#26 | May Q&A: Refusing Newborn Interventions, Birthing the Placenta, Breastfeeding Support At Birth, Co-Sleeping

We are back with another monthly Q&A episode. This week we have some big topics such as "mandatory" newborn interventions: can I say no to the antibiotic eye ointment and/or the Vitamin K shot? Next, we explain the birth of the placenta: when it happens and what to expect. Also, we address how to get started with breastfeeding immediately following birth--don't miss the one simple first step! Lastly, we talk about co-sleeping: what does it mean, who is it for, and is it safe?

Thank you to all of our listeners who submit wonderful and inquiring questions for our community.

Co-Sleeping & Bed Sharing

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Transcript

There's such a belief within us that things are mandatory in the hospital that we have no control that we don't own our bodies once we're in there and that somehow the state owns us, and how does the placenta come out? And when does this happen? Will someone be able to assist me with breastfeeding as soon as the baby is born? I have an easy answer to that.

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.

It's Wednesday, and we are back with another q&a for you today. We did get some really good new questions for this week's q&a. So shall we jump in? Let's do it. So the first question is about newborn intervention. So standard newborn interventions are erythromycin, also known as the antibiotic eye salve, and the vitamin K injection, which is a synthetic vitamin K. Those are the two biggies. Which newborn tests or exams are we able to opt out of and which are mandatory. There is such a belief within us that things are mandatory in the hospital, that we have no control, that we don't own our bodies once we're in there and that somehow the state owns us. The state does not own us, the hospital does not own us. And the first point to make here is you can opt out of absolutely anything and everything. Now, if you're seeing a doctor during your pregnancy, it's possible if you refuse some tests, they might say, well, then I won't work with you. That's within their right. But once you're in a hospital, it isn't within their right, they must serve you whether or not you adhere to hospital policy. There's a law in this country that you must be served. And because of voluntary informed consent laws, you may always refuse an intervention or a test or any procedure. So the key point is, this is why education is so important because now that you know you have the right to make those decisions. What decision will you make, and that's why we're so responsible and getting educated and making our own decisions because it is in within our control. That's the first point I wanted to make because no one - not we, not your childbirth educator, not your doula, not your family members, and not your doctor or nurse - should tell you what decisions you must make around your baby. So therefore, you must be responsible.

So I think what couples struggle with a lot is if these tests and exams are so routine, and I say no, how am I going to be treated? And am I making the right decision to have or have not to have these tests?

And so let's talk about why you might choose or choose not to have them. erythromycin tends to be an easier one for people than vitamin K. erythromycin is an antibiotic eye ointment that specifically addresses chlamydia and gonorrhea. So if you know for a fact that you do not have gonorrhea or chlamydia, you know for a fact your baby didn't contract it from you vaginally in coming through you. I think the erythromycin is a very easy decision to make because there is absolutely no benefit to having it if you are not a carrier. And there are downsides to putting it in your baby's eye. It really interferes with the newborn sight. It is like a sticky, gooey globby point that goes across the eye opening. And that newborn eye contact between mother and baby or parent and baby in the beginning is really important. Why? Why would you do that? And I do think that the hospital practitioners are a lot more receptive to to families declining the ointment especially if they have a negative test on record. Vitamin K does tend to be a trickier decision for parents because there is a small risk on either side of this decision, it is possible, the baby could be born with such low levels of vitamin K that they could suffer from something called vitamin K deficiency bleeding, which can potentially be fatal. And then there are the risks from the injection, which you can look up online and see what the pharmaceutical inserts say. But that too can give some people pause. Really, the bottom line is that the majority of the major medical associations around the world do strongly recommend the shot. But some people like to see if they can get oral vitamin K as an alternative. The bottom line is that we're more responsible for these decisions than we realize. And because we're responsible, we have to do the research so we can make an informed decision and partner with that doctor and come up with a plan that you know is right for you and your children, good luck with that, because these hard decisions. These don't go away now that now that you're a parent. So I totally agree it's a good way to put it that this is just the beginning of one of the many difficult parenting decisions that that you will make and we don't know what the right or wrong answer is in this situation. So, Alright, here's a little easier question.

And how does the placenta come out? And when does this happen? What does this feel like and what should I expect? Well, typically, it typically does happen within 30 minutes to an hour after your baby's born. It obviously comes out after the baby and it comes out by uterine contraction, same as what brings your baby out. It's much easier to give birth to than a baby because it's soft, it has no bones, it has slides out, it has no head. It has no shoulders. It's squishy. You do notice the birth of the placenta because you have just given birth to a baby and you're very sensitive. And as the placenta comes through, you will feel it, but it is nothing. It's not comparable to giving birth to the baby. You know, in my years of doing this work, I've never met anyone who expressed a concern about birthing the placenta. And I found it to be very easy to do. I do remember with my first I was so incredibly exhausted at that point that I was very eager for the placenta to come out and I didn't have the strength to sort of be patient will it out well or just be patient for it. It created a little, a little bit of that feeling of like, I just need this to be over. And I think sometimes that is a natural feeling. For women that they're just exhausted at the end of it, they just want it to be done. And if the placenta is taking longer than that can be hard. And sometimes, you know, you're still having contractions and they just want that to be over. I think the most important takeaway from this question is just that the placenta has its own process, and it will come and it's very mild compared to giving birth. And if you're breastfeeding, this can happen a little more easily right, because the breastfeeding causes the blood vessels to constrict, which then makes the uterus start to contract which causes the uterus to shed the placenta off the uterine wall totally. And it's not necessary. It's not necessary. It's not like you need to put the baby to the breast to get the placenta to be born. It's just if your placenta is taking a long time in some do, hold on, for whatever reason, a little longer and sometimes your doctor or your midwife may have to help facilitate the birth of a placenta a little bit but if you are struggling with it, is taking too long you can breastfeed and that certainly is helpful for continuing the oxytocin flow and keeping those contractions going. Sometimes a woman is just so exhausted at the end of birth if she's had a very long labor that the uterus just goes into this long resting phase, and that can delay the birth of the placenta. But it's not something to be anxious about. But it's also a beautiful, it's this incredible, Oregon and if you really take you should after birth, if you can get your provider to give you a detailed tour of the placenta. It's amazing to look at some people do like, not an imprint of it, but don't they Yeah, but prints they can eventually take the blood that's left on the placenta.  And you press the placenta into the paper and you make it. It literally looks like the tree of life. It's like a painting. It is the tree of life. That's what I did.

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Let's do this quick one. This question is simply, Will someone be able to assist me with breastfeeding as soon as the baby is born? I have an easy answer to that. Your baby will assist you with breastfeeding as soon as your baby is born. How did I miss that? Let your baby lead the way. Now if for some reason that isn't working, then will there be another person there to assist you with breastfeeding? Maybe Exactly. So that this is where Okay, so the first question, the first point here is, are you birthing in a baby friendly facility if you are birthing in a baby friendly facility. Now this is a designation that some birthing centers and hospitals get after many years of going for this, let's say credential. And it means they have to adhere to about 10 criteria that support breastfeeding, meaning they won't give you a formula on your way home, they have to have a lactation counselor on hand at the birth. So that means Yeah, there will be a lactation counselor there. That's the first point. But here's the thing. The majority of women in this country are birthing in facilities that are not baby friendly designated. And then the question becomes, what misinformation should you be prepared to potentially receive after your baby is born, because now it's the nurse or potentially even the pediatrician giving you breastfeeding advice. And very frequently, it's not going to be evidence based. They might see your baby has a little bit of jaundice. And the best thing to resolve is formula when in fact, the best thing is colostrum. They might say your baby has low glucose. And that the best thing is formula when in fact it's better to start pumping if your baby can't latch on immediately, or latch your baby on immediately and wait and give it time for those levels to normalize. But the key thing is you How are you going to protect yourself from potential misinformation? If there isn't someone there credentialed to support you in breastfeeding? Should you need that support and trust go in there trusting that you won't, but be aware of this in case you do. So I you know, I have fairly strong feelings about the first 24 hours and breastfeeding and really not trying to have a lot of intervention, even if it's a professional lactation consultant, because this time period is a really important opportunity for you and your baby.

To learn how to do this together and to let your baby Lead the Way, so if you have never heard of or seen a video of the baby's breast crawl, I would just Google that and watch that. And I think you will be inspired to not want to intervene. In this process after you see how competent and capable babies are at latching on the breast crawl is pretty amazing. It's remarkable. And every single baby does it, which tells you that they know exactly how to do this, they know exactly what to do. And if we get involved too soon, if we get our hands in there, and we get pillows in there, and we get blankets and we get all complicated. We completely disrupt that innate instinct. And I just believe that breastfeeding works best when we don't intervene a lot in those first 24 hours, even 48 even maybe the first few days. However, if it really is not working, which sometimes is the case, then having a professional person there to just tweak it a little, you really don't want a whole lot of manipulating and rules, I mean a very anti rules for a mother and baby to learn how to breastfeed together. It's kind of like two strangers on a dance floor. You put them together, and they start this dance. And they don't know much about each other. So they're sort of clumsy and stepping on each other's toes, but you got to let them go. You got to let them work through it. You got to let them find their own pace and their own rhythm. And then they kind of fall into this beautiful dance together. And much like the birthing process itself, there are times where we don't understand why the birthing process works so well by default, like that fear around tearing How come so many wins.

And don't tear it all, the vast majority of women who choose their own position for birth do not care at all. And in your conscious mind, you're thinking, how is it possible that I had this big can come out of an opening this small, but you don't have to consciously understand things in order to know that they work and breastfeeding is the same, we just have to trust it. In the case of the baby touching the parent em, you may never have known before that you get a surge of relaxing to the parent, and that allows it to yield as soon as the baby touches it. But I often say to my clients, did you did you have to know that? Now that you know that it's really cool. It's really interesting. But did you have to know that now in order to trust or could you just trust with breastfeeding? They're all the same things like your nipple gets darker, it kind of looks like a target. There's a scent from the amniotic fluid that starts emitting from the areola, right Trisha? It's, it's like magical stuff. It sounds like it sounds incredible when you hear it completely. Yes, and

Both birth and breastfeeding are not intellectual activities and the more we intellectualize them, and the more we create rules around them, the more we disrupt the natural state, which works, it works very well, the vast majority of the time. So bottom line trusts that breastfeeding will work perfectly, allow it to happen rather than making it happen. And as Plan B if need be, make sure you're getting evidence based support from the right provider. Should you have questions or need any support? Yes, and just to be sure, we're being clear that like, this doesn't mean don't pay attention to your baby's output. You want to make sure that they're having poops and peas and the normal amount and you do want to check their weight and stuff like that. This is not just like, ignore everything and you know, let it be, but just in that beginning stage, establishing breastfeeding. Really, the fewer the rules, the better it goes. Cool. Okay, we got a question about co sleeping Trisha.

I wanted to ask if y'all had any good resources and helpful blogs or advice on co sleeping. I've heard it's controversial and that there's a safe and unsafe way of going about it. My husband is very hesitant to co sleep especially in only a queen sized bed, which I can understand. Any resources or info you have would be so helpful. Thank you so much. And thank you, Deb for instagramming us with that question. So we're

We begin with this Trisha, there's so much to say about co sleeping and what are the key points? Yeah, there's a lot to say about co sleeping. And I think it is an important to just say that there are a lot of different ways that you can sleep, co sleep or sleep near your baby co sleeping doesn't necessarily have to mean bed sharing, right so your baby doesn't have to be in the bed with you. Your baby can be in the bed with you. But your baby can also be in a separate sleeper that attaches to the bed.

And they're basically right next to you but not in the bed. It can also be that you have your baby's bassinet or crib or whatever they sleep in, right next to your bed. The important thing, the real benefits of co-sleeping come from sleeping near your baby very close to your baby so that you and your baby are in attuned to each other's cycles, sleep wake cycles and this is what we know is actually preventative forces is that when mothers and babies sleep near each other and are breastfeeding, the risk of SIDS goes down. Yes. So Deb, you're absolutely right, that there's a safe way of going about it and an unsafe way of going about it. You can get really good information online. So please make sure whatever we say you complete your research on this. So as Trisha said, there are actual benefits to your baby co sleeping with you. And if you are going to breastfeed, I can't begin to tell you how much more sleep you're going to get. If you co sleep because if your baby wants you to, if your baby wakes up every hour or 90 minutes during the night, and you're jumping up on your feet, you can literally feel weak in the knees. You know, we get so hypersensitive to our baby, that we can be halfway across the room to get to our baby in the middle of the night without even being consciously awake. You can just react and be on your feet when you hear the baby and you're sleep deprived, and then you're picking up your baby 10 seconds later in that state. So there is something to be said right off the bat. For a breastfeeding mom who is going to be disrupted all night long for her baby. Let's give her some support. In making that process easier. Sometimes the partner gets up and brings the baby to her which is great because and frequently they fall right back to sleep anyway. So they can get up and bring the baby to her. But how do we take care of this mom who keeps jumping up to get to her baby and then walking back to the bed or walking somewhere carrying that baby in that absolutely sleep deprived state.

When the baby is co sleeping with you, you can almost unconsciously make you know get your breast to the baby and your baby can nurse and you doze right off together. It's really lovely and beautiful. There are ways to do this responsibly. One of the first things to consider and again read about this but it typically does not make sense to have your baby

You and your partner, that doesn't tend to be safer. It's not uncommon for that primary caregiver to be hypersensitive to the baby and for the other parent to be a little less sensitive to the baby. So they might roll over in bed and potentially, you know, knock the baby a little bit. So there is a method of using a blanket that is touched partially under you, with the baby in it, and then wrapped around the baby and re tucked under you so that the baby can't possibly roll away because you are pinning down the blanket. But that's just one idea. You know, if you're going to be having alcohol for any reason, you don't want to co sleep if you're drinking, that's one of the top risks to a baby who's co sleeping. There are some Yeah, there are some definite no no's with CO sleeping that it has. It has to be done responsibly. Yes, it's also really important that you make sure that where you co sleep is a designated area that you're not falling asleep with your baby just anywhere. For example, falling asleep on a couch with a baby is very high risk or sleeping with the baby in a bed that's against the wall, it's not safe to hide, it's not a best practice to have the baby between you and the wall.

Some people use a pool noodle under the fitted mattress so that it's some kind of barrier, some kind of ledge that is up above the baby and the baby can't roll out. That's really the key thing you're looking for. But you could also get the one that attaches next to the bed, which is really nice because then you can sprawl out and sleep in whatever position you want. And you don't always have to sleep on your side with one arm over your head, allowing you to breastfeed that can just be positioned who you're like you could walk around midday with your arm over your head because you get so used to sleeping in that position. Your body just goes that way, which can cause a lot of neck and shoulders dream. I can remember getting to a point where I was so exhausted and at this point in time I was having the baby in bed with me and I don't remember which baby it was and it probably could have been all three but sleeping topless and nursing was well established at this point, and my baby was a little bit older, but like, literally, the baby would latch on by themselves in the middle of the night and I wouldn't even I would barely wake up, and they would just feed and go back to sleep. It was, it was like, Oh, perfect. I barely even missed a wink. You know, they have an innate ability to do it just it's what they're hardwired to do. Just a couple more points on this just making sure that we you know, really address some of the risk factors like people who smoke should not go sleep with their babies. There are certain things that really increase the risks and baby should be put to sleep on their backs. That's still a recommendation. Baby shouldn't be sleeping in bed with other children that's not a safe co sleeping situation. And you know, fluffy pillows and comforters and things like that should be removed from the bed should be very simple, small amount minimal amounts of bedding. They even say no stuffed animals. No sorry. No plushies in the bed with you. I don't know why anyone would want to give any of that real estate to a stuffed animal in the first place. But it's worth mentioning. In those days, the stuffed animals can stay on the floor. Yeah, they can just go anywhere. We don't really, really are not concerned about the stuffed animals. And waterbeds. There's so much we can't possibly mention. Yeah, it's it's, you know, if your choice is too closely, it is worthwhile to do your research to make sure that you are following safe protocols. And again, the risk and SIDS reduction is seen in babies and mothers who are breastfeeding and co sleeping. There is that is an important part to it.

I think another point worth noting is this is also maybe just the beginning of you and your partner really disagreeing about how to go about certain things.

So welcome to that part of your life. Welcome to the world, that is also going to become a lifestyle for you. But when it comes to something like co-sleeping, the father has a legitimate concern about the safety. All you can both possibly do is keep your open mind and begin your research together and don't get too attached to any decision until not only you do that research but until you have your baby and you're living it because almost every couple I know that ended up co sleeping went into that pregnancy being sure that they wouldn't. We really can't evaluate and silver in it as to what feels best and safest and right for us. And it will evolve, it will evolve. You may start one weighing and switch to another way and go back to another way but it's the great thing is that today we have so many options for how we co sleep with their babies. So that was another wonderful question and what do we have to say, Trisha we have, you can text the words downtobirth as one word. You can text that to our number 22828. Yes and sign up for our monthly newsletter. And on Instagram we're at down to birth show and birth photos, we'd love to see your pregnancy or birth photos, so please share those with us as well.

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