#331 | August Q&A: Sugar Cravings, Exclusive Breastfeeding vs Bottle, Moxibustion, Obstetric Coercion, Late Onset GD, Dystocia, Fundal Height

Welcome to the August Q&A episode! What is your secret quirk? We want to know! We share a few of yours along with our own. 

Today's first question is from a mother who had a large first baby without a diagnosis of gestational diabetes. She's concerned in her second pregnancy that she might develop late-onset gestational diabetes.

Next, a pregnant mother's mother is a medical doctor and is having a hard time supporting her daughter's natural birth choices because of her experiences in the medical system. 

Another mom is struggling with sugar cravings in pregnancy and is wondering what advice we have to reduce those cravings.

In the extended episode, available on Patreon and Apple subscriptions,  we address the benefits of exclusive breastfeeding over exclusive bottle-feeding, whether or not you should have a planned cesarean after a shoulder dystocia, and if moxibustion works to turn a breech baby. 

Quickies: Fundal height measurements, prenatal appointments at the end of pregnancy, hemorrhoids, spotting postpartum, short breastfeeds, LEEP procedure and cervical scar tissue, high lipase milk, laboring down, restless legs in pregnancy, and finally, would we tell anyone about our pregnancy before 12 weeks? 

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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.

It's August. Hi, nice to see you, beautiful hot weather. Yeah, you look like you have a great dress on. I bought this in Spain. It's a wonderful every all the clothes there are great. The only thing is they're all hot weather clothes. So I, I would love to buy my whole wardrobe there if I could. But everything is scorching hot all the time. So everything I bought there is for a hot day, and I'm going to the beach after so perfect for right now. Perfect. So, yes, perfect for now. Why don't we begin today with sort of I thought it would be we could open with something a little more lighthearted. But remember when you're here the other day and you I opened my the drawer in my kitchen, and you were like, Why do you have 50 corks in there? And then you showed me your true stash of corks, record collection, hundreds of them. Yes, I had no idea. I knew you. I knew you liked wine. I didn't know you liked corks.

Okay. Well, so anyway, we thought it was kind of a funny moment. You're like, Oh my gosh. I just, you know, learned something really quirky, or, as some say, quirky about you. Quirky. Yeah, yeah, quirky, quirky, quirky. So we asked the community what their little quirks are, and we got a few responses, not as many as I thought we would, but I thought it'd be kind of funny to share with them. Share with them. Show them all right, so let me find them. Maybe people are a little more secretive about their quirks. One says, I like to do household chores naked when I'm alone. No, oh, I've done that. Why?

Because it's just why. Like, this is just, like, freeing. You just, I don't know. Okay, so you're on your hands and knees on a tile floor in your bathroom, cleaning up, like, long hairs and dust. How is that? How is that freeing? How is that? I don't see the appeal. It's not like they're saying I like to lie in my chaise lounge and read naked, that I would be like, Oh, lovely, right? Clean your house naked, hauling a vacuum. I mean, what don't get? I'm just doing dishes with rubber gloves on. How exactly does this look? How does this play out? I think the idea is just like doing whatever you normally do, but just doing it naked is freeing all right. Well, there we go. Yeah. Like, I work. I'm home alone currently, and I walked downstairs totally naked the other day and made coffee. That sounds exactly like something you would do. Why not? I was like, why I didn't, didn't feel like getting dressed yet. I was still hot from the shower, so I just nobody's here. Who cares? No, it's who cares. It's the how I think it's, I think it's the household chores. Like, if someone said dance naked, I'd be like, Oh, it's kind of, you know, feels kind of freeing and sexy, and doing household chores is another level. Well, that's why I took quirk, because I really like a person like that, because women are so hard on themselves, and I just love someone who's that liberated?

That's great. I think it's great. Um, this woman says, I order water without ice. With you coming ice and water? Yep, it's gross. First of all, so I think that's a little bit of an overstatement.

It's ice, but I don't like from restaurants. Who knows how long it's been sitting there. It's not always very fresh. Oh, you mean restaurants, yeah, I was thinking my house, I don't love freezing cold drinks anyway, but I'm not into like, super duper cold drinks, so that's kind of where I'm coming from. But, yeah, okay, I guess it's okay. I guess it's gross to to some people, I just think it's cold,

it's it's cold, and sometimes potentially gross. All right, not always depends on where you go. I suppose I'm very particular about how straight and even my bed sheets are. Okay, nice. I know somebody who irons their bedsheets. Okay, could you do that? Would you do that? Would I iron them? No, I don't mean to. They look fine after they're out of the dryer, but I like the bed to be very neatly made. I love the way that looks and feels, but I'm not like, totally extreme about it. She might be really extreme about it. I do like it very neat. I go from one side to the other and then back to the first side, and then it's perfectly straight. Yes, to make sure everything is even and straight, I do that too. Yeah. Joanie midwife, Joanie says, I have the same cork collection. I wonder if it's a midwife thing.

That'd be hilarious. If you're all secretly doing that, and no, none of your friends ever knew, but you all found out you're all doing it, that would be great, remarkable. Okay, I bought my own dental tools so I can avoid the dentist.

Okay, no, what? I sounds like a lot of work. 

How does she look in her own mouth? And how does she know what to look for? You can't just open them see a cavity, right? I mean, maybe she's just talking about the little scrapers. Oh, dental cleaning,

I guess. Okay, very interesting. My God. People really have quirks. I have specific laundry baskets for dirty laundry and clean laundry. I feel like that's not that uncommon.

I don't know I get it so when the laundry is done, she won't put it back into the same laundry basket where the dirty clothes were right. Interesting.

I save, this is a great one. I save all my egg cartons because I want to have chickens someday, she's gonna have all the egg cartons she ever needs for the future chickens that she's gonna have. She's manifesting her chicken life. But everyone I know maybe has chickens just puts them in a bowl anyway. They put them in bowls.

Well, not if you want to give them to your neighbors. That's true. I guess she better save up hundreds and hundreds of egg cartons.

Maybe I'm destined to be a vineyard owner. Maybe that's why I'm saving all these corks.

And you'll find out from the Department of Health, you're not allowed to reuse corks, especially ones I'm rolling around your kitchen for collecting dust for 20 years. So you have to keep coming up with the rationale, but I'm gonna do everything too. Okay, fine, snap you back into reality.

Fine. I have a giant jar of corks too. Does everyone not save them for some future art project? There we go. You were not saving them for that reason.

I don't know why I was saving them only because my brother once mentioned that corks were very the cork tree might be going extinct.

What are you going to do with your particular corks? And how are you going to help to save the world or make it better? Well, maybe it'll be on one day. It just happened, and now it's hard to throw them away. That's the thing. Once you start saving a particular thing, it feels like you're invested. So how do I start throwing corks away now?

Yeah, no, it would be, it would be, you have to read the life changing Magic of Tidying Up and that. But I have that book kind of puts a different brain into your head for a few weeks, and you can throw anything out while you're reading that book. I need to reread it so I can go through that wave again of just not wanting anything. It didn't work. It didn't work with my cork collection. Oh, it learned it worked for me. But no, not with that. Yeah, you saved it last time. Okay, that's true. You'll save it again. What's next?

I take cold showers in the summer. Makes sense. Not a quirk, not really. I most often have chocolate in my nightstand or top dresser drawer.

Really nice. I don't get that little midnight snack, no Chocolate

Snack, then you have to get up and brush your teeth. I don't get that. I don't get any eating in bed at all. What? Well, you don't, well, no, I don't get eating in bed at all. You get eating in bed. I don't get eating in bed unless you're sick and you're drinking tea or something. No, because crumbs, because you have to brush your teeth after you eat. No, I don't get it. No, I have a bowl of ice cream in bed before you go to bed. I have I love ice cream. In my life, I've never had ice cream in bed. I would never have ice cream in bed. Oh, that's a regular thing for me in bed. Well, you watch TV from bed, though, don't you? No, I don't have a TV in my bedroom. Your phone. Don't you watch on your phone? No, not in a million years would I eat ice cream in bed. Not in a million years I would have then a dirty bowl in my room that would annoy me. I would have to get up and brush my teeth anyway. And just the feeling of lying down in bed eating ice cream, you're not lying down. You're sitting up well, like leaning back in bed eating ice cream, I could, I would never.

I wasn't the same way. Next time I go to Cliff House, Maine, we're getting ice cream and we're going back to the hotel, and we're gonna sit in bed and you're gonna eat some ice cream in bed and see how lovely it is. Okay, I promise I'll have ice cream with you, amen in bed long enough to take a photo for Instagram, just to say that, Okay, fair enough. But I will slip out of the bed and proceed to eat my ice cream, as I usually do. It's just something you have to try in your life. Okay, yes, all right. Um, just a couple more real fast, um, new dress equals Princess day and lots of twirling. That's very cute. When she gets a new dress, she pretends she's a princess for the day.

I did that at your house the other day, I twirled wearing my new incredibly fluffy skirt from Yes you did, yes you did. I'm secretly a Disney adult. I don't know. I don't know what people say. It just brings me joy and heals my inner child, sweet, cute. I save glass kombucha bottles for water bottles. I always have backups. That's great. Glass jars are another thing that is really easy, really tempting to save. I have a really hard time throwing away the empty pickle jar.

You have a hard time throwing away a pickle jar. I don't save any food containers. I don't get that at all. What do you do with it?

Well, I end up throwing them away because I don't really want to save them. But it's like painful why it's just a jar. Just seems like you could use a jar. There's just something you're going to need a jar for.

I am not someone who reuses food containers. I mean, I don't get that, not necessarily. Certainly for food. You might use it for your paint brushes, for your quirks, or for your corks. You might put your corks your Epsom salts for your bathtub. I don't know. Okay, all right, moving on. That was That was fun. That was fun. We want to know more, though that's not enough. I want to know more of our community's quirks. We do.

Shall we begin? Well, you didn't ask me if I have a quirk.

Oh, of course, I need to know your Quirk. Yeah. Well, I realized after we did the Instagram post, I wouldn't have been able to think of one. But then that very night, I was like, Oh, my God, I have a really weird quirk, and it's not that exciting, but it's something that I do. I have this beautiful dresser in my bedroom. It's one of my favorite pieces of furniture, and I have no idea why I don't close the drawers all the way. I close them, like, within a centimeter of closing all the way. And once in a while, I don't know why. I just, I don't like to kind of, I guess, bang the wood or something like, again, I don't know why. But once in a while I walk into my bedroom and I can tell that the drawers are not all closed. I'm like, What am I doing? This is a such a it's such a lovely, beautiful piece of furniture, and it doesn't look very good the way. I'm I'm living with it. So I'll walk over and I'll close them all. But it's, that's a that's a true definition of a quirk. I think, yeah, that is a true Quirk. You know, it's not an OCD thing, it's not a neurosis, it's not a superstition. It's just a true Quirk. It's like, I just do it, and I don't know why I do it, but I know that I do it, and our brains just get programmed to do, to do a certain thing, yeah, yeah. So I'm, I'm gonna, yeah, it is, I think it is a good one, and I'll see. I'll keep my eyes peeled for any other strange, strange behavior that I have. I'm sure there's other things, so I absolutely can't wait to share them when I do okay, well, we're gonna keep we're gonna keep sharing our quirks as we go. All right, on to the questions, let's go all right.

Hi, Cynthia and Trisha. I'm currently pregnant with my second baby. My first baby was a beautiful home birth. She was bigger. She was nine six, and her head and chest circumference were only about a centimeter different, with her chest being slightly bigger. I did do for my glucose testing two weeks of at home testing with the fasting and after every meal, and my numbers were always perfect. I did those between 26 and 28 weeks, I believe. So. I'm just wondering if there is concern that I should have about this pregnancy with gestational diabetes, and if you know, if there's any research on late onset gestational diabetes that maybe I should be testing later in my pregnancy. Love you guys. Thank you for everything you do. Thank you. I think she's overly concerned about the measurements of her baby, right? She's talking about head chest circumference, head circumference. It's just it's creating an unnecessary fear she has. She is testing her blood sugars. There is, has been no issue with her blood sugar. She did not have gestational diabetes the first time, unlikely she's going to have it. The second time is late onset gestational diabetes, something that can occur or undiagnosed gestational diabetes, probably more often occurs. Yes, it does. It happens. And every time there's a big baby, everybody thinks, oh, there must have been gestational diabetes that went missed or whatever. But this is way over worrying. And gestational diabetes generally is early onset. That's why it's that's why we test for it by 28 weeks, because it has to do with what's happening with the placenta and the beginning of pregnancy, so it's really unlikely, and I don't think she should alter her birth plans in any way. And I think she probably needs to do a little bit of work mentally to just sort of switch around her beliefs and trust that her baby's size was great and her next baby size is going to be great.

Absolutely agree. I remember years ago joking and not even joking, but like saying to my clients, mark my words. The day is going to come. People are talking about head and chest circumference, and here we are just, there's no end to trying to measure and control birth. And this is the biggest journey we have as mothers. It's truly relinquishing and just get yourselves back in that, as I always say, Little House on the Prairie mindset. Just imagine you simply miss your period for a few months. You realize you're pregnant, you're noticing bodily changes, and you just wait until the baby arrives. Just practice that mindset once in a while to restore yourself to what virtually every one of your ancestors did experience. And the question is, does it serve you to have that degree of trust? It does serve you. You're not going to neglect care, you're not going to stop all the things that you're doing, but maybe in between those appointments of checking on your baby, you're just going to relax sufficiently and let go of what's really ultimately out of everyone's hands. You have no choice but to trust. Keep playing the devil's advocate today for whatever reason, it's just the mood I'm in. But now what I'm just saying back in the day, when we were not doing any type of prenatal screening, gestational diabetes really didn't occur much because we lived a very different lifestyle. Our diet was very different. We were active. We were in the fields, Little House on the Prairie. Days, gestational diabetes was not nearly the issue that it is today. It is a legitimate concern, but she doesn't have it. It is a legitimate concern when it is real and when it is unregulated. When blood sugar is unregulated, it can cause complications in pregnancy and birth. But we are over worrying about it, we are overlooking for it. The tests that we have to look for it are not very accurate. The screening tests are not very good. She's doing the best possible thing she could do, which is to regularly screen her own blood sugar. That is the best way to know what's happening in your body. So I don't think that's contrary to what I said. I just said, in between all your checking and all your usual doing, just let it go and just practice that level of trust, just for a little bit. Just practice that trust. And in the meantime, she is checking everything. That's all she can do, and it's enough. We want to control and measure everything, and then for what, we can't change it. Anyway. You can't change the baby's head circumference anyway, the chest circumference anyway. We can't do anything. She's doing everything, right? And she's just got this fear imprinted in her brain. And I think the work is mostly in shifting that mental belief, yes, because she doesn't have it right now. Right? Exactly. All right.

Hi. I had a question. I don't really know if there's an answer to it, but I just thought that you all could weigh in I recently gave birth to my third and my mom was there, and she's a doctor, and she's now seen me give birth unmedicated, not in a hospital setting, and she's heard me talk about things very holistically for years, and as I'm talking about my distrust in the medical group, you know, she feels a little defensive because she's immersed in it, and she's a phenomenal doctor. I definitely think she's one of the good ones. But she was saying, you know, a lot of these things that you're bringing up, these situations that you're bringing up, if a doctor hadn't done due diligence, and the patient had been harmed, or the baby had been harmed, they're just they're open to being sued. And she was pouring her heart out, because the situation just isn't easy, and as my mother, I would hate if she had to go through a situation like that, like if she did not do due diligence, and then someone turned around and sued her and dragged her name through the mud. So again, I don't really know if there's a good answer. I know there's good doctors and bad ones and all in between, but yeah, it's hard when you can sue someone if they don't do everything they could to make sure you're okay, and then turn around and say, I wish you were more hands off with my birth so I hear where she's coming from. And just thought you could weigh in. Thanks.

I think the first point is, all perspectives are correct, and you and your mother don't have to agree. You don't have to come to some consensus where you agree on every point. I totally understand your mother's bias toward doctors or her perspective. Everyone comes into everything with their own background and perspective, and I just think the general thing they're arguing about is very rhetorical. It's like this whole line of doctors doing everything they could do is exactly where the entire debate lies. So it's just rhetoric. Again, we're not talking about anything specific. So if the mother says something to her daughter like, Well, I understand doctors doing everything they can do to save a baby, no rational person would disagree with that. I believe doctors should do everything they should do to save a baby as well. So it's a futile thing to argue about. So I don't hear where the debate is, but surely the mother must understand, and there's data to support this, that unnecessary intervention, for example, routine interventions, does drive up the risk of maternal and infant mortality. We have decades worth of data to show that so surely she and her mother actually do agree. Where they might not agree is, many would argue, by default, the safest thing is for the doctor to do nothing. And the mother might be saying, by default, the doctor should do something. And I would say that the data doesn't at all support that. By default, the doctor should do nothing until there is a medical indication, and that's what I think any reasonable person on either side could agree on. But honestly, they don't have to agree. It's okay if they don't totally have the same perspective.

Well, this is the whole real struggle in healthcare, but particularly in maternity care, and the whole. Debate that we were having earlier this morning about coercion in obstetrics and fear of liability is a major player, major player in decision making for OBS, and they admit it. It's there is research to show that they are some of their decisions are driven by liability and protecting themselves. So the like you said, the question comes down to what is an unnecessary intervention? In their mind, a routine IV or antibiotics for every GBS positive woman is not a routine intervention. That is a strategy to protect the baby, doing everything they can to protect a baby or a mother.

But think about amniotomy. I mean, there's, there's tremendous debate around that. It's, it's hardly supported by evidence at all. And I wish what would happen in the court system. I wish, frankly, the court system understood this issue better. Because instead of asking the doctor, did you do everything you could do? I wish they could say, like, let's say everything went south after an amniotomy. I wish there would be more questions around asking the doctor, what was the medical indication for, what action you just took? What was your medical indication? But they completely forget that part. All roads lead to whether there's a medical indication for an intervention, and that's the part of the conversation that never seems to happen. It's just the Did you do something? Did you do everything you could? Doesn't mean, well, the flip side of that is, if you did not do an amniotomy, they could say, and a baby, you know, died in labor, well, you didn't do something that could have sped up the labor. It's just the it's, this is why it's informed consent. This is why everything needs to come down to the risks and the benefit giving to the mother, and the mother making a decision, but that, see, first of all, it comes down to consent, as you said, and the whole thing should end there. If the mother said, No, alright. Well, the here was an adverse outcome, and Mother, do you take responsibility for the fact that you declined? But if, if everything went south, and the doctor never did an amniotomy. There's no evidence there you there is no evidence for something that hasn't been done. They can't say if a, God forbid, if a baby dies, and they say, Well, you should have done an amniotomy. Should have done XYZ, 10 different interventions. You can't prove that that intervention actually would have saved a baby. So it's a very weak argument, but when you can prove that everything changed after an event took place, which which is the intervention that's a more risky place. So as a doctor, if I were a doctor, if I actually ever had to defend such a thing, I would be very concerned, obviously about an adverse outcome, obviously about personal or professional liability. And I would just think, do I have a rationale for everything I do? Is there a justification for every risk I take? That's where I think everyone should be paying attention. But that's hardly ever how the conversation goes, even between this mother and daughter.

The real problem lies in the lawyers, because I can assure you, this is why doctors don't get sued for doing a C section. We know that there are increased risk, increased risk to C section, they will always come down on the provider who does less. You could have done something. You could have ruptured her membranes and sped up the labor. You could have taken her to a C section 10 minutes earlier. It will always come down to them doing more, being supported by the lawyers. That's how it goes in court, it's not true. And again, informed consent has to be the only way. It is the only answer, and it does come down to the attorneys, because in that case, the prosecuting attorney would have to ask the doctor about the risks of a C section where you're aware, where you're aware that these risks could occur if you performed a C section. That's where more of the conversation needs to take place, because we do have the worst outcomes in the industrialized world. It's just it's right in front of everyone's noses, and that's that's the key difference. And the more interventions we've had since the 80s, the worse the outcome. C sections, inductions, everything has gone up as far as interventions, and our outcomes have gone worse in accordance with that. But again, the mother and daughter don't need to agree. She's allowed to deeply respect her mother. I have no doubt her mother is an outstanding doctor, because this woman is informed, and she can judge and tell that her her mother is an outstanding doctor. But they don't have to agree on how to frame everything. They both have points. All these things are true and exist, and everyone just has to stop trying to agree with everyone on every point around this, because they usually end up just talking about rhetoric anyway, which is exactly what happened. And when everything you can do, you know, doesn't mean anything.

If you have been to medical school, you are going to have a belief system around birth, that is that birth is inherently dangerous and an accident waiting to happen. So it's going to be very hard to have a conversation. It is very hard. This is why it can be challenging for midwives and OBS to work together, sometimes, because one is coming from a perspective of believing that birth is natural, normal and that mishap. Ops are unusual and rare, and we should just let the physiology take its course. And medicine is coming from the perspective of, if we don't do something, this is going to be a disaster.

But the bigger thing that doesn't get discussed enough is when ACOG was established, they made a decision. They opted for AML, they opted for active management of labor, they opted against expectant management. So I think sometimes they all lose sight of the fact that that was a choice that was made decades and decades ago, that their whole premise is they must get the baby out. They must do something to get the baby out. And it's only in that framework that they've all been trained. So I don't think that was the best choice. Obviously, we have the worst outcomes in the industrialized world to show for it, but they're losing perspective. They're losing the big picture perspective that they're still operating in that framework of management, of labor, and within that framework. I'm sure her mother has a valid point, but it's the very framework that many of us would dispute. Let's go to the next one.

Hi ladies, I am eight months postpartum, and I had a question about sugar. I crave it all the time. I'm breastfeeding still. I've been exclusively breastfeeding for eight months. It's really hard to not want sugar all the time, ice cream and cookies, and I know it's not good for me, and it's definitely making me gain weight, which I don't enjoy. And I'm wondering if you guys have any tips or tricks to stop craving sugar so much. I think it's partially like a mood boost too, like I'm tired and I want sugar, I'm sad, and I want more sugar. So anything would be helpful. Thank you. Do you remember that time, years ago that we had a recording and we were, I think we were in between recordings, and I showed up to the Zoom call, and you didn't know you left your camera on, and as soon as I sat down, and your headphones weren't in, so you couldn't hear me trying to get your attention, and you were just sitting there with this perfect, full on profile, looking out your window, eating a cookie slowly. I never forgot, you're just sitting there holding a cookie. It was just so sweet, one single cookie, and you were just looking out at the beautiful green yard and just slowly chewing this cookie. It was just such a memory. I don't forget kind of cookie resin. I don't remember, but it was just seemed so unlike you, because it's not, you know, it was just such a sweet thing. You went and got one cookie, and you were just treating yourself to like this one little cookie as you just sat, not multitasking. You were looking out the window, and I was kind of, I, you know, you couldn't hear me, so when you noticed me, you'd put your your headphones in and said, Oh, I'll never forget you said, Thank God, that's all I was doing. Thank god that's all I was doing. Because you couldn't hear me. I couldn't it was so funny. Anyway, so my I think she answered her own question at the end, then she said, maybe it's just because I I need a mood boost, or I need energy. It's true. Both of those things are probably true. She may be a little bit depleted postpartum. It's super normal to crave carbohydrates when you're breastfeeding. It requires a ton of calories. Your body needs carbs. The problem is, when you choose sugar, you get an endless cycle of crazy, of craving sugar. Sugar is not the answer. More energy through, you know, complex carbohydrates is probably the answer. But she might have, you know, she's eight months postpartum. I can't remember, did she say she's Yeah, breastfeeding, she probably is a little depleted. She probably needs more protein. She probably needs to eat a more balanced combination of macronutrients every time she eats, eating protein, fiber and fat at every single meal. That balances your blood sugar. And if your blood sugar is steady throughout the day, you don't get those kind of cravings. You can have some sugar, but always have it after you have had protein, fiber and fat, never the first thing do you eat sugar on an empty stomach, your blood sugar just goes spikes, and then it crashes, and then you need to replenish by doing it again, and then you are just in this vicious cycle. She can break the cycle, right?

You don't want sugar to hit the bloodstream quickly and an easy way to deal with the sweet tooth. Part of it is it's might not be what she wants to do, but she's still having that craving is switch over to fruit. I mean, just eat a container of strawberries or raspberries or something. Instead, it is going to satisfy the craving or make herbal tea and put honey in it. It might not be as delicious as whatever you're currently eating, or whatever snack you got yourself hooked on lately that you're really enjoying, but if you drink a cup of herbal tea with honey in it, it is going to satisfy the sweet part. You just have to be willing to do it. You have to be willing to eat or drink something that isn't as tasty and that you're as excited about as the dessert.

Think just in general, it's really about thinking of the bigger picture of your blood sugar management over time. And you don't have to deprive yourself of sugar, but you need to start eating in a way that helps you balance your blood sugar. And she needs to make sure that she's just eating enough in general, because if she is not eating enough, as an eight month postpartum breastfeeding mother, her body is going to crave sugar because that's fast fuel, and then that, you know, just what you said about spiking your insulin, and then that tells your body to store the calories as fat, and then it's just a bad cycle to be in.

Well, that's a wrap for the regular part of the episode. Now we're moving into our next three questions, and I have no idea what they're about.

I wrote all the questions out. Okay, so you'll just have to read the episode description. We'll type them out in there, and you can get these by being a subscriber on any level, tier one, two or three. On Patreon, we always post these episodes in full, ad free, extended and if you're on Apple subscriptions, which is not even $30 a year, you get every single episode ad free, and with every single extended episode included. And you don't have to do anything. Once you do that, once you sign up for that, it's they automatically go into your feed. You don't have to do anything to go find them or anything like that. So we hope you're with us, because we do double the work, and we want everyone to benefit from it by getting the full episodes.

And I don't remember what these questions are, but I know they're good. Oh, and if not, then it is time for quickies. Okay, it is quickie time. The quickies are just fun. I like them. They're fun, easy, playful, not too serious. Okay, how accurate is fundal height? Should the weeks exactly match the centimeters? Isn't this really fascinating to you, that the fundal height matches the weeks, the number of centimeters that the weeks pregnant you are, matches in centimeters, mind blowing like why? But what's funny is just how arbitrary it is, because humans came up with centimeters to begin with. So this is not an inherent law in nature, because nature didn't come up with centimeters. So that's partly why it's interesting, and it isn't the the average is, is exactly weak to centimeter, a one to one ratio, but isn't it plus or minus one to two centimeters on each side that's still under the range of normal, I would say three plus or minus three. Good. Yeah. It's just interesting that when a baby reaches the belly button, it's about 20 weeks,

and I find the purple line more crazy and wild and fascinating. Oh, that's all well, that's all nature. And who the heck knows why that's happening and how that can measure, how, how that can tell how far a woman is dilated, is wild, but centimeters, yeah, it's just an incredible coincidence. Since humans came up with centimeters, it's very cool. And I wish we would measure more women by fundal height. That's the way it should be. Absolutely, that's the way it was always done. I know. And really, it's just about looking, about growth. So you your it does not have to match exactly. Around 20 weeks, your baby should be the top of your fundus. Should be right around your belly button, and then it should go up about one centimeter each week thereafter, until 40 weeks. However, around 36 weeks, if your baby drops down low in your pelvis, it could drop three centimeters, you're going to be measuring a little bit off. Yeah. Anyway, variation is normal. You have providers who you know, measure differently. Women's torso length plays into it. It just it varies. Okay, is it really necessary to go to weekly appointments at the end of pregnancy? Some would say no. I mean, some women don't do prenatal care at all. We do know that in a large on a large scale, that does tend to lead to worse birth outcomes on a large scale, on a population level. But I would say if there's any time to go to prenatal visits, it is the last few weeks of pregnancy. I'd rather you skip early on and go more later, because that's when this goes up. More concerns can come up. Yeah. Do you have any remedies for postpartum hemorrhoids? They are actually worse than giving birth. Witch Hazel. Yeah, the witch hazel Tux pads are helpful. And really it's about making sure that you have soft bowel movements, that you're not straining, because if you're continuing to strain, those hemorrhoids aren't going to heal. If you have very soft and no straining, then they can heal. But the witch hazel tucks do work. Well, okay. Is it normal for an exclusively breastfed baby to start feeding for only five minutes? On a side, it can be if they're older, for sure, yeah, especially between the four and six month age, when they're really distracted, then they just have to feed more frequently, but they might feed for one or two minutes at a time, and then come back five minutes later and do it again. Is spotting normal and postpartum when you have not gotten your period back? Yes, I could say. I would say that could be, could be normal. I don't know how far postpartum she is. I mean, if she's, if she's five weeks postpartum, yeah, I think what I think she's not though, I think she's probably past her initial bleeding and she hasn't gotten her period back, and she's probably spotting, and that is probably hormonal, and she's probably gonna get her period soon. Yeah. Period soon. Can breastfeeding amenorrhea stop then start? Yes, it's not really that breastfeeding amenorrhea stopping and starting. It's just that your cycles are irregular when they return after breastfeeding. So you might get one and then skip a month or two and then get another one. But you're not protected at that point, like you can't count on lactational amenorrhea to prevent pregnancy. Can leap scar tissue prevent or stop cervical dilation. Ooh, which episode is that with Nathan Riley, yes, it's true that any type of procedure to the cervix can create scar tissue, and that can definitely create stalls or slow dilation.

That was episode 299, perfect. Listen to 299. Does defrosted breast milk that tastes like vomit. Mean it's high light paste milk. I describe it as vomit tasting. Ew.

That's such a horrible thought. Say something else quick.

I mean, probably yes, that's her perception of how it tastes. Typically highlight paste milk is described as soapy or metallic. Okay, so maybe the metallic and the vomiting thing kind of go together. I don't know. No idea. Does laboring down cause fistulas. Well, it could, I suppose. I mean, any birth can cause a fistula, but if you're very medicated and not feeling anything, and you're laying in bed and you're on Pitocin and your uterus is being forced to contract harder than it might otherwise do or be, and you don't notice because you have an epidural, then, yeah, that could definitely put more strain on the posterior vaginal wall or even the anterior and cause a fistula. Okay, one more, and then we're on to the personal Do you have a fix for restless legs in pregnancy? I'm already taking magnesium and iron. Please don't say giving birth. Restless legs could be very irritating in late pregnancy. Iron and magnesium are usually the go to remedies for that. But also, hydration is a really important one. So if you're not doing electrolytes, you should do that. And good sleep hygiene. It's very hard to sleep well, in late pregnancy, I get that. But the more it because it's also like a nervous system thing. So the more that this is happening, and the more you're anticipating it happening, the more it's going to happen. So if you're sleep deprived, it's going to happen more. If you're tired, exhausted, depleted, deficient, dehydrated, it's all going to happen more so I would say a good sleep schedule and movement throughout the day, just, you know, making sure that you're walking and moving and not being stagnant, which is hard in late pregnancy. Okay, that's it. Personal quickies are, do either of you paint your nails?

Well, I obviously do you go to you get manicures a lot. We were like, just talking about this, you just had a manicure, and on the very next day, one of your nails completely chipped. So I get Pedic ones. Yeah, I get pedicures, but I don't get manicures because they never last more than day. So sometimes I'll just do my own with a clear but my toes, my toes are my toes are painted night by now?

Yeah, so you have to a regular manicure is worthless because it lasts like a day or two, but you can get longer lasting polish, I like, dazzle dry, and it can last seven to 10 days with no chipping, really, yes. So yeah, there's no way I'm going for a manicure every week. It's too much maintenance, but I can handle it every two weeks.

All right, not personal.

Well, there's one more. Oh, I spoke too soon. Would you tell anyone besides your partner about your pregnancy before 12 weeks?

Sure, yeah, I don't know about like work, but the reason is that we, we conceived upon my first ovulation, when my son was 15 months old, at completely unexpected, immediately pregnant again. Last thing we ever expect, you know, we, we had Vanessa four years later, and that was intentional, so we never expected to have children close together, and we were shocked and happy, and thought, Oh my gosh. And then I miscarried almost immediately, very, very like within that week. And then I found myself telling a lot of people close to me because I was miscarrying, and I thought, this is interesting. I was. Not telling people, because the whole argument is like, what if you miscarry? But when I experienced a miscarriage just a few days later, I did tell people I was pregnant, and now I've miscarried because I just wanted to be able to have a little bit of that understanding and support from the friends close to me and the family close to me, that's all so I just, I, you know, I would say, tell anyone who you would tell that you've tell anyone who you could trust with your miscarriage business if, God forbid, it resulted in a miscarriage, I feel like that's the level of trust of the people you can tell under any circumstance. Why not just happily tell those people? Because no matter what, you'll have them in your inner circle, so might as well share the joy early on with them. That's my those are my feelings.

Yeah, I wouldn't put it on social media, but I would definitely tell the people I'm close to sisters, mother, close friends.

Yeah, alright, that wasn't that hard either. No, they, they're a little easy on us this month. Sometimes, sometimes it's really tough, sometimes really tough, and it's hard to think of things on the spot once in a while. But those were, those were easy to answer, all right? Well, thank you everyone for the excellent questions, yes. And thank you guys. If you love the show, please don't forget to give us a five star review. The reviews are very helpful in the podcast reaching new audiences. So if you love us, please leave a review. If you don't, please just let us know. If you don't love this episode, you don't love us. No, don't love us. Just go on with your life. Don't find a different just yeah, there's no reason for an official breakup. There's not just you find your peace, leave, we'll find ours.

See you next time. Thanks guys for being here. 

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.