#369 | May Q&A: Postpartum Hemorrhage, RhoGAM, Family Boundaries, Induction, and Placenta Previa

Happy Spring! And welcome to the May Q&A!

We start with a listener email we loved, followed by a discussion on creativity and why it matters, especially in the early years of motherhood when it can feel completely out of reach.

Then we get into your questions.

We talk about postpartum hemorrhage and how it’s defined, including whether 500 cc of blood loss is truly cause for concern, and the use of Pitocin and Cytotec in that context, particularly for VBAC mothers. We also revisit RhoGAM and walk through when it may or may not be necessary, especially if you’re not planning future pregnancies.

One listener asks how to handle being the only one in the family making different choices around birth and parenting. We share our thoughts on boundaries, restraint, and when saying less is often the stronger position.

In quickies, we cover induction at 42 weeks, complete placenta previa, vitamin D for breastfed babies, pelvic floor therapy access, low libido in pregnancy, newborn weight checks, birth combs, and how to get through the third trimester in the summer.

Finally, when one fan asked our opinion on which of us may be the better driver, one of us shares an old story of getting a reckless driving ticket!

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Transcript

I'm Cynthia Overgard, birth educator, advocate for informed consent, 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 Show. 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.

All right, welcome to the May Q&A.

Yes, yes. Well, let's start off today’s episode with a beautiful email that was written to us from one of our longtime listeners. She says, “Hi, ladies. I’m writing to you for the first time after being a listener for five years. I started listening back when I was taking my birth, postpartum, and Hypno doula courses. Unfortunately, due to COVID and other circumstances, I wasn’t able to attend any births after getting certified, but I continued to listen almost every week because I loved your content, your wisdom, and your humor.

“When I became pregnant with my first baby this past spring, I went back and re-listened to many of your episodes with the new perspective of actually being pregnant, and I found them incredibly comforting and educational as I prepared for my own birth. I have a rare kidney disease that caused protein to spill into my urine, and I knew this would probably complicate my pregnancy and birth. My biggest fear was arriving at L&D with elevated protein and slightly high blood pressure and being coerced into an induction or even a C-section out of concern for preeclampsia.

“To prepare myself for that possibility, I listened to your episode with Emily about Pitocin without an epidural. Since an unmedicated birth was my plan, that episode really made me feel like I could do it. I could labor on Pitocin without an epidural.

“Fast forward to the night after Thanksgiving dinner, I woke up to strong, consistent contractions. I labored at home for five hours as they grew stronger and closer together and then decided it was time to go to the hospital. When we arrived, I had an elevated blood pressure reading of 141 over 93. I was clearly nervous and basically in the middle of a contraction when they took it, so I wasn’t overly concerned. Over the course of the next hour, they continued taking my blood pressure, and it steadily went down until it was back in the normal range.

“Then a very concerned OB came in and told me I needed to start Pitocin because I could develop preeclampsia. This was exactly what I had hoped to avoid. I pushed back and asked, shouldn’t I have multiple high blood pressure readings for that to be a concern, and shouldn’t there be more justification than one white coat reading right when I arrived? She shook her head and said it was against her professional opinion to let me go home to labor any longer on my own. I was only three centimeters, so they couldn’t admit me without starting Pitocin, and she left to give my husband and me time to deliberate.

“I was so torn. I didn’t want to start the cascade of interventions, especially since my contractions were already strong and consistent, and I felt so good laboring on my own. But I also didn’t want to drive 30 minutes back home only to have to turn around again and do the whole process again later that day. I couldn’t decide. I sat and prayed for clarity. I quietly listened to my baby, hoping she might somehow tell me what to do, and then I heard your voices in my head saying, ‘Hear everyone. Listen to yourself.’ In that moment, I knew in my heart that I was meant to stay there and have my baby that day.

“When the OB came back, I told her I would stay only if they started my Pitocin at a two and increased it every 30 minutes instead of every 15. She agreed. After about 10 hours of intense back labor with Pitocin turned up to an eight, I had my baby, no epidural needed, just the strength, knowledge, and empowerment I gained from listening to your podcast. You truly had a hand in my entire pregnancy and birth. I genuinely believe it would have gone very differently if I hadn’t been exposed to the incredible information you and your guests share. I wanted you both to know what an amazing resource your podcast is and how deeply you are impacting women’s birth experiences for the better. I love you both and your podcast so much. Please never stop doing the amazing work you’re doing. All the best, Abby.”

That’s beautiful, and she took all the time to write that after having her baby. That’s always what I think about. It is not easy to sit and write a thoughtful message of any kind when you’ve got a baby in your arms.

It sure isn’t. I never even got around to writing my birth stories.

That’s really sweet and lovely that she did that for us. So thoughtful.

All right. Well, you know, I’m on a kick too. I’ve been talking about this for quite a while on the podcast as well, to get into the creative space. This is not something that is normal for me. This is a recent thing in my life that I’ve been focusing on, and I was always in my left brain. I was always thinking in terms of productivity. It’s just my default, and I think more intellectual pursuits in my free time and things like that. And now I just realize how good it is for me to get out of that.

So obviously I’ve become extremely active. That’s been really fun, but I took up a hobby, and I think I’m going to share more of it. I shared a little bit on Instagram called paper quilling that I’m just enthralled with. I’m so happy doing it. I can just sit there and hours can go by. It’s incredibly creative. I’m really proud of myself for what I’ve learned and what I’m producing. Did you see some of my things on Instagram yesterday that I did?

I did. They’re gorgeous.

Aren’t they great?

Well, the most beautiful thing I’ve made so far is a gift I’m giving my mom, so I can’t share that yet because I don’t want her to see it. But I’m having the best time. So anyway, I’m always talking to the postpartum women that I work with, and even on the podcast. So what are you doing creatively? And I know if anyone had said that to me postpartum, I would have thought, that’s ridiculous. There’s no time to do anything right now. But what’s your intention, at least, to get creativity back in your life in any way, working with your hands, for example, or something like that? I do think it’s something to hold on to.

So I posted this gorgeous cake. Did you see that image of that cake? My mother went to a dinner party a few days ago, and the hostess made two breathtaking cakes. They don’t even look real. So that was a good example of creativity. And then I asked the question, what is a hobby, sport, or activity you’ve been wanting to try? That was the first thing I asked. And I just want to read some of them because it’s really interesting, the things women shared.

Okay. Homemade ferments, sauerkraut, kefir, furniture refinishing and restoration, clay earrings. That sounds like fun, doesn’t it? Jewelry making sounds like a lot of fun. This one, a woman after my own heart, swing dancing. I love swing dance. Gardening, pottery, like on a wheel. I think there’s another kind, isn’t there?

Okay, so pottery, yeah, you can do pottery off a wheel.

Basket weaving, satchel weaving, knitting and sewing, scrapbooking, voice lessons. How cool would that be for a regular person like us to just want to up our karaoke game? I could totally be convinced to take some professional voice lessons for the sake of better karaoke.

Yes, I did those. I had Lola do voice lessons for a while, and I remember being like, help me.

The last time I sang karaoke was not that long ago, and I sang a hard song, Blues Traveler, “Run-Around.” I got the whole room singing the main chorus with me. But why? It’s one of my favorite songs in the world. But yeah, I would like to actually do a real song that requires a really good voice, that’s maybe slower and more, I don’t know, less of a fast song that I could get away with being a little off tune. Okay, snowboarding, cross stitching. That’s something I’ve done all my life. I love cross stitching. Pickleball, go for it, please. Quilting, clay, pottery, air dry clay, pottery, sourdough making. That’s a big trend right now. A lot of my friends are sourdough making. Figure skating, wow, that’s ambitious. Jujitsu, carpentry, make my own furniture, fishing, rowing, gardening, pickleball again, backpacking in the mountains, fresh milling flour. I’ve done that.

I want to do that.

Okay. For years, yeah, for years, Eric and I made homemade pancakes from grain. We would buy the whole grain and grind the millet. Yeah, we did it for years, and then we would sift it and we would make pancakes. I can’t believe it either, because I haven’t done it in probably eight or 10 years, and that’s what we did. That’s the only way we made pancakes for years.

Not bread, nothing? Just pancakes?

Just pancakes, just pancakes, starting with the flour.

Yeah, not just like sifting the flour through a flour. No, whole grain.

With the grain, whole grain. Yeah, we had to buy whole grain. Yeah, yeah, wheat berries, I believe, is what they were called. Yeah. Floral arranging, fun. Bow spring. Oh, that’s the type of yoga that I used to do. I haven’t heard about bow spring in years, but that’s a good, that’s a cool type of yoga. I really haven’t heard about that in a long time. Boxing, playing the harp. Would you have ever thought of these? Aren’t they so creative?

Not playing the harp, no.

Running a little farm stand. That’s verbatim, running a little farm stand. Isn’t that the sweetest thing? Okay, and beekeeping again. Wanted to get back to my figure skating and dance after a decade away from them. So another figure skater. And then one woman, of course, wrote, “I forgot how to have hobbies,” with a sobbing face. I know. That’s why we ask. We want to remind you of that part of yourselves.

Now next thing is, I wrote, “If you’re working full time and/or home with your baby or babies right now, it can be hard to envision a time when you can learn a new skill or get back to an old beloved sport or hobby, but you can and will if you stay connected to how it will feel when you return to it.” And then I just wrote, “Tell us more.” So I want to share some thoughts that this brought up for women.

One woman wrote, “I started smocking when my first was born, and now that I have three, it’s hard to find time.” So I wrote back and said, “Did you mean smoking?” Of course, I was kidding. I didn’t know what smocking was. So she sent me an image, and I realized my mom used to, I used to have a nightgown that was smocked. It’s like those old-fashioned nightgowns with the elastic short sleeves and the beautiful embroidery around the neck, like all the layers I used to wear.

I would have no clue how somebody does that.

Tiny stitching. She sent me an image of something she made, and it was gorgeous. It was really beautiful. So that was cool.

“Reading the books I buy would be nice.” I relate to that. I always buy more books than I can keep up with.

“Doing something solely for me is out of reach right now.”

Okay, fine.

“I take time daily to create something with my hands and to do something fun for my spirit.”

Okay, I just want everyone to know.

Let’s comment on that, okay? Because I think what she said is really impactful, which is doing what she said: “I take time daily to do something with my hands.” It’s different than doing something like reading or something with the brain or playing chess or even playing a sport. Doing something physically with your hands, very simple something, even just very simple sewing, sewing something, coloring in a coloring book.

Jewelry making, yes.

I mean, jewelry making, paper, good, fine if you’re good at it. It feels simple. But baking something, just using, actually using your hands. For me, that’s why I did cloth diapering, because I actually loved to wash, fold, and hang the cloth diapers. It was very calming for me. It wasn’t a stressful thing. Many people think that is stressful, but it was a simple thing I could do with my hands every day that felt fresh and creative. And it’s not that creative, but it was just the act of using your hands.

Yeah, yeah. And I recognize the woman who wrote that. She’s in my postpartum group and was on the podcast, and she has three boys, all incredibly close in age, one of them just a few months old. So if she can find time daily, we all can. Probably anyone can, right?

“I can’t wait to get back to my horse,” one woman wrote.

That’s harder. Okay.

This is interesting. “I started English paper piecing quilting that I can take anywhere.” So I just looked that up. That’s a type of quilting where you have the shapes already cut out, and you can wrap the fabric around it and make a perfect quilt. It’s all in small pieces, and it’ll be perfectly aligned because you’re using these templates underneath the fabric. So it’s a, and you can just take it anywhere with you. So that sounds like something that would be really, that sounds like something that would be really fun. Okay, let’s see what else we have. Hot yoga, sourdough, hair, makeup, and beading. Yeah, getting into how to apply makeup can be a fun one, you know, how to do your hair a little differently. That can be fun. “Desperately wanting to get back into recreational sports. No time for anything new right now.” Yes, we know. We know. Just remember that part of yourself you intend to get back to.

And find and take moments where you can, because we truly can go 10, 15 years without doing anything that fuels our creative self. And when you lack creativity, when you’re not feeding the part of yourself that needs to be creative and expressive, that’s how we get sad.

Yeah, that’s right. Well, there are things we’re meant to do. We know humans do that outright, absolutely. They were using their hands and their bodies all day long.

And finally, I did a quick poll and said, “When was the last time you were in your creative space?” And exactly 50% of women, and we had hundreds respond to this, exactly 50% said, “It feels like years. It’s been years.” And 25% exactly said, “It’s been months.” And then the remaining 25% said, “It’s just been days or weeks.”

You know, when we talk about self-care, we have said before, we’re not talking about getting massages. We’re not talking about getting your nails and hair done. We’re not talking about lunch dates. When we’re talking about self-care, we’re talking about this, what lights you up, what fuels your energy, what allows you to feel expressive. That is self-care. Find that little thing that makes you feel like yourself again, that makes you feel creative, that makes you feel in flow. You’ve got to find those things and spend some time on that, or you get sad, lonely, depressed, resentful, frustrated. It affects your whole well-being, right?

So some great ideas in there. Maybe someone got inspired by hearing some of those. And don’t be a perfectionist. If you take up a new hobby, you can just do a little bit, just learn a thing or two at a time, and play again. That’s going to remain my key word for at least another year here, play.

For the rest of your life.

I wouldn’t mind that. I think it is. I think it’s a noble pursuit.

I think it’s a noble pursuit too because by default some of us are so, we don’t need to be told to work or to produce or to be productive or keep our home organized. Some of us need to be reminded to actually just play or to do our job as parents, which is what most of these moms are just in, on the hamster wheel of just giving, giving, giving, giving, giving, giving. Where can you stop for a moment?

My son is super into my paper quill, and he’s so excited about it. Every time I produce something new or I sent him a little something for Easter at college, and he just makes the biggest deal about it. And I gave him the, I showed the electric guitar that I made from scratch. It was totally from scratch, out of my imagination, and I gave it to him with his birthday gifts when he was home over spring break, and he just can’t get over it. It was on his wall within the hour. He had it hanging on his wall. He just loves it, and it’s so motivating. And I love that they see me doing something so creative.

And it’s, it’s not what makes you feel good in doing that is the use of your imagination. That’s why it feels so good, right?

Yeah.

That part of our brain needs to be exercised, just like our body needs to be exercised.

Yeah.

And it’s very hard to get into that space when you are so busy and exhausted or a workaholic or just postpartum. So we have to be very conscientious about choosing it. And you know, I’m not saying I did a good job at that. It’s very easy to say hindsight is 20/20, right? I can look back and say, oh, you know, if only I would have done that more. That’s what I was missing. Because now I have that back in my life. That’s what I was missing in those years.

Well, I hope that’s something we can do for our listeners because I know we have listeners of all ages, but obviously the vast majority are preconception through early childhood. And I think it’s good for them to see what is coming and what they can make of their lives after this stage. And hopefully we can lend some inspiration there.

Yeah. Zu’s mother, who lives in Europe, is having, her birthday is coming up, and Zu said, “Oh, I need to mail her a card.” And I was like, “Can I paper quill her a card? Give me a week and I’ll make her a card.” And she was like, “Oh my God.” So it’s really fun. It feels like a nice opportunity to keep doing things and a way to keep giving to people. So find something that lights you up.

All right, so with that, are you ready to jump into our questions?

Yes, let’s get back to business. All right, out of business.

“Hi, Cynthia and Trisha. My question is about Cytotec and postpartum hemorrhage. I just had my third baby. I had my dream home birth in December, and I had a wonderful team that I really loved. This was my VBAC. Yay, VBAC. And in my preparation and research for this birth, I had found that Cytotec carries a pretty big risk for VBAC mothers, particularly around uterine rupture, which I know is the major worry with all VBACs.

“Anyway, I received IM Pitocin pretty much immediately after my son was born, and five minutes later I received 400 milligrams of Cytotec that they put in my cheek, and all of this because my midwives said that there was a sizable blood loss. I did look back in my records, and it looks like the documentation said 500 ccs of total blood loss. For the record, I had no drop in blood pressure, no dizziness, no tachycardia, and I was completely asymptomatic.

“My first question is, did I actually have a postpartum hemorrhage with that amount of blood loss? Secondly, is there any risk for VBAC mothers who receive Cytotec after birth when it’s used to manage postpartum hemorrhage, or is there risk really only when Cytotec is used to induce labor? And finally, are there any implications for future pregnancies and subsequent deliveries having received Cytotec in a previous birth?

“For context, my labor was four hours from start to finish, and the midwives said that they believe that the large blood loss was a result of the placenta possibly partially detaching maybe a little bit prematurely since the labor was so fast. I’d love to know your thoughts. Thank you for everything you do for women and babies everywhere.”

Very thoughtful. Good questions from this woman about her experience. So let’s hope we can remember to get to all of them.

Okay, so first of all, did she actually have a postpartum hemorrhage? Well, technically, the definition of postpartum hemorrhage starts at 500. For a C-section, it’s 1000 ccs of blood loss. Very hard to measure, right? It’s very hard to gauge those things. Other definitions of postpartum hemorrhage in some places are whether or not the mother is symptomatic. They don’t consider you to have had a postpartum hemorrhage unless you are symptomatic, low blood pressure, lightheadedness, faintness, things like that, which she did not have. So technically, 500 ccs of blood loss, yes, that would be on the books as a postpartum hemorrhage.

They gave her Pitocin first, and they must not have felt that it was sufficiently stopping the bleeding, which is why they moved on to Cytotec, which is the next level of medication to manage a hemorrhage. Her question about VBAC and Cytotec is, it is an increased risk to use Cytotec in labor if you’re a VBAC because it can create hyperstimulation of the uterus, which is not, you can’t, once you give it, you can’t take it back. With Pitocin, if you turn it up too high, you can turn it down, and it has a pretty short half-life, and you can control it better. But with Cytotec, once you give it, it’s there and it’s going to do what it’s going to do, and you can’t control it. So it does increase the risk of uterine rupture, which is why it’s not recommended in labor. But giving it postpartum has nothing to do with that. So giving it postpartum did not increase her risk. There are side effects to Cytotec, so she could experience the side effects. She didn’t describe any of those things. But her last question, I think, was, would it affect a future pregnancy?

Right, that was her last question.

And the answer to that would be no. So did she need it? Probably not, but she got it. I mean, they probably could have waited a little bit longer, especially since she wasn’t symptomatic. I don’t know what was happening in that situation, but it is the second-line treatment for postpartum hemorrhage.

“Hey ladies, my name is Michelle. I’m calling from Illinois. We just moved our family, our two kids, from Colorado, actually, to be closer to our family and have a couple questions about being the one in the family to do things differently. I always knew that this was going to be a point of contention, by the way. This is not a surprise to me. It’s kind of been hard with my in-laws this whole time, but now that we are around them a lot more and will continue to be around them a lot more, I’m just struggling to figure out how to navigate being so different.

“My husband has no problem really with it. He is totally fine to be misunderstood by them. And when we do things differently, which so far with our two kids, we’ve done everything differently, home birth, breastfeeding, co-sleeping, not circumcising, just basically everything. And I’m having kind of a hard time knowing how to navigate when I get questions. I will say, they’re pretty nice to my face for the most part. There’s never been a confrontation per se, but I know what they’re thinking and probably saying behind my back, you know? And my husband’s totally fine being misunderstood and doesn’t really care to explain our reasoning to them, even though it’s all very intentional.

“I’m looking for your advice if I need to just be okay with just being misunderstood and not even try, or if you think it’s worth a conversation with my mother-in-law or something like, ‘Hey, you know, I know Andrew can be pretty short with our explanations. If you ever want to have a respectful conversation, I would be happy to explain our decision-making to you. It’s all very intentional.’ I guess I’m just trying to figure out how to navigate now that they will be a much bigger part of our lives and our children’s lives. I want to keep things nice and good, but we do things so differently than them, and it’s just a little tough sometimes. Okay, well, thank you so much. Bye.”

Well, I’m curious to know what other people think when they hear this question. It’s complicated and affects a lot of young couples. So they recently moved back to Illinois. They’re near family. They’re near her in-laws. They’re doing things very, quote, naturally, and it’s very different from how the other family members do things. And she senses that they’re talking about her, but nothing is overt. I’d say it’s not a lovely situation. It would be nice to be completely respected, not to have the feeling that they’re talking about you. You might be right that they’re talking about you, but I would say consider yourself pretty lucky if they continue to not involve you in whatever their opinions are. As you love to say, Trisha, your opinion of me is none of my business.

I would definitely just keep my focus on unapologetically doing things the way I do them, keeping the focus on making sure your husband is on the page that you’re on. That’s the only thing that matters. Being on guard for any snide comments, comments of disrespect as the children get older, seeing if they try to cross boundaries or intervene in some way that everyone knows you would not agree with if they’re doing that with your child. I had a little bit of that when my son had sleepovers at my in-laws’ house. There was a little bit of that, like they were doing things very differently, feeding him very differently from how we were. And you know, sometimes you’re provoked a little bit. If they’re not provoking, you consider yourself lucky. And I definitely would say do not open up a conversation and say, “Hey, if you ever want to talk and understand.” Absolutely not. Because if you do that, in my opinion, unprovoked, no one’s asking you to do it, that’s your way of saying, I need you to agree or approve or be okay with what we’re doing. And once you do that, you’re really relinquishing a lot of your power. I mean, why would you open yourself up to conversation with how you and your husband are doing things? So I would avoid that at all costs. Let them talk about you if they must, but as long as they don’t bring it to you, you’re good.

Yeah, so I was actually gonna say I agree with both things. I agree with her husband and how he manages it, just, we do what we do. We don’t care. We don’t talk about it. And yes, she should try to adopt more of that style. But also, I would say, if you want to have the conversation once, fine, have the conversation once. If it would make you feel relieved to say, “If you are open to understanding how I do things, I’m happy to explain it to you,” and if they are receptive to that, great. It might open the door to further conversations, and if they’re not, you did your part, you said what you needed to say, and you never need to open the door again.

Optional. I think it’s such a potential recipe for disaster. If they’re curious, they can ask, like, “So why do you cloth diaper anyway?” Sure, I’ll be happy to tell you. But if you volunteer something like that, like, “Oh, by the way, we cloth diaper because of toxins and chemicals,” if they’re already talking behind your back, you’re just going to give them more content. They’re going to go talk behind your back and roll their eyes and be like, “Oh, she says it’s because of the toxins and the chemicals. It’s for the environment.” It’s not like they’re going to go behind your back and be like, “You know what? She made a lot of sense.”

They might be open.

Optimistic. Because if I really had respect for a young couple that did things differently, I know I wouldn’t be talking behind their back, and I would be open to learning and receptive. And if they’re already showing themselves not to be that way, then it looks like you’re seeking approval or acceptance, and that can really cause, you’re breaking down the boundary that you both seem okay with. They’re not talking about it. They’re not involving themselves. Beautiful. Consider yourself lucky, like I said. Those are my thoughts. Different in every family, but I think it is the safest way through this.

“Hi, Cynthia and Trisha. I’m 23 weeks pregnant with my second baby girl. I am O negative, and in my first pregnancy I received the RhoGAM shot twice, and then another time after my baby was born. I found out more about the shot later and was pretty disheartened to learn about how the shot is made. At my latest midwife appointment, the shot came up again, and I mentioned that this will be my last baby, and from my understanding the shot is only important if I will be having another child. I was asking if I could test to see if I was sensitized in my last pregnancy or if I could test the blood type of my baby now, and was quickly turned down. I’m in BC, Canada, for reference. I was wondering what my options are, and if I’m correct in my logic that if I’m done having babies, I don’t need the RhoGAM shot to protect future pregnancies. Thank you so much for all that you do. I adore your podcast. All the best. Bye.”

Okay, so when a woman is pregnant, she is tested for her blood type. If she has negative RH status, so she can be any type of blood type, A, B, O, AB, but the RH status is what matters, positive or negative. If you’re negative and your husband is positive, those are two blood types that can be potentially incompatible. So if your husband is RH negative and you’re RH negative, this is not an issue because you both have the same RH status. But if you have different RH status, then if you are pregnant with a positive type baby, which could happen if your husband is RH positive, then there is potential for your body to mount an immune response to that blood type and actually attack the red blood cells of the baby. This doesn’t happen very often in the current pregnancy. It can, but it’s pretty rare. You have to have something happen where the maternal and the fetal blood mix, so maybe after a car accident or something like that, that could happen. But it’s unlikely in the first pregnancy.

Now, at the time of birth, there’s a much greater chance of maternal and fetal blood mixing, and then the mother can become sensitized to the RH positive blood of the baby. And then in a future pregnancy, her own immune system will recognize that as foreign, and it can actually attack the red blood cells of that baby in a subsequent pregnancy. And in rare cases, it can lead to something called hydrops fetalis, which is a very serious disease that a baby can die from. In more mild cases, it just leads to jaundice.

And this would be if the baby in the subsequent pregnancy has a positive blood type, right? I mean, if that baby has a negative blood type like the mom, it won’t be an issue. But it will happen if the blood mixes in that first labor and then if the next baby has the opposite blood type, meaning the mom is negative, the baby is positive. That’s the only situation.

Okay, there’s a high chance of the blood mixing at birth, but there’s a lower chance of the mother actually becoming sensitized. I think it’s around 17% if they don’t get the RhoGAM shot. Now, if the husband is RH negative, this is a complete non-issue. You don’t even have to discuss it, and many women are given multiple rounds of the RhoGAM shot even when their husband is negative.

We don’t really know if that’s the father of your baby, which is outrageous. Don’t get me started on that. I would never. That’s unforgivable to me. But it also doesn’t matter if the mom has a positive RH. We also need to make sure that we know they shouldn’t even test the fathers if the mom is positive. It’s very, very few women, maybe more now, but very few people do actually question the RhoGAM shot because the consequences are so severe if you do get sensitized. That doesn’t mean that it’s a serious, high-risk. And this mother is saying that she’s not having more children. So if she’s not having more children, the risk to the current pregnancy is much, much smaller, almost not even really worth considering. So if you don’t plan on having more children, you do not need to worry about sensitization, and you can pretty comfortably decline the RhoGAM shot.

Okay, and just to clarify what this woman was saying in her message, she knows what the shot is made of. It’s important to tell everyone she’s referring to the fact that the RhoGAM shot is made of, isn’t it combined human plasma? So it’s basically human plasma, and it can be from multiple sources, right?

And that’s what causes a lot of the controversy for many women.

Yes.

Okay.

They don’t know what’s in that human plasma necessarily, right?

Okay, well, that was it for our questions.

It’s time for quickies.

Whoa. Okay, that was fast. All right, quickie time.

What’s the average cost of a home birth midwife? Average. Okay, well, of course it’s dependent on where you are in the country. I mean, I think it could probably be as low as $2,000 to as high as 20 in some places. So average, probably six to eight.

That’s exactly what I was thinking. Six to eight average.

How can you obtain domperidone in the United States?

Well, if you’re really into champagne and you like Dom Pérignon, go to the liquor store and ask for Dom Pérignon.

You can’t, but you can go to Brazil and you can walk into a pharmacy and you can just buy it over the counter.

What about Canada too? Don’t they have it?

It’s not over the counter in Canada. It is prescription in Canada. But in many countries, Caribbean islands, South America, Central America, you can walk into a pharmacy and you can pull that shit off the shelf and bring it back to the United States. So take a vacation.

Grab some ivermectin while you’re out there. Drug smuggler. Become a drug smuggler.

Readily available all over the place, but not here. I mean, but it just bothers me so much that that medication is banned in this country, and it’s an over-the-counter medication like Advil, Tylenol, in other parts of the world. Most of the world, it’s an over-the-counter medication. Medications are not, I mean, Tylenol comes with risk, true, but most medications, if they’re safe enough to be over the counter, they’re safe enough for most people to take. And it’s such an effective medication. It’s just really frustrating.

Is virtual pelvic floor PT effective? I live in a care desert.

Well, it’s more effective than nothing if you live in a care desert.

Yeah, I believe it would be effective. It’s certainly more effective than doing nothing. Yeah, so I would go for it if you need it.

What is the best firm phrasing to decline excessive newborn weight checks? The pediatrician is calling nonstop.

Why are they calling them? They’re expecting weight checks at home.

I think they're expecting them to come in to get the baby weighed now. Why they're expecting more than the normal weight checks, I'm not sure if there's something going on in this particular scenario with the baby that might actually justify more weight checks, but I would say, you know what, come to my house and weigh the baby if you care so much.

That's a great response. That's a great response.

Every pediatrician should be doing home visits in the first two weeks. Yeah, I know you want my baby to be fed well and gain weight. Come to my house and weigh the baby.

I have low libido at 12 weeks pregnant. Maybe I need a quickie.

And this is her quickie. We got lots of quickies, so people are now coming to us for all kinds of quickies.

It's so normal to have low libido at 12 weeks pregnant. Oh my gosh. Don't worry about it.

What do I need to know about having a posterior uterus?

You need to know nothing. Forget the person who told you that.

How do I survive summer in the third trimester of pregnancy?

You get a pool in your backyard. I don't mean a $100,000 installed-in-the-ground pool. I mean get a horse trough.

Yes, they make great little dipping pools. Sit in it when you're hot.

Well, you can also just walk into your own bathtub and not be in a trough.

Yeah, but you want to be outside in the summer.

Okay. First of all, I would love to know where she lives. Second of all, most of the overpopulating areas of the world are in extraordinary heat. So, you know, air conditioning, baths, stay hydrated, and don't make too much of it. Don't overthink it too much. Your body's totally equipped to handle the heat.

Does my exclusively breastfed baby really need vitamin D drops?

None of my exclusively breastfed children ever had vitamin D drops. So the guidelines basically say that if you yourself are taking 5,000 to 6,000 IUs daily of vitamin D, your breast milk should have sufficient amounts of vitamin D to provide for the baby, and they don't need vitamin D drops. If you're deficient in vitamin D, if you tend to run really low in vitamin D and you're not taking it, then maybe giving your baby some vitamin D is helpful. But also, just take them outside. Let them make their own vitamin D. You can take a baby outside year-round, but take it yourself. I would take it. I would be good about that.

Should you squeeze a birth comb or relax your hands during contractions?

Well, I'm very much in the camp of relaxing your hands. I know some people, and even some professionals we've had on the podcast, are really into the comb. Hold a comb and squeeze it. I could never give that advice. I know it works for some women, and I think the idea is it takes the sensation away from whatever you're feeling only to make your hand hurt. So I would say take the sensation away with a lovely cold washcloth on your forehead. That's one of my favorite tools. You do want to keep your jaw, your mouth, your hands, your shoulders, your limbs very relaxed in labor because it helps to keep the endorphins flowing and it helps to keep the oxytocin flowing as well. So I'm not a fan of the comb technique. I think it's funny. I know a lot of people are really into it, but I can't recommend it.

Yeah, I'm with you. I think it's better to relax into the sensation rather than trying to distract yourself from the sensation. But if it works, you've done it, and you love it, go for it.

Do light touch massage, someone touching your hair, cold effleurage, if you're in the water, cold water down your shoulders, a cold washcloth on the forehead. There are really lovely ways to bring your focus elsewhere. I'm just not a fan of that one. It doesn't make sense. I don't want to squeeze a comb right now sitting here recording a podcast, so I wouldn't want to do it when I'm in labor.

Yeah, it just seems like one of those hacks that might be unnecessary. There are other ways to just get through a contraction. You could always just—

Prick yourself with a needle. There are lots of ways to hurt yourself wildly in labor if you're really looking for that.

Yeah, you know, bang yourself on the head with a hammer.

With a fork. We can do all sorts of things.

Okay, no offense to the people who do it. If it works, it works.

We just don't get it, and we don't have to, maybe, just because we haven't tried it either in labor.

I'm struggling with having a C-section at 37 weeks due to complete placenta previa. Will it move?

Well, the first question is, is it actually true complete placenta previa? Because we know dozens and dozens and dozens of stories of women who have been told they have previa whose placenta moves just fine, and it's not actually a complete previa. A complete previa covers the cervix fully. It's attached on both sides, so it's not going to be able to move. If it's moving at all, it's probably not a complete previa, and it will likely move. So I would push that C-section off as long as you can.

Okay. Is there ever a point where you would choose elective induction, 42 weeks or wait?

Interesting question after our episode we just recorded with Erin and Jess. Yeah, I mean, yeah, there's a point where I would choose elective induction if there was a problem with me or the baby.

I think she really wants to know, if nothing else comes up, is there a point by which you're not comfortable being pregnant anymore? Easy for me to say because I'm not in that situation, and I never have been. But my belief is I would absolutely not, until and unless there were a special circumstance where the risk would outweigh the benefit. There really is no benefit if there's no apparent risk. There is no benefit to induction. It's all risk otherwise. I mean, the risk of stillbirth goes up after 42 weeks. It is still a very, very small amount. You're still looking at the vast majority of births being perfectly fine without induction. So the question becomes, do you want to take those chances when the odds are dramatically in your favor and introduce risk?

My quick answer to that would be only the woman who's at 41 and 6 or 42 and 1 can know the answer to that. You have to know. You have to see what's going on with yourself emotionally, physically, and your baby at that time. But like you said, if there's no medical indication, there's no reason for induction.

But listen to your instinct.

That's listening to your instincts. Yeah. All right. Okay, last one. Oh, this is funny.

The personal one is funny.

Okay, yeah. Which of you guys is the better driver?

Oh, how would we know that?

Well, I certainly know which one of us drives the most. You.

Yeah, so I drive.

I can say you are. You have to make 14-hour trips on a regular basis many times per year. So let's just give you—

So how do we rate what better driver is? How many speeding tickets have you had in your life?

I got one speeding ticket in my life, and it was when we were driving to Canada. We were on the Taconic, and there were no cars around, so I was completely comfortable driving. I think it was like 84, 86, and we passed a police officer, and I was like, oh shoot. And I didn't—

Slow down. That's 30 miles per hour over the speed limit on the Taconic Parkway.

Yeah. Okay, so I didn't slow down because if I were a police officer, I would really resent people speeding and then hitting the brakes just because they see me. That's honest to God. But I was thinking maybe he understands this is safe. There's no one around, it's clear, it's beautiful weather, and maybe he's cool with this, and I'm not going to hit the brakes because that just feels like the wrong thing to do. So he ended—

Up coming after me.

He ended up coming after me, and then I slowed down, of course, so he could pull me over. And he said, "You didn't even slow down when you saw me." And I said, "I know, but I thought you wouldn't appreciate if I hit the brakes just because I saw you." So he said, "Well, I'm going to lower it by 10 miles an hour, but I'm still giving you a ticket." It was hundreds of dollars. That was my only speeding ticket in my life. But the day after I got my license, I got a reckless driving ticket.

The day after you got your license?

I was driving in my beautiful hometown of Ridgewood. I was so conscientious. I went to visit my now sister-in-law. My brother was at college at the time, and I went to visit her to hang out with her. I just had to drive a couple miles home, and I turned down this beautiful, charming little street in her neighborhood in my town, and I didn't know it was a one-way street. It was just a little one-way street and a very short street, and it connected to the main avenue, Ridgewood Ave, and the police followed me. I was just like, what? I couldn't believe it. I went home. I was almost crying. My mom, I will never forget, she had so much grace. She almost didn't even react. She said, "Okay."

Because it's kind of cute. It's kind of like, my God, it was the day after you got your license. Of course you didn't know it was a one-way street because you've never driven it before.

And I was like, how am I going to pay for this? This is $70. I was making like $3.65 an hour at my job. I was like, how am I getting— She said, "Dad and I'll pay for this. It's okay." I never again got a reckless driving ticket in my life. At Thanksgiving last year, I was thanking family members for creative things. That was one of the things I thanked her for because my kids got a kick out of it. Thank you for how you handled my reckless driving ticket, because my kids found that so entertaining.

That's cute.

Yeah. Anyway, so yeah, we can say you're a great driver because you really drive under so many conditions, such long trips, and you've always got a great attitude about it, which is the part I love.

Should we go to the Speedway and have a race?

No, those days are over. No more reckless driving tickets for me. That was it. Okay, no, no, no, that's it. I've virtually never gotten tickets. All right, so did you ever get a ticket on one of those long trips?

Oh, I've gotten pulled over. When I first moved to my hometown of Reading here, somehow they always identify the new people, the police here. I got pulled over within days of moving here at like four o'clock in the morning, but I was on my way to a birth. So it was truthful. I was like, listen, sir, I am on my way to a birth an hour away. I am sorry. I was going 20 miles per hour over the speed limit. It's four o'clock in the morning. Nobody's out. And he was like, go, go, go, go, go. He didn't even say anything.

He didn't even check. Well, you midwives have—

Yeah, as long as I have my birth bag in the car.

Yeah, just remember, there's always someone in labor somewhere.

That's right. Thank you for the questions, everyone. Please keep calling us. We love it. 802-438-3696. Call us with your problems, your questions, your comments. Just, when in doubt, pick up.

Keep them coming. Keep us coming. It doesn't matter. We will talk about anything.

We will literally talk about anything.

We will talk about anything. Anything. Bring it.

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.