, like in a hospital and they tell you, your baby's life is in danger, you're right. We can't do much about that, you know, it's one thing to go in there informed of some of the recent reasons that intervention isn't necessary. But you're right, we're really vulnerable. And if someone says, we need to speed this up, we need to do a C section. We can't really stand up to that too well, if we don't have all the information they have. So you have to learn to ask questions. But again, this always comes back to hiring the right provider, because you shouldn't be feeling that way. Once you hire someone who you really know respects you and understands what you want for your birth. So if you do birth in a hospital, it sounds like you haven't found the right provider yet in a hospital. So I think there's a lot of middle ground for you and your husband, check out the birthing center and if you do decide together to stick with a hospital birth, I think your work isn't done yet and finding the provider because you wouldn't be going into it with all these feelings like, well, what if they just say this and then I'm at a loss?

Yeah, that really stuck out to me that just use the language of feeling that you could be successfully manipulated into agreeing to interventions to me is a red flag for that provider client relationship, you shouldn't feel that your provider is going to manipulate you into anything. Also, in my experience, we I had a lot of reluctant husbands come in for the first initial home birth consultation when I was working as a home birth midwife. And generally, by the end of the consultation, they had a very different feeling. Because once you explore the facts, it's hard to argue with the safety of home birth or the safety of a birth center birth.

There, there's also a middle ground in that many hospitals have midwives and that would also be a good option 95 percent of nurse midwives work in the hospital.

That idea that midwives are happy to be out in the back country birth workers is because that is that's how birth was always done and midwives were the people who attended them. So yeah, that that association is still there. And there are midwives still practicing that way. 95% of midwives are attending births in the hospital. And you know, they're they're attending 10 to 15% of the bursts across the country. And it would also be supported by evidence to hire a doula for your birth no matter what you do. So definitely check that out as well.

Hopefully, that's helpful warrants a conversation between you and your husband, I hope you can start from that perspective that you both have to put a little more stock into what you want and where you feel safest, and then work hard together to try to get on the same page from there.

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So one way that we've been getting a lot of our questions recently is through our Instagram stories and our little asked me anything tabs so we encourage you to keep submitting your questions that way. So here's a Quick one that women are always curious about in pregnancy. Can I take a bath? And if so, how hot? Yes, absolutely. You can take a bath. This is one of the first questions people always ask me in prenatal care, because you know those warning signs everywhere you go where there's a hot tub that saved no pregnant women allowed.

Oh, yeah, that's right.

So what I'm concerned women get really freaked out about temperature.

What are they worried about? What can happen?

Well, you don't want to overheat.

if your core body temperature gets up really, really high for too long of a period of time. Sure, there's risk, but most of the time, we don't do that to ourselves.

I mean, yeah. So that's why the recommendation is to not sit in the hot tubs which are generally 104 degrees. We generally don't take baths of that temperature either. So boughs during pregnancy are totally fine. They can be really alleviating some of the discomforts of pregnancy. They can be relaxing, I encourage them to take baths all the night I take baths every day, Pregnant or not.

When it comes to pregnancy, we are more prone to getting lightheaded or feeling exhausted. So you do need to be a little bit more temperature aware and just listen, listen to your body. The only other thing I would say is that late in pregnancy when your center of gravity is really kind of changing out of balance. You need to be careful getting in and out of the bath and I would always recommend that you use like a nonstick mat and just be cautious. It's kind of like common sense. If you're starting to get overheated if you're starting to feel thirsty. If you're starting to feel a little lightheaded, get out.

If you don't feel good in the bath, get out let's just stop it. That's it switch to a shower. It's don't they say the same thing about sleep.

Oh, yeah, so that was in the same series of questions. Can I sleep on my back?

Oh, I get that all the time.

I think that one is so funny, because it actually, like presumes that we're aware of how we're sleeping all night. I mean, like, how often do you think you actually roll onto your back in the middle of the night and we sleep that way for hours without even being aware whether we're pregnant or not, all the time, right all the time. I mean, if if it were unsafe to be on your back, we would be having a lot more complications in pregnancy. Now, that concept comes from the fact that as your uterus grows, as your baby grows, your uterus gets more and more heavy, and that when you're on your back, the weight of the uterus is pressing on the vena cava. So as the uterus grows bigger and the weight of the baby gets heavier, when you're on your back, especially if you're on a hard surface, that weight can put pressure on the venous return. So as the blood is you know pumping through your body and coming back to your heart, the weight of the uterus can put some pressure on that and that that venous return can slow down. So that's what the concern is. But you actually would begin to feel lightheaded first before your baby was experiencing any type of decreased blood supply while you're sleeping in this scenario, so what do you mean feeling lightheaded?

So if you're lying on your back, and you're not sleeping, for example, women will often talk about you know, being on their backs. And they'll get lightheaded. You always want to be a little bit prop to the side. If you are feeling lightheaded, that is a sign that you need to shift your weight. But again, we probably fall we probably roll onto our backs and then I when we're pregnant all the time, and this doesn't cause problems.

When I was pregnant with my daughter Vanessa, I was on my back all the time. And there was no way around it because it was just more comforting. It was Yeah, it was like the almost the only thing that was comfortable and I and again my Yeah, like I heard that it's it's okay like I would get I was trying to wake up if it was an issue, right? That's right. Is there any chance though, like something? What's the concern? Exactly? The concern is just that you could potentially decrease the perfusion of blood to the baby because the weight of the uterus is pressing on the venous return to be on your side is preferable. But if it's not comfortable, like you said, you were on your back, you can always put just a little roll up a little towel or a small pillow, just prop it under one hip, a slight angle, you're slightly angled. I mean, mattresses aren't really hard surfaces. This is more of an issue on a really hard surface, the the effect of it is stronger, but I think it's a lot more of a fear than it is fact legitimate cause for concern.

Trisha in our last q&a, the golden hour came up. And we got a question on that. Maybe because of that last episode, but can you can we do this one?

I've been wondering if you could talk more about the golden hour and how much it affects your relationship with your baby. My husband held my baby up to my face shortly after birth, but I wasn't able to hold him for about two hours. I was put under to deal with complications with a C section. It took around two months to establish breastfeeding, which I'm guessing is in part due to missing this initial time with him. But I've heard people attribute problems with their teenagers to missing the golden hour. So I was wondering if you could talk about what really is connected with the golden hour and also what moms who miss it can do to help with that relationship? Wow, holy way to put pressure on ourselves. I've never heard that. Have you heard anyone say that before?

Well, I think what's happening right now is there's so much emphasis on the importance of the skin to skin bonding that mom and baby should have right after birth, which is great that we're talking about it because prior to this sort of movement of the importance of the golden hour, we know that moms and babies We're being separated at birth. And now there's this big push in this big movement to make sure that moms and babies are skin to skin and stay together in those first hours after birth. But the downside of that is that women who aren't able to do that, for whatever reason are feeling that they're missing out on something that's irretrievable. That is and that heartbreaking to me that it does feel that way. Exactly. That's exactly how it makes me feel to think that you would carry that feeling of guilt through your life all the way through teenage hood. And, you know, take it back to that moment that you weren't able to bond with your baby. Is is really sad. And if that's the message that women are getting about the golden hour than we are, then we are talking about this in the wrong way.

Oh man, the okay. I think the most important thing for any parent to know is bonding always happens. The big picture here is is this child Born to a safe and loving home. That's it. That's what's going to determine your child's character, your child's life. That's what matters. It's ideal. It's optimal if we get to enjoy that bonding in the beginning, but by no means is that going to develop your child's character do we want to worry about being a perfectionist about any of this sometimes the smartest and most loving thing you can do is hand that baby over if that baby needs any kind of medical intervention. my very best friend from college had her twins at 31 weeks. They were two pounds, three ounces and three pounds two ounces. And they had to bond with machines. There was no way around that they had I believe it was eight weeks and 10 weeks. And what choice was there? You have to do that. What do you mean eight weeks and 10 I think one baby got to the home after eight weeks and the other one after 10 weeks. That was a hard moment when they had to leave that last one behind for two more weeks. But you know what? She is so emotionally intelligent, so loving. She's in a good marriage, these children are now 12 years old, loving, kind, empathetic. I mean, she went showed me a letter that her son wrote her when he was nine. And it blew my mind how empathetic and how he was. So you never have to draw conclusions like this. What really affects a child, as you know from your own childhood is not we most of us don't even know what that first hour of life was like. And pretty much none of us, for the most part, did enjoy the golden hour ourselves in these past decades. But the question is, what was that upbringing? Was it a safe and loving home? So we have to take the pressure off of mom's here.

Yeah, nature would be doing us a great disservice if that first two hours of life were that critical for our emotional and social well being throughout our lifetime, that that would never work.

So I think as we say, in yoga, if it's available to you, then you do it.

And if it's not, such as in the case of this mother, who was was it wasn't the babies that were her baby That was an issue it was that she needed to go have her own medical issues tend to to the baby can be placed skin to skin with the father or the partner.

And that is just as good. The purpose really of this golden hour is to keep moms and babies or fathers and babies together. The reason that that's helpful is because it helps we've talked about this previously, but just to kind of reiterate it, it helps with temperature regulation for the baby. It helps with initiating the first feeding. It helps produce oxytocin in both the mother and the baby and that that initial rush of oxytocin is really helpful for slowing down the mother's bleeding, post birth as it helps the uterus contract. It also helps the baby be exposed to the healthy bacteria from the mother and the mother skin and everything around them on their body. It is recommended that moms and babies be scan to scan immediately following birth. But again, we can't twist this into some, you know, over emphasized, special, unique, irretrievable hour that if you miss it, you've missed this golden window of opportunity. So I don't love the name, golden hour. It's just It sounds very finite like this is your choice. Actually, it's not like yeah, in an effort to promote the skin to skin concept and all the benefits of not separating mom and baby this golden hour concept has been overly idealised on the Internet and on social media. Uh, one other point about this question that we didn't touch on is she mentioned that it took around two months to establish breastfeeding, which she thought might be attributed to having missed this golden hour and I just want to say that that is probably not the case. There are probably other things that happened that made breastfeeding difficult Establishing there could be a whole slew of those things. But I'd like you to just not feel so much pressure about this two hours of time. And as far as we know, we there's just nothing to say that missing that golden hour with your baby has any impact on your relationship with your child in toddlerhood or in the teenage years. Teens are just teens teens are saying what we do they're hard. We think the twos are bad - teenagers man. They're they're like from different plan. I thought twos were harder. Did you really yeah, they're just I guess different.

We haven't met ourselves as teens. We all look back with our own memories of like, thinking it was also smooth, but mainly we had emotional moments that our parents were just like, Whoa, boy. I just thought you know, you just really got to take the teenagers with the light heartedness. Yeah. Oh yeah. Take it Serious sense of humor. Yeah, he totally. Well, I think that's a wrap for today's episode.

Yeah, we covered a lot of good stuff today. Thank you to our listeners for writing in with your questions. We really love hearing from you. And it's super fun to be able to answer your questions and our shows.

And I have to say it is so much fun when you guys tag us on Instagram. Thank you so much for that. It's so much fun to just say oh my gosh, there's this person is connecting with us. And now we feel we can connect back and picture you when we, when we post these episodes. We love to know who's listening. And I have to say the most fun thing about doing this podcast is, is connecting with all of these new people that we're that we're reaching out to and we're reaching out to us and the people we're getting to know and the people we're bringing on the show and it's just like your whole world is just like expanding in such fun ways. Wonderful.

It's amazing how many like minded people there are. Yeah, and we just haven't all met each other yet, right?

It's like, basic human desire to connect. Mm hmm. Bam.

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