#96 | April Q&A: A little About Us; Risks of IVF; Uterine Massage; Postpartum Essentials; Pre-term Birth; Birth Prep Tips; Low Lying Placentas

This month's Q&A kicks off with a couple personal questions of Cynthia and Trisha about their dream travel and what they admire in themselves and in each other. After our little heart-to-heart, we get down to business discussing: Pregnancy & birth risk associated with IVF; why you don't need painful uterine massage after birth; what our "must-have" items are for new moms and baby; tips for preventing pre-term birth; tips for preparing for birth related to teas, supplements, & foods; how to handle a low-lying placenta; and the likelihood of your baby coming early if you were born early. See chapter markers to jump to a specific question.

Don't forgot you can submit questions for our Q&A episodes through our website or DM us on Instagram.  We hope you enjoy today's episode and if so, please share with a friend or two:)

For more on the active management of third stage labor see episode: #40 | Q&A: The Placenta & Advanced Maternal Age; COVID-19 Silver Lining ; Chapped Nipples & Poor Latch; Who Can Have a Natural Birth; Pitocin Postpartum; Unsolicated Family Advice
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Transcript

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.

If a baby is born to a gestational diabetic mother then that baby is at increased risk of having blood glucose challenges in the immediate transition after birth. However,

if they are currently 33 weeks pregnant with my second son, and was just told I have a low lying placenta this time around, and that I'll need to schedule a C section at 39 weeks.

What are your favorite things to include in a birth prep routine? And when do you start each one,

I'm a labor and delivery nurse. And we have several physicians in our hospital who continue to check the baby's blood sugar for the mothers who had gestational diabetes. Why do they do this and is research supported.

So when you check the fundus, you want to make sure that it's feeling like a solid ball, which means that it's toned in tight, and that helps prevent bleeding. If you could talk all day about whoever submitted these questions, you derailed us from the task at hand.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut childbirth advocate and postpartum Support Specialist.

And I'm Tricia 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. Cynthia? Yes, if money were of no consideration, where would you travel to? This question came in through our Instagram and I thought well, that would be a fun way to kick off the q&a. Wait that question I came from Italy? No, some Yeah. Oh, that's real. I'd

really I'd really much rather ask them if time were no object. How about both? Yeah,

if I'm limited resources of time and money, where would you travel?

I think right now, the place I probably think about going the most if it were if there were no constraints. Sydney, Australia for a few weeks now for like six months. Now for I'd love to go for like two or three. I've been to Asia, I've traveled that far when I worked at MasterCard. I went to a few countries over there for about three weeks. And I kept thinking what an opportunity this is to just, you know, hop a plane south and stay here longer. But I wasn't with my husband, obviously. I mean, he was home with our dog at the time before we had kids. And I just I know I would fall in love with that city. I've had so many friends stay there. I'm almost afraid to go because I'm afraid to love it too much. And to realize it's just always going to be a difficult place to go back to maybe New Zealand. I don't know. I just they look beautiful and relaxing and all the dreamy things that you see in the movies and the pictures. Every city has a way of looking that way. Anyway, that's where I would go What about you?

Win New Zealand is definitely on the top of my list. But truly, if there were no restrictions at all, I would travel around the world on a boat to all the tropical islands. Oh, starting with like, Tahiti, Bora Bora, Fiji, PG. by boat for sure.

I would sooner want to go to all the cities in Europe, then on a boat to islands. I know marva Europe girl, I'm more of an island girl. Yeah, just more like language culture and the opportunity to speak foreign languages. And it's just all really exciting to me, hence my lifelong love for learning foreign languages. I mean, you can't beat that. I'd like to see at all that would be my answer. Yeah. My niece went to Stockholm last summer. And I'm longing to go to Stockholm, because it's a city I haven't been to yet in Europe, and it just looks amazing. And I just feel like oh, like how do I even choose which one to go to next? You know, so it's tough. But that's a fun question. So thank you to whoever sent that in. Yeah, anything else? That's

off topic. There was one more a little harder to answer but we could throw it out there and see another one through our i g stories says, What is your favorite quality about yourself and the other person? Oh, was the other person you talking about? Me me talking about you? Unless they think we're schizophrenic? Yes.

Okay. I never I never have to think long about my favorite quality, but anyone because my consciousness is always around my favorite qualities about the people in my life. It's just I literally yesterday was talking to Eric about you, which we were we went out to lunch. And it was really great. And while we were out we had this lovely time talking and when you came up because of course he always asks what we're up to. Yeah, I found myself talking about one of my favorite qualities about you. So there you go. See, it's always top of mind. I didn't even know this question was here. Well, what is it? We should guess what we each think the other person's favorite quality about us is? So what do you think my favorite quality about you is? Oh my gosh, I have no idea. Um, my spontaneity? No,

I don't think we've done enough spontaneous.

I think it's if I really had to pick one. Oh, I know what it is. Yeah. What my amazing tasting coffee? Yes. And that you look good. And hats. And hats? No, I would have to say that. My favorite thing about you is that you stay calm in a difficult moment, which is one of the tenets of yoga and HypnoBirthing. The first time this really struck me, I mean, it's I've always seen it in you. But the first time it struck me was we were recording a podcast episode like a year ago, it was on a Friday, you were I thought you were about to head home at like 3pm on a Friday. And you said, Alright, I do need to get out of here. I've got to drive to JFK. And I was like, why are you driving to JFK Airport. And you said, Oh, because when I flew in last night, I left my Mac there. And I called and asked them, if they have it. They said, you have to drive here to look for it. Like, I just thought I've spent the afternoon with this woman. And she didn't complain once or even mentioned that she has to drive to JFK on a Friday in rush hour, where it's going to be an hour and a half, at least without any traffic, just to look for a laptop. I mean, you were you were just so calm about it. So that's a quality that I really, really like about you.

I remember that that was because the on the flight, there was an emergency on the flight. Do you remember this story? There was an emergency on the flight and they needed medical assistance. They're like, Are there a nurse or a doctor on the plane and I was like, I'm kind of maybe maybe I could help and I had been working on my computer. And I got so distracted because this person thought he was having a heart attack. And I got involved in the situation. And I slammed my MacBook close and I put it in the seat pocket in front of me. And then I was so like, distraught after the whole thing so

well, is that when you gave the guy mouth to mouth resuscitation in the airplane? did not do that. Thank God did not have to do that. What? What What did you do that day? Did you like that the pressure is unbearable, like a plane of people are looking at you. And they they're like, how is this dying? Man? What did you do?

Is this guy having a heart attack? And I'm like, Oh my god, I'm basically whatever I say they're going to decide to land the plane or continue on to our destination. Remember

this part of the story at all? What? Really? Yes, we talked about it that I was more impressed that you were calm the next day about your laptop, apparently, what happened? He was I think having a panic attack. Not a hard thing to talk to him and tell him how to stay calm in a difficult moment.

Is that your skill?

I think I tried. I mean, I was definitely a little bit nervous a moment. So that's how it got left on the plane. Because after that moment, I was like, Oh, my God, I can't believe this or even land and I left it in the seat pocket in front of me. And then it's interesting that you say that because when I read this question, that is exactly the first one it says what's your favorite quality by yourself? I mean, that's hard to pick. But that is my favorite quality about myself. But it's it's something I work on. It's something that I am, you know, have had a lot of times in my life where it's really served me to be able to stay calm in a difficult moment. So yeah, I was sure

you were going to say that you look good in hats.

Anyway, okay, so my turn my favorite quality about you? It's this is very easy for me because there's only one. Yeah. I didn't know how to choose and you're like, this is easy. Quality is your hair. Your hair. Yeah, okay. But you don't ever have to blow it dry. You don't ever have to brush it. It always looks amazing. Are you serious? No, I'm totally kidding. Oh, I was like, thanks. But yeah, that's true. Now my favorite quality about you by top of the list, by far and away is your level of emotional intelligence. Well, I mean, it's, you're one of my favorite people to talk to you about anything because your emotional intelligence is very high. And I mean, when you have a person like that in your life, then no, it's it's a it's a great, great quality in a person and it makes it super easy to get along with you and super easy to work through things with even super easy to do a podcast with you. And it just makes you a good friend. And you have good hair too.

Thank you. Thank you. All right. My favorite quality myself is my honesty. That's my highest value. trust and honesty are my highest values. And, you know, my family has this joke about me that when I was about four I came in from preschool or something like that. And I had this best friend, his name is Kenny. And I came in and complained to my mom, the first thing I said was, Kenny kicked me. And as I walked away, she heard me go

back.

Because I couldn't, I couldn't tell I have to. I figured you had to tell the full title. I figured if I said it quietly, it was still technically the truth. But I do feel the weight of being an honest person in moments where it's not easy to be honest. I don't I just it there's so many times in life, it's it's difficult to be honest. But I have to say, I think it is so much easier than not being honest. And the reward is that the people close to you know, they can trust you. And there's literally no more important trait in a relationship than that. Well, we could talk all day about our so whoever submitted these questions, you derailed us to the task at hand. Oh, my God. People must be skipping to the episode like, Oh my god, get to us already. And here we are having a heart to heart. We'll have a long lunch and talk about how wonderful we are after this. Well, we'll take our time, Trisha. Alright, let's get to the questions. Yeah, let's come on. Okay, onto the onto the business of the day. They're gonna be like, thank you, like, who sent those questions? Alright, let's go. Here we go. Um, Trisha, the first question is from me, because I emailed this to you about a week ago, the one about IVF. Yes, yeah, this is an email or a text I sent Trisha. So I had my prenatal support group. And it turns out that three of the women in the group have done IVF one, one is actually one just conceived. And I wrote this to Trisha, I wrote, I have a few women in my prenatal support group who use IVF to conceive. One of them asked me the risks IVF can present during birth. I wasn't aware of any. Another woman said, I thought the risk were around the baby's health and not the birth. And then a third woman in the group said risks once you get pregnant with IVF, I didn't think it was any different from any other pregnancy, which is what I would have thought to be the case as well. So Trisha, do you know any information about this?

Well, I can't say I know a ton. This is not my area of expertise, because I don't work with it much. But I do know a little bit about it. And the the answer would be that they are both right, that there is some increased risk in the pregnancy and that there is some increased risk with IVF babies IVF pregnancy is technically considered high risk, because there is a more like, increased chance of preterm birth, there's an increased chance of developing hypertensive disorders like preeclampsia, there's an increased risk of seryan birth, there's an increased risk of placental problems, so more postpartum hemorrhage, more low birth weight or small, small babies. And I think there is also an increased risk of birth defects. But I think the question is, are these risks related to the actual IVF treatment? Or are they related to the more related to just the fact that in IVF, you have a much greater chance of multiples. And we already know that when you have multiples, you have all these increased risks? So if he took out that factor of multiples, is there still a true increased risk in IVF? cases? I don't know. I think probably some.

That's very interesting. I didn't know that. But I have worked with so many IVF couples over the years that I will say that, from my perspective, the non medical perspective, I have noticed that when couples are very dependent on medical intervention for conception, they have a hard time visualizing their pregnancy and birth going any other way. So when they have this inner conflict, because the conflict being that they're drawn to my class, and they want to get informed, they want to have the most natural birth possible or the lowest intervention possible. It's hard for them to see themselves any other way. And there's some work to be done there. Sometimes. That's the that's the angle I've seen over the years that I've found to be interesting. And then they do overcome that. It's really beautiful process. We can thank me for submitting that question. No, really, we can thank the women in my group for challenging me with it because I didn't know the answer. And I'm glad. I'm glad you can answer a Trisha. Thanks. Okay, is the next one for me to read? Sure. They Oh, yeah. This one says my provider told me after I give birth, they'll have to give me a shot of pitocin and then do fundal massage. I wasn't sure how I felt about the fundal massage Do they really have to do this is that is that when they like palpate on the belly on the massage?

Well, there's a difference between just palpating where the fundus is after birth and doing fundal massage. The fundus is the top of the uterus, the very top of the uterus and right after birth, there's parameters of where it's supposed to be. And your providers always going to check for the tone of the fundus because that indicates whether or not you might be having what's called uterine acne. So lacks uterus after birth isn't going to clamp downhill very well and you're more at risk for bleeding. So when you check the fundus, you want to make sure that it's feeling like a solid ball, which means that it's toned in tight, and that helps prevent bleeding. If it's if it's flabby and loose, or boggy, they call it then then people usually will do a fundal massage to help try to tighten, tighten it up. And it is responsive to that, but it's very uncomfortable. When is it really necessary, though? Well, it's only necessary if your uterus isn't responding properly. If you're bleeding, you know, you, you do whatever it takes to stop the bleeding. But when we talk about giving pitocin for the active management of third stage of labor, which we addressed in a q&a A while back, and I can't remember which episode is but we'll include in the show notes, then you There is no need for fundal massage, if you do that, and there is actually evidence to suggest that the two together don't improve any outcomes which is bleeding postpartum. So it's no better to do both and it's uncomfortable to do fundal massage. So if your uterus is boggy and bleeding, and you've had pitocin hands off the uterus, if you have declined pitocin and your uterus and you're bleeding, your provider may use their hands to try to stimulate a little bit or you may at that point opt for pitocin.

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Here's kind of a fun one. What are good items to have postpartum for mom and baby? Well, we could go on and on and on. Or we could say not much. You don't need much. I don't know if she means recovery. In which case I would say postpartum sooth for sure or those herbs to help you recover. But if she means like products for me, that's very easy. There's one product you need and only one literally that's what that's I think that's what she means, by my view on that one only products you need. postpartum in my opinion, is as a baby wrap, a sling. It's life changing. You don't have to spend $1 on a stroller, that's my opinion, you don't need it. You learn how to use a wrap and you never need to do anything else. It's the best thing ever, and learn how to use it. They're intimidating at first. But once you figure it out, you're going to be able to do it in your sleep. And you will do it in your sleep. But I could go on and on about babywearing it's completely life changing.

Totally in agreement with you on that. I mean I personally reject all the baby stuff out there. I like I could never go into a baby's RS when I was pregnant. It was so just kind of disgusting to me that we think that we need all this stuff to birth a baby and have a baby and I prided myself personally on having very few things after birth. You need your boobs, you need your body. You obviously need some blankets and some diapers. I mean to really just be practical like truly you need about 10 things nursing pads, a sling 100% you obviously need a car seat. A hand pump is a great thing to have. If you're planning to breastfeed you need bottles if you're not planning to breastfeed. Some sort of sleeping thing for the baby, a co sleeper, a cramp a bassinet, whatever it is. And honestly, you really don't need much more than that.

I have a funny story for you. Okay, when my mom and I went to um, Babies R Us and you're right, it's like it's it's like this wretched excess in that store. It's just, it's just insane. It's truly insane. I'm gone now. And you know, it depresses me when I say this is just who I am. But this is like when you see all the media they're trying to sell babies like all the DVDs they want you to prop in front of your baby. And I saw this one where they had like an Elmo doll that would sit in front of the to the head of a TV setup with some DVD and an Elmo doll was clipped to some product facing the TV and the Elmo doll laughed. I was incredulous. I remember saying to the person who worked in the store. What Why is this doll laughing and he's like, well, you can buy this with the DVD products. And I said Why'd he said well, because it's interactive. It's like it's not interactive for the baby. It's really, it's really concerning, like the extent to which we're marketing things to parents. Anyway, here's my story. So we put everything on my list that I wanted, you know, I was with my mom, and it was enjoyable. And as the salesperson was kind of walking us to the door out of the store when we were all finished, I start I said, wait, wait. And I said to both women Wait, we forgot shoes. We didn't put shoes on the list for the baby. And both my mother and the salesperson were like, newborns don't really wear shoes. Just like shopping for someone who doesn't walk yet. It just insists you're in such a stupor you're into such a state of see no, sir reality it's it's it's it's bizarre. But yeah, anyway, that was fun. Yeah, hopefully that was helpful.

Yeah, too, too much to manage after baby You don't need all that stuff to manage on top of it.

Okay, so my next one, okay, this one that says hello with an exclamation point. That one. Hello. I love your Instagram account. And I wondered if you have any posts or advice about how to get a baby to come to full term. My last baby came right before I was 37 weeks. Well, that means the baby was premature. So right before 37 weeks, and I'm wondering if there's anything I can do this time around to get the baby to stay put until closer to 40 weeks. It's a big deal when a baby's premature. I can see why she's asking those. Yeah, she had had the baby at 37 weeks or 37 weeks in one day. She might not be so concerned. But right before I got that that week is is a pretty big deal.

Right? Exactly. So So yes, this is technically considered a preterm birth and there are certainly risk factors for preterm birth. And some of them are modifiable and some of them are not. So things that are risk factors for preterm birth is a prior subsequent early birth. That's a risk factor, just like you know, she's she's concerned and her concern is valid, vaginal or urinary tract infections, being underweight, pre pregnant or obese, pre pregnant, both of those can contribute to preterm birth. Having had IVF, we talked about that earlier, that's a risk factor for preterm birth, having less than six months between your pregnancies. Some modifiable risk factors are the use of alcohol, tobacco drugs. Obviously, women who are in high stress, living environment are subject to domestic violence, sexual violence, physical violence, emotional abuse, all of those things are risk factors for preterm birth that are potentially modifiable, lack of social support stress, long work hours and being on your feet excessively. Did you say smoking? Absolutely. Smoking, drugs, alcohol, all of the big risk factors. So if none of these things apply, in this particular case, to this woman asking this question, then I would just say, I mean, we all have stress. So that's probably the most modifiable risk factor that she can work with. And just really trying to take this pregnancy day by day and reduce as much stress as you possibly can identify where these stressors are in your life and try to eliminate some of them. But sometimes our body just does what our body's gonna do. Yeah, I'm okay. Hi, there. I love your podcast, and I'm so grateful for it. Here's my question for you. I'm a full time mom and I hear so many tips about birth prep in terms of teas, tinctures, supplements, and dates. What are your favorite things to include in a birth prep routine? And when do you start each one? I will not take this as medical advice. And of course, we'll check with my midwife before I started anything, smiley?

That sounds like a listener who's heard too many disclaimers from us. It's like Yes, yes, I know. You can't give medical advice. Please answer my question already. All right. We haven't done that. But Alright, go ahead.

Okay, so some of the most common things that women will include in their birth plan are, the first one would be red raspberry tea. So red raspberry tea is made from the actual leaf of the raspberry fruit. And it helps to tone and strengthen the uterus. It's very high in vitamins, vitamin C, Vitamin E, magnesium, potassium, calcium. It's helpful for supporting the contraction and the relaxation of the uterus, which is why it's called a uterine tonic. It is not recommended to start in the first trimester. So you can start it in the second or third trimester at one to two cups per day and it is actually shown correlate with a lower risk of preterm birth, a lower risk of post term birth, and a lower risk of cesarean section or instrumental delivery. And I would assume that it's a lower risk of severe infection or instrumental birth because it helps the uterus to tell its job better. So that's a very common one. Another one is, and this is more new to me, this was not really around when I was pregnant, but there's a lot of talk about red dates, and they actually work on the oxytocin effect. So they can help with cervical ripening, they can help support dilation. And they can reduce your need for induction augmentation, anything that would require pitocin because they're supporting oxytocin. They're associated with less bleeding after birth. And they actually one study suggested that they can reduce the first stage of labor by 50%.

Oh my gosh, that's huge. How many people were in that study? Quite a few hundred. Oh, my gosh, so six dates per day, one month, starting with a month before your due date? Easy. I mean, if you like dates, that's easy. If you don't like dates that can be difficult. We don't like
dates, you can make them into a host of delicious desserts with Raka cow, coconut milk. I mean, you can turn them into like things that tastes like fudge. And it's like sugar. It's delicious. They're delicious when you put them in desserts.

So one of the things I always recommend because they are high sugar, is that you eat them with, you know, you buy a pitted date. And in place of where the pit is you slide an almond in there. And it's like, then you take a bite at the date with the almond and it gives you the protein in the sugar balance to help balance your blood sugar and it's really delicious. Is it acceptable not to slide the almond inside the date?

almonds next to the date. Yeah, so we have to turn this into cute. Pinterest worthy does it have to be chore? Well that's how you feel like you serve him as an appetizer, you know, or entertainment. I always do it that,

you know we do in my family. I don't know if this is an old Italian thing because my great grandmother did this. And I still do this at our Christmas brunch, dried figs. And you can use your thumbs to turn them into like almost like little bowls. They look really In fact, on my private Instagram page. I have a picture of it from a few years ago. It's beautiful. And you stuff it with walnuts and chocolate chips. And it's delicious. And it looks really pretty. It's all Whole Foods and it's delicious. And it's so satisfying because it's got the nuts and it's got the fig and it's got the bite of chocolate which is a total requirement and anything on my table. Does it help your cervix? Trisha, not everything in life has to do with the cervix. Just a lot of things. Okay, it sounds good.

All right. Well, there's one more thing actually two more things that are both related. The other thing that is very common for people to do is to take evening primrose oil from about 37 weeks on an evening primrose oil contains process works like a prostaglandin and it contains one of the essential fatty acids and it works like a prostaglandin on the cervix. And the prostaglandins are the things that help ripen the cervix for birth. So you can take 1500 milligrams of evening primrose oil orally per day for 37 weeks. Um, you can also have sex and you have to have a jack ulation and semen reach the cervix that is the thing that makes it work. So that's the same reason prostaglandin and semen is a cervical ripen or a lot of people don't feel like having sex late in pregnancy. So if that's not for you go with the evening primrose oil. If you want to do both, that's fine, too.

The best way to get the baby out is the way the baby garden is the way one slice doula has put it at least that's the way many babies get in. Well, I just always want to say that remind people that if your waters are broken, you do not put anything in the vagina.

Well put. Do we have another? I think we do. Yeah, sorry. Let's do it. Oh, am I reading this? Sorry. Yeah. All right. Yeah, I got this one on Instagram. Hi, Cynthia. I was in your life after birth group in 2018. With my first son after a beautiful HypnoBirthing experience. I'm currently 33 weeks pregnant with my second son, and was just told I have a low lying placenta this time around 1.3 centimeters from my cervix. And that I'll need to schedule a C section at 39 weeks. I was hoping you might have some advice or resources where I could reach out for a second opinion or any alternative methods that might help me to have another budget on delivery. I so appreciate your time. Thanks, Trisha. What do you say to that?

Well, she's 33 weeks so there's definitely still a good chunk of time for the cervix or for the placenta to move away from the cervix. So I would not be worried about this in this moment. All So yes, reach out for a second opinion, because this provider is telling you that you absolutely have to schedule a sanitary inspection. And so long as the placenta is low lying and not a previa, which means that it's actually covering the cervix, that is an absolute contraindication to trial of labor, and does require a C section. But if it's low line, that is not a contraindication, to at least a trial of labor and see how it goes. That does mean though, that if something happens during the labor, you are, you know, putting yourself at risk of needing needing an emergency cesarean section. So yes, I would definitely suggest a second opinion. There was in fact, a study just done in 2019, that was published in the British Journal of Obstetrics and Gynecology, which suggested that vaginal delivery is still possible, even if the placenta is within two centimeters of the cervix. So I would take that study, and I would go to your provider, and I would say, this is what I want. And if they're still unwilling, you might need to switch and get another provider. Anything you want to add to that?

No, that covers it. We're good. Alright, the last one says I was, oh, I was two weeks early. And so were my two older siblings. Does that mean I'm more likely to deliver my baby early? Well, is there research on that? No, no way.

Everybody will say there's some Yes. If your family history is this, then you are more likely, but I don't think that there is solid evidence on I don't think that all anecdotes, either. They just thinking about this. I mean, my mother had three of her four children at 37 weeks, all of my children. So this, For comparison, I actually thought when I was pregnant for the first time, who I'm probably going to have my baby at 37 weeks. No, all three of mine were born at 40 plus one plus two plus three, something like that. So there's a little evidence of that not being true. Okay. And the next one says, I'm a labor and delivery nurse. And we have several physicians in our hospital who continue to check the baby's blood sugar for days after four days after for the mothers who had gestational diabetes. Why did they do this? And is research supported? Yeah, Trisha, what is the deal with all the glucose chetek checking, because when I had my children, and but they weren't doing this with my clients either 10 years ago, and now everyone has to face what they say about glucose levels and newborns. Why is this going on right now, in the first place? Do you know anything about that?

Well, there are serious risks to a baby if they are hypoglycemic. So that is why you would be checking in and if a baby is born to a gestational diabetic mother, then that baby is at increased risk of having blood glucose challenges in the immediate transition after birth. However, if they are feeding Well, if the first feed is initiated soon, and they are feeding Well, it's reasonable to check their blood sugar once or a few times in a 12 to 24 hour period. So the American Academy of Pediatrics suggests screening these babies for 24 hours if they are born to a gestational diabetic mother. But beyond that is really unreasonable and invasive and, you know, can create a lot of anxiety and worry and disruption of the normal breastfeeding process because you already have to check before every tiny feed. And we know breastfeeding babies are like, you know, they feed for 15 minutes, and then they're off for 15 minutes, and they're back on and like how do you incorporate glucose screening into all that without being very disruptive, and you know, forcing your baby onto a schedule.

And what I see happening is for couples that are not necessarily gestational diabetic, they're checking glucose levels, and they are so often telling them the glucose levels are low. And then encouraging formula, which I know is not supported by evidence. I know that colostrum is but then the couples are in this really stressful situation where they're like, Oh, my gosh, the medical people are telling us, we shouldn't be breastfeeding right now. And that really is important to them, in a lot of cases. very distressing. And I don't think it's evidence based.

I don't think there's any evidence to support checking a non at risk, asymptomatic baby, for blood for glucose levels.

Just another trend, just another trend that we see happening as long as they're feeding. Well, you know, if they're not feeding, that's a different story. But that would be a different story. This seems to be a lot of this seems to be routine in some places. I don't understand it. Alright, well, thanks for these great questions, everyone, just a reminder that we have prenatal and postpartum support groups and even adding some workshops to the lineup. So if you're interested in any of those, you can reach out through Instagram.

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