#318 | May Q&A: Precipitous Births, Tearing Tips, Best Foods After Birth, Epidural Removal for Pushing, Induction & VBAC, Cord Clamping, Jaundice

Welcome to the May Q&A with Cynthia & Trisha. If you have been wondering what you should plan to eat after giving birth, we've got the answers in today's episode, and we think they'll surprise you! For today's regular episode, we answer the following:

• Can you remove an epidural for pushing?
• Can the cervix swell shut if you push before it is fully dilated?
• Can you prevent a tear in a precipitous birth when the baby comes flying out?
• Can I still have a VBAC if I had a big baby and didn't dilate in my first birth? Is it possible that my body doesn't go into labor?
• Does delayed cord clamping cause jaundice?
• Is there anything that can be done to prevent tearing in a precipitous birth

In the extended version, available on Apple subscriptions and Patreon, we further discuss:

• Anxiety around the anticipation of your second birth;
• current evidence on stillbirth rates after age 35 (all the data!); and
• breastfeeding through pregnancy and into tandem nursing.

Finally, in quickies, we touch on sushi in pregnancy, bleeding too much and cord clamping, when a baby can first have water, how to lower fasting blood sugars, and so much more plus...how Cynthia and Trisha met.

Oh, and one more thing: Are you a folder or a squisher with your TP habits?

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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.

Welcome to the May Q&A. Hello, hello. We've got two openers today, right? Which one do you want to start with? Well, you go first. You said, Okay, so we're going to start with something light and fun and easy. Do you remember how we were talking in the last Q A about having lobster dinner after being served lobster dinner after birth at Greenwich Hospital, and how silly that seemed. Yes, apparently, it's not silly, and a lot of people would like to have a lobster dinner or a filet mignon. So we asked what preferences would be for their first meal after birth, and I thought I'd just share a few of the more unusual ones. So these are just what they think their preferences would be, because there's a big difference. I wonder how many of those women? I wonder how many women choose to birth in Greenwich Hospital. I've met several who were lured in by that. I wonder how many actually eat their lobster dinner. Remember, this is not necessarily 6pm that you have just given birth. Someone's got to be holding that baby like you give birth at three in the morning. You're exhausted, you need to rest, and they think you're going to sit at a white white tablecloth and a little romantic table in the hospital room, of all places. I just wonder how many actually take them up on that dinner? But all right, so is this what women think they would want to eat after birth, or is it what they did? What was your question to them favorite postpartum meal? What did you say?

So the question is, what's the meal you're eating immediately after giving birth? So that really could mean what's the meal you want to have, or what's the meal you did have? It could go either way. So here's what came in very first one, right off the bat, steak. The biggest, nicest burger I can find, burgers, burgers, plural burgers.

Oysters in my own bed. Wow. Oysters in bed, other than it being an aphrodisiac. Supposedly, I never would have paired oysters with bed. Super nutritional, very good Philly made Mac and, yeah, oysters are so good for you. I'm allergic to shellfish, and I never thought shellfish was very good for anyone. Why is it good for very nutrient dense. They have a ton of iron and

lots of other things. They're good for you. Yeah, you, okay, homemade mac and cheese, steak, oysters and caviar. I mean, we thought lobster was a lot.

This is amazing breakfast. It's always been breakfast. I agree with that. It's always been breakfast for me. Scrambled eggs and toast, nice and easy.

I had a whole wheel of brie cheese, a whole wheel. Wow.

Steak free, steak and mashed potatoes. Wow, turmeric, bone broth and apples and peanut butter. That sounds very healthy and reasonable. Hibachi steak, a burger for a daytime birth.

Chili and cornbread, chicken noodle soup, cheeseburger, Jimmy jahanza, spicy Margarita. Come on.

I think they're saying the first meal they look forward to enjoying after giving birth. I don't think they're thinking right after giving birth, this is what they're in the mood for. Do you I don't know. I don't I don't know either. Maybe.

Okay, maybe answered that way all my favorite sushi in my own bed. That sounds good. That's the woman who is answering the question to say what she looks forward to having again after the baby's out. If she's saying sushi, that's what I chicken and waffles. What? Oh, right, that's a thing, isn't it somewhere? Isn't it so good? I can't even picture that in massage. Fried chicken for breakfast. Wait, it's fried chicken and waffles. Fried Chicken and Waffles, or fried chicken and pancakes. I can't like do you put, do you still put maple syrup on something like that? I do definitely. But not everybody likes salty and sweet. I love salty and sweet.

Okay, a rare steak fresh off the fire. So much steak, preferably a steak or a double cheeseburger. Let's see people are looking for that iron right after birth, hot soup or a squeezed lemon with honey, a big fat Italian sub, a Papa John's pizza. Do we not know our followers as well as I thought we knew our followers.

What is going on? They must all think I'm crazy. Guys so far, nobody, nobody said a plate of fruit. Or, I know that's the kind of thing I would want. And then my oatmeal. In the last episode, I said, uh, go for coconut water. They're probably all listening like, oh, go to hell, talking about but that's the kind of thing I was craving, just like hydration and I guess minerals and lighter meals. Interesting. Here's one for you, butternut squash soup. Okay, good turkey sandwich. Dr Pepper, a giant Italian sub, a smoothie. There we go.

A smoothie first, then a ribeye. Oh, there we go. As soon as I thought I found my people, yep, okay, okay, fajitas, chips and guac and a margarita. That's two for margaritas. Yeah, they're looking forward to the next decade of meal where they can eat and drink whatever they want immediately after, I had dates and peanut butter and a few hours later a huge plate of gnocchi.

Nice soup. Always soup, steak and a baked potato. Weirdly, I had zero appetite for weeks after giving birth, not like me at all. Anyone else experienced that weeks? Weeks. That's long time. That's a long time.

Fried eggs and sourdough toast. I'm right there with you. Shepherd's Pie, no meal, just a spicy Margarita. What the heck? Just a spicy Margarita. Don't do that. Well, that was fun. Anything else? Let me see if there's anything this goes on and on and on. I cannot believe how many times margaritas are on here.

Those are your people.

I do love, I do love a spicy Margarita. But I am not having that after birth, French toast with maple syrup. Yes, yum. Nachos, bone broth, steak, lasagna, sushi, filet mignon, Subway sandwich, fat burrito. I know what sausage. You know what?

You know, what, what? This could have been a multiple choice sushi, steak, burgers, margaritas, boom.

90% of women chocolate cake. Oh, that's good. That's funny. You know, it's so nice to have a birthday cake for your baby right after birth. I love that idea. So you bake a cake in early labor, especially if you're a first time mom, and then you have the cake with your steak and Margarita after the baby arrives and you give the baby a tiny, tiny, tiny, little bite. Yeah, no, no.

Definitely don't do that. Definitely don't do that. All right, that's it for that. So let's hear what you have. Well, there was a woman who called in, but the audio, we have to turn down a lot of questions when women call in, because either they're much too long, some use the full three minutes, which is too long, and then many of them use the full three minutes and then call back to continue. And the longest one we got, I think, was like 11 minutes. And I just thought, this is not happening. It's just, yeah, it's we just even if, even if we dedicated a whole episode to it, we wouldn't play 11 minutes of a question. But many are 345, minutes to we just can't use those, unfortunately. And we really, sometimes they're really great questions, but they gotta, got, just gotta get down. And then a lot of other times, the quality is just poor. You can tell women go outside to get out of the noisy home, and then the outside is loud and noisy. We We do try our best with that in post production. We try to really improve that as much as we can, but sometimes we just can't. But anyway, one woman called in, one such woman called in, and I don't remember the issue, but, like, the sound quality wasn't great, but the question was interesting. And she said, can I just take out the epidural when I'm ready to push? What's like, why is that not more of an option, and what's the big deal if I want to do that, why am I led to believe that once you get an epidural, you're basically stuck with an epidural? I've had a client who did that once, so I know it's possible, but I really don't have the full explanation on why any woman would be discouraged from doing that. So we put a quick post out on Instagram and said, Hey, any RNs, listening to this, can you call in and answer the question based on your own experience? So one woman did call in. Her name is Kat. She's an RN in New Jersey, and she answered the question for us. So I thought I would play it. Hi. This is Kat, a labor and delivery nurse in New Jersey. I am just calling the hotline to answer this question that was posted on Instagram, can a woman with an epidural remove it when pushing? Why would any OB say no? What considerations are there? So can a woman with an epidural remove it when pushing? Yes. A patient, in my opinion, can do anything they want. The other reason that's more medical that I can think of is a low platelet count, or sometimes, if a patient has preeclampsia and is trending towards help syndrome or low platelets on their CBC, the doctor and the anesthesia anesthesia team could be nervous about increased bleeding, and sometimes we have to draw an extra CBC before we remove the epidural, just To double check. I'm not sure if that totally answers your question, but I hope it helps. Well, first of all, there's a big difference between removing an epidural and turning it down or off. It doesn't really make sense to remove it unless it's causing you a pain or a problem. Why does it not make sense? Why not remove it if she doesn't want it? What? Because you would not want to be in the situation of having to put it back in. So as she's pushing her baby out, let's say, suddenly, you know, there's a fetal heart rate emergency, and you have to go to C section. You don't want to be trying to put an epidural back in. So if you have it, you don't take it out. You can turn it down. And you should turn it down, especially if you want to feel the sensation of pushing more, so you just leave the catheter in place, but you can turn off the medication, and that way, if she decides that she wants it on again, you can just turn it back on and turn it up. But, yeah, I love the idea of turning it down, because, again, it gives you that a little bit more of that physiologic pushing feeling removing it. I think what she was saying is just that, yes, there's the potential for bleeding, and they wouldn't want to do that in the middle of labor, especially if she was, I think she said, you know, if the mother was preeclamptic, she was trying to give, like, the a medical indication for why you would not remove it. But for the most part, it just doesn't make sense to remove it when you can turn it off and leave it in place in case she needed it.

All right, I think we're ready for our questions then, right? We are ready for our questions. Let's go. Let's do it. Hi ladies, my name is Shelby, and I am from Texas. I'm currently pregnant with my second child. Actually had my son about two years ago, and I had a question about if something is possible in labor, I don't think that it is. It was something kind of said to me by a nurse when I gave birth in the hospital, and it still to this day, Rose me the wrong way, but I essentially listened to you guys my entire first pregnancy. I felt really prepared. My water broke. I didn't have like a trickle water break. It was like a full water break. But I had no other signs of labor. I had no reason to go in, so I went to sleep, and I woke up the next morning to my first contraction got really intense, really fast. I had about 30 minutes, and all of a sudden my contractions were 60 seconds apart. So I headed to the hospital, and I skipped triage, went straight into the room. Everything was going according to, kind of like, what I wanted, and what I have a question about is towards, I guess, what would have been kind of the end, at least. I know it's the end. Now, it felt right at the end of the contractions to push a little bit. I'm not talking like full bear down, but I just push a little bit. And the nurse at the time, who was, I guess, my labor and delivery nurse, told me that if I didn't stop pushing, my cervix was going to swell shut and my baby was going to get stuck. Needless to say, I asked for the epidural about five minutes later. And also I found out later that when I got to the hospital, before they gave me the epidural, they checked me, and apparently I was already nine centimeters. I didn't let them tell me that, but I found that out later, and yeah, it's still to this day to drug me the wrong way. And I'm curious, is that even possible, or was she just completely out of line? Thanks, ladies. I appreciate it. All right. Bye. I'm going to go on a limb and say that was out of line, no matter what, especially finding out she was nine centimeters at the time. Well, how the heck did the nurse assume that she was she was nine centimeters, she could have been 10 centimeters two minutes later, and her pushing could have been absolutely normal. I mean, even at nine centimeters, it's normal. But how is this nurse assuming that she's not fully dilated unless she had another cervical exam to confirm that she was not, and even if she was not, even if she were still nine or nine and a half, as we have discussed before, the physiologic urge to push when your cervix is almost completely gone is.

Potentially very normal. And yes, you don't want to keep pushing on a cervix that isn't budging, but if you have the spontaneous urge to bear down and you have a little bit of cervix left, sometimes that's just the thing that gets rid of the cervix.

So yeah, out of line. Out of line. I'm so sorry that happened.

Those little things become part of the birth story.

You know those words, right? She's replaying that in her mind. Yeah, even if she didn't end up acquiescing, it still becomes part of the story. And I resent that things should not have happened to her. Hi, Cynthia. Hi, Trisha. I have a question related to feedbacks. Long story short, I was really hoping for a natural birth, but unfortunately, had an emergency induction of 41 weeks and five days because of low amniotic fluid. I wasn't dilated at all. After 30 hours of labor, I was told I needed an emergency C section because I had only progressed to three and a half centimeters, and they had broken my water, even though I didn't want them to. So I was running out of time. My baby ended up being an unexpected nine pounds, 11 ounces, and I did not have gestational diabetes. It was really devastating to feel like my body failed me, but I was hopeful to have a feedback for my next kid. However, my midwife just told me I wasn't a good candidate for a V back, and I would most likely need another C section, because I didn't go into spontaneous labor, didn't dilate very much and had a huge baby. She said it was highly unlikely I would go into spontaneous labor for my next baby, and since I wouldn't be able to have cervid, an induction wouldn't even be possible. I would really love to experience a vaginal birth even better, a natural one without an induction. But I'm wondering if that's just a pipe cream at this point, am I someone who just physically can't birth a baby to people like that even exist. I'd love to know what your thoughts are on this. And thank you guys for doing what you do. I love the podcast. And thanks.

Why don't we just not talk about induction with a VBAC? This is, this is all her midwife is saying this because she is saying that she is going to need to be induced if she's a V back, well, she said she can't be induced with cervidel because of the risky rupture. First of all, you don't need to be induced with cervid That's not an absolute. There are other ways. There are mechanical inductions. There's some people just go straight to Pitocin. But she shouldn't be induced period. But the whole premise, remember, is the is her telling her you don't go into labor on your own? I'd like, I would really like that midwife to witness what happens when she sits around for two years watching the woman who never gave birth. What? How can she say to a woman your body doesn't go into labor and you don't dilate very much either? What like? What the heck kind of midwife is this? What? What kind of med wife is this? Why would anyone like that go into midwifery only to to spread such lies and also just to rob a woman of it's, well, she's, she's, she's just been, she's just been indoctrinated. I'm sure she's a good person. Went into midwifery with good intentions. But this is the system. This is what is. I don't know if this is a good person or not. It's very nice to say things like that, but if this is a good person who went into the system, why didn't she have control over her own mind before allowing herself to get this is very nonsensical information to begin with, and then they use it against a woman, where exactly does the good person reside when now you're using that to hurt a woman whose dream is just to give birth normally, and it's not a pipe dream. This is meant to have a normal birth. This is the belief of obese and many midwives in the system that it's dangerous to let a woman who is that it is dangerous to let a woman who is having a V back go into spontaneous labor, because the baby is going to get too big and her uterus is going to rupture. I do agree that she spoke inappropriately to her, but that's quite common in the medical world. It's not excusing it. But this is just the this is the thinking about birth. These are providers who really don't trust the process. It's not, it's not the norm. But you're speaking about, you're speaking about the common refrain that a woman planning a VBAC really shouldn't because it's too risky. And yes, that's all incorrect. But what I really am upset about with this situation is that they this woman is telling her, you don't go into labor and further, you don't dilate very much. That's what I really have a problem with. Give me a break. Yeah, that's just, I'm gonna say that once per episode, but come on, yep. I mean, who is she to say that? Who is she to know that labor? Of course she will go into labor. Of course she will dilate. How can she tell her that she's not going to of course she will. And now you have this woman like any of us would. We would succumb. We would be scary. We would be thinking, oh gosh, healthy baby, please. I mean, all that matters to healthy baby.

Into that fear based place. And she's actually asking if there are some women in the world, and might I be one of them who just don't go into labor. If you are pregnant and your body is carrying a baby, you will go into labor. It might be very late. It might be problematic. It's so late, 4344 weeks, that can happen, but you will go into labor eventually. All all babies come out, yes. So she needs a new midwife. I mean, this midwife is not going to support her in having a VBAC, because this midwife doesn't believe that she can have a VBA back. So she needs, she needs somebody else, and she needs to find somebody who trusts her body can give birth, and who is going to let her give birth on her own terms, on her own time.

Step number one of planning VBAC, hire somebody new. Don't birth with the same folks who attended your C section. Step two, don't be induced.

Hi, Cynthia and Trisha, I have two questions for you. Today. I had a very fast labor that only lasted about 90 minutes. I birthed that home completely unassisted because my son came so quickly. We went to the hospital after to get my son, and I checked out, and I had a third degree tear. I delivered my son in the shower on all fours, but I think I tore so badly because he flew out like a rocket ship in one push at the hospital. My midwife said, If you called us earlier and we were there, maybe you want to have torn so badly. While my feelings on this comment are a different conversation, my question is, is there actually anything they could have done to prevent a severe tear in that situation, my second question is about delayed cord clamping. We waited until the cord was white to cut it, and a few days after my son was born, he was admitted back into the hospital to go under the bilirubin lights for jaundice. He also had high hemoglobin levels. Multiple pediatricians blame the jaundice and the high hemoglobin on the delayed course landing, and I'm wondering if there's any validity to that statement. Thank you so much for everything that you do.

We should have called this episode things providers shouldn't say. Yeah, well, we still can, because the first three questions are all, you know, they all fall under that category. The next three don't, but the first three do. So you should have called us sooner. Blame. Why are we blaming? What the heck the baby flew out like a rocket ship, she said, which is when she tore presumably, that's what she's indicating that they can't prevent a baby coming out like that. If the baby comes out like that, there are ways to prevent tearing. There are ways to reduce the likelihood of tearing, but that is not one of them. When you call your provider, is not one of them. Even if they were holding the good old compress there on the perineum, if that baby was flying out and she was predisposed to tearing, she was still going to tear. Yeah, all the blaming, I can't get over that. I mean, you you can help control the birth of a baby's head a little bit by using some counter pressure. Not that you necessarily would want that, but it can be done. But the whole, the whole problem with this is that the midwives were blaming her. Her body was going to do what her body was going to do. She was in her hands, on her hands and knees, which was the most comfortable natural inclination for her, obviously, or she wanted to give him birth in that position, which also made it so she potentially couldn't, you know, put her hand on the baby's head, either. That's a definitely harder position to do that in. So, yeah, could you she did. She did say he came flying out. Yeah, that does happen.

But I do think it's, if you have somebody there, sometimes you can slow that down a little bit. But it she, what was she going to do? I mean, she probably didn't even have enough time to call anybody into the to the room to help her. I mean, when babies are coming like that, babies are just coming like that. They're coming fast. You can't really stop it. So, so how to prevent tearing? This is something we want to talk about in an upcoming Patreon event. But how to prevent tearing is going to come down to a lot of different things. Nutrition plays a big role. The mineral content of your food plays a big role. Pelvic Floor health plays a big role. So there, that's a whole other conversation. So there are ways to reduce the likelihood of tearing. Sometimes it's inevitable based on how the baby comes out or the position the mom is in, though she was in a good one herself, it's but again, the provider never should have said that, and it just isn't true. Three for three so far in this episode. Okay, so can you answer the other part Trisha about the Billy Rubin and the immediate cord Yeah. So, yeah, yeah. So the there's, the evidence is pretty mixed on this. You will certainly hear providers say that delayed cord clamping causes more cases of jaundice, and then you'll see some evidence that says that it doesn't. But no matter what, I would take a little jaundice over.

Early, clamping and cutting of a cord and depriving a baby, potentially of a significant amount of their blood volume. Yes, when the cord is left intact longer, the baby obviously gets more red red blood cells, but those red blood cells belong to them. So what's your point on that? What do you mean? Well, red, more red blood cells is what causes jaundice. So the breakdown of the red blood cells is what contributes to jaundice. So the theory, the theory is that if you cut the cord earlier, they're going to get fewer red blood cells and have a less likely chance of having jaundice. And the evidence does not necessarily support that, and there are so many more benefits to getting the stem cells and the blood volume that belongs to the baby. There are also other reasons for jaundice, even if you clamped the cord early, sometimes it's just the compatibility of the blood type between the mom and the baby that can cause jaundice. Sometimes it's because they haven't fed enough in the first 24 hours. We know this, that babies who don't feed well in the first 24 hours have a much higher rate of jaundice. So there's lots of things I would say it's always worth it to give the baby their maximum blood volume and delay cord clamping. Okay, well, that's a wrap for the regular portion of this episode, and let's see what we've got in the next in the extended portion, we have a question from one mom who had a perfectly good natural birth center birth first time around, but now she's facing pretty extreme anxiety in her second pregnancy. Not an uncommon situation. You can hear what we have to say to her about that. The next one, a woman is asking for the statistics and the data on the actual risk of stillbirth, because she is talking about a woman who's told to be induced because she's over 35 and the risk of stillbirth is just too much greater over 35 than under 35 so the woman is told, so we've got all the data on that we will be sharing. And then finally, a question for Trisha about tandem nursing for a mom who finds herself pregnant again and her first baby will be just 16 months when that second baby is born. So if you have not joined us on Apple subscriptions yet, please join us. It is just $30 for an entire year. No ad ever again. Always extended episodes right there in your feed. You don't have to do a single thing after you subscribe. Or if you are with us on Patreon, in any tier, you're already getting these episodes loaded every single month into your Patreon feed. So be sure to go to Patreon and enjoy them, and there is nothing else you have to do. And if you are holding on to the regular episodes, no matter what come hell or high water, then it is time for trisha's favorite part. Trisha favorite time. Quickie time. Okay, so off we go.

All right for our quickies today. The first one says, Can you eat sushi while pregnant? Is salmon a yay and tuna is a nay.

So she thinks it's about the metals, and it's really about bacteria, isn't it? It's really about where you live. If you live in Asia, nobody's questioning this at all. No, I know it's like, either you're okay with eating sushi or you're not, either you're okay eating tuna or you're not. I mean, tuna, how high is that risk? I avoided sushi, and I'm not sure I ever needed to.

The short answer is, is yes, you can eat sushi while pregnant, I would say yes. You're going to be told you can't eat soft cheese, you can't eat tuna, or you can't eat raw meat, you can't eat raw milk, because there are risks of infection. But if you have a strong, healthy immune system, and you're used to eating these things again, around the world, in places where this is commonplace, they

just eat it because it's part of their standard diet. If you never eat sushi, I wouldn't start in pregnancy.

That's the quick answer.

Okay, how long should you wait after a cesarean to get pregnant again?

I mean, I think it. I think in general, it is best to give your body at least a year between pregnancies, not between giving birth, but between pregnancies, probably a little longer for a cesarean, maybe not necessarily, though it depends on your vaginal birth, but I fall in the 12 to 18 month range. You just said, not necessarily, it depends on your vaginal birth. What did you mean to say? Oh, I actually meant to say that. I mean, like if you had a fourth degree tear with your vaginal birth, then you might actually need to wait longer than a C section. Oh, okay, yep, yeah.

What have you do with your core and your pelvic floor? That's what it all comes down to, no matter what the condition of your core and your pelvic floor, but I also think it really comes down to giving your body the time.

Time to replenish. It isn't just about your C section scar. It isn't just about your second degree terror healing. It's about your body. Pregnancy and breastfeeding are very demanding, and you need to give yourself some time.

Next is a mama bleeding too much, an indication for not allowing delayed cord clamping. Well, this is not a quickie. Well, that's potentially a quickie, because if someone says the mom leads too much, the question is always, is that really true, and are we? Are we going to sacrifice the baby getting all of his or her cord blood over that? Because women are told that all the time. Women are always told that. So what if it is true? Let's just assume, for the sake of the quickie. Let's assume, for the sake of the Quickie, you were there Trisha, you determine She is bleeding an awful lot, and you're concerned about it. Would you immediately cut that cord?

And why? If so, you can deliver a placenta more quickly if you have to manually get involved with the placental delivery because you believe the source of bleeding is from the placenta or partial separation or uterine atony without cutting the cord, that's still possible. So that's the quick answer. So you really wouldn't be very much inclined to cutting the cord right away in my previous midwifery life, yes.

Now I don't know, I in a given such it's just, it's not a quick answer. You have to evaluate the whole situation. But I would definitely be trying to keep the court intact.

Are amino acids and creatine safe while breastfeeding. Okay? This is a quick Yes, sure. Fine amino acids are just amino acids. This is what the you know, food creatine is. Yeah, it's all just protein. Those are all just amino acids and food. So, yes, as long as you're getting a safe source, I guess is there anything I can do to prevent a nuchal hand at birth? I can't imagine there I beg your baby, beg your baby to move their hand away from their face. Just so anyone listening knows a nuchal hand is when the baby has his or her hand up by the cheek or by the forehead, by the head, and they literally come out of you with that hand. So the head is emerging with little fingertips, and they are born with their head sort of resting in their hand, and it, you know, just makes birth just a little bit a little bit more intense or complicated. So I guess this woman probably experienced it for the first time around, and is wondering about the second time, which would be unlikely I would think twice for the same woman, best not to know and best not to worry about it.

Are you more likely to conceive when still breastfeeding?

Yes and no, yes, if you ovulate and you haven't gotten your period back because you don't know that you're fertile?

No, because, for the most part, you don't have your period while you're breastfeeding until you do. Okay, but let's say she has her period back, she is well aware she has her period back, because this is probably what's her question is about, and she wants to conceive. Is she more likely to conceive or less when she ovulates while still being a breastfeeding mom? Well, I think someone, I think some women, say that that that is true, but it, I don't know that it has anything to do with breastfeeding or not. Okay, can you have a glass of red wine at the end of pregnancy? A glass of red wine at the end of pregnancy is not going to cause fetal alcohol syndrome, but it's still a toxin. It's still a poison. It still gets to your baby. There are other ways to relax, but it's up to you. Yeah, yeah, many women do, many midwives recommended, yeah, that's why. I mean, there's other ways to relax. You could take a Yeah. I think it's a weird recommendation. I think it's weird that that's the go to for a lot of midwives, that is the go to go have a glass of wine. Yeah, there are so many other ways to relax. I don't think one glass of wine is going to harm anything, but yes, it still does cross the placenta.

How can you get your fasting glucose levels down?

Walk more.

Walk more after meals, you have to get your daytime postprandial and fasting levels down to really have a low fasting level in the morning, although sometimes women actually have a lower fasting level when they eat before bed, too. I have heard that, so try both things, but walking and balancing your blood sugar more throughout the day is going to ultimately help your fasting levels. And so you should never eat carbs alone. Always eat them with protein, fat or fiber, or preferably all three. When should a baby start getting water?

A baby getting water? I mean, if a baby is getting milk, then it's hydrated enough. Do they mean a toddler? Do they mean interesting? What? How do you answer that?

What do you do? Do you remember when you started giving your baby's water? I remember doing extended breastfeeding, of course, with both of my kids, they both weaned. They self weaned when they were about two and a half, and then the primary drink that they drank outside of breast milk, was coconut water and and my homemade almond milk, and that's it. I don't remember when they started with water, but it was somewhere probably around that I don't remember, but those were their drinks outside of breast milk. I remember that for a long time coconut water and homemade almond milk.

They don't really need water as long as they're getting breast milk, but you can certainly start exploring with it around the time you start offering them solid food when they're ready to hold a sippy cup, but their hydration still comes from breast milk or formula, whatever their milk source is. So I guess the earliest you could give a baby water, generally would be like around that same time you start solid food, six or seven months. But it's also just kind of more exploratory at that point.

All right. Finally, we have our closing quickies, which are personal, okay? One is very silly.

Do you fold or do you squish your toilet paper?

Who, in their right mind, squishes? No judgments at all.

Okay, you squish right? Because we're always opposite on stuff like this, I could see you crumbling a big ball. No, you're a folder. I have squished, sure, of course, especially when I'm like out in the woods, but typically I think I'm a folder, definitely. Anyone know, honestly, I don't know, definitely a folder. I bet you filled yours like perfectly, too. Oh yes, little origami. That's exactly what I did. Little swans, triangles, of course.

No, not triangles, no weird geometric shapes beyond the square that they are meant.

Okay, we'll have to do a poll on that see who's on one, who are squishers? Okay, okay.

Last one, how did the two of you meet?

You should answer? What did you say? You should answer this one? Well, that means it's not a quickie. Now I'll answer it quickly, because the whole long, beautiful story with dozens of photos is on our Instagram page in a highlight called our story, starting with photos of us when we were little and where we grew up, and then ultimately how we met. But we met when I was in labor with my daughter Vanessa on June 5, 2009 and my midwife, Amy Romano, was on the way, and I knew some other second midwife was on the way, because it's always how it is at a home birth. And Trisha, thank my lucky stars. Was that second midwife who walked in with this huge smile, looking so excited, and wearing like black yoga pants and a T shirt that said Yale midwifery at your cervix. I loved her, and the rest is history.

I mean, that's it. I just remember walking into your apartment. You had a penthouse apartment in Stanford. I had no idea who you were, and I was just walking into another birth. And to me, it was just another beautiful birth with a very calm, relaxed mom, and I had no idea what it I had no idea what it would become. I don't think we really talked much again after that birth, until, well, I got, I saw you guys at my house once, when we moved to Westport and I got each of you a gift, remember, like a jewelry gift at my kitchen table right here. Remember that you guys were here? You don't remember that, yeah, and then we, then you started teaching workshops at my business a few years after that.

So many of those years with my young children are a blur to me. Yeah, you don't remember that. Yeah, I can't remember that. Gave you a gift from a store called it was the coolest store, agubami, these beautiful stones, and I gave you, like each a stone necklace. Guess you don't wear it, and God knows where it is, but yes, it's in my keepsake box, of course. Okay, fine. One day we're gonna look through it, and I'm gonna hold it up and say, this was the gift. This was the precious gift we threw in your keepsake box. Yeah, this really beautiful store. I was very excited to give it to you. But anyway, lo and behold, you don't remember at all. But that's it. That's it, as we walk down memory lane here. So thank you for the great questions everyone and in June, every quarter, we add an extra Q and A to the month Trisha is breastfeeding questions. So we're going to have our regular June Q A next month. But also in the month of June, one of Trisha is breastfeeding only Q and A's so that when we collect some we get a lot of questions about breastfeeding. So that's how we work it out. We got enough of them in.

Thereby giving Trisha the floor for for those episodes once a quarter. So I'm excited to do that episode with you. And yeah, so if you still have questions, go ahead and give us a call at 802-438-3696.

And call them in breastfeeding or otherwise. We're always looking to accumulate questions for the Q and A's. If you have any personal questions, family stuff going on in my postpartum group, women show up every week with so much on their heads and minds and hearts, so much stuff. And you can bring any of that to our Q and A just call it in and hear our take on it, or opinion or advice on whatever you're dealing with and going through postpartum or anything else can be a little outside the scope of the usual, we're happy to get those as well. 802, get down. Have a wonderful end of May, and we will see you next week for our first June episode. Have a good one.

See ya.

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.