A Q&A episode where we talk about unmedicated twin birth, caring for perineum lacerations, how to find a doula, coffee mugs, induction for low fluids, advice for the first time mom, and Pitocin and the third stage

Listen on Apple Podcast | Listen on Spotify.

Mentioned on the Show:

More on unmedicated twin births- Listen to Episode 5

Learn more about Dr. Stu: http://www.birthinginstincts.com/

Postpartum favorites on Amazon.

Evidence on Induction for low fluids.

Learn more about not going in too early- Listen to Episode 29

No Time to Listen? Here’s the Transcript:

Welcome back to the show moms. We’re in that in between Christmas and New Years and, I don’t know which way is up. And I actually started this intro like four times, and I just cannot get my brain on straight. This is the first time in a week that I’ve sat down to do any work. So I feel like maybe that’s part of it, where I’m just out of my groove, I don’t know. But anyways, I’m gonna just jump into the episode. So I don’t restart this intro again. And for the sake of keeping things simple, because we are in the middle of the holidays. And I’m not super organized and caught up on my episode. So the episode you’re listening to, I recorded it the week prior, like I’m not super caught up and weeks ahead or anything like that. So we’re in the middle of the holiday season, I almost wasn’t going to put out a podcast episode, but I was really looking forward to sitting down and creating something because I do love creating episodes, creating content, it really does fill up my cup. And I hope that you guys appreciate it too. Anyways, for the sake of keeping things simple, we’re doing a q&a today. Today, I put a question box up, and I got a couple of questions in there. And then I pulled some questions from the question box from last week that I didn’t answer and even one that I didn’t answer just because I thought it was such a good question. So let’s just jump in.

1. Is it possible to have natural birth with twins/triplets?

So the more babies you’re carrying, the higher your risks are. So you definitely can have an unmedicated birth with twins and triplets. You’re going to see it less with triplets. It’s actually more common than you think with twins. I feel like twin birth isn’t that common, or I had that notion that it wasn’t that common. When I set out to create my course, I had already had one mom who I did birth ed for who was having twins. And I was like, that was just like a rare thing. I’m not probably going to get a lot of twin moms. Well, we have two twin moms in the course right now. And another twin mom was asking me about the course and if it would be a good fit for twin moms. So it’s more common than I ever thought. And I’m thankful to my first twin mom for opening up that thought for me to even do the research on twin birth and specifically like an unmedicated hospital birth for a twin mama. Because you guys know my course Unmedicated Academy is specifically for moms wanting an unmedicated birth in the hospital setting.

And so, if you check out Episode 5 of the podcast, I go through all of the things that kind of come up with the twin birth in the hospital, and the questions you should be asking your provider and what your options really are. And there’s a lot of common things that come up with twin births in the hospital, like you have to push in the OR is one big one that I know mom’s asked me a lot about. And so if you go check out Episode 5, I’ll link to it in the show notes. I go through all of that. And you definitely can have an unmedicated twin birth, we actually see it a lot in home births, which some states allow midwives to attend twin birth at home and some states do not allow midwives to attend twin births at home. California is one state where a midwife cannot attend a twin birth at home, but an OB can and so there is an OB in Southern California, his name is Dr. Stu, you should follow him at @birthinginstincts and I will put Dr Stu’s information in the show notes as well for you. He actually attends home births of twins so that moms can have a home birth without having to be forced into the hospital.

The other thing that comes up a lot with twins is that very often one of the babies is breech. And in the hospital that tends to mean that you’re going to have a cesarean for that breech baby, because most hospitals don’t quote, unquote allow you to have a breech baby vaginally. And Doctor Dr. Stu says that any provider that wants to give you a cesarean or is telling you that you can only have a cesarean with a twin birth is not an expert in twins and to run away from that provider as fast as you can. So keep that in mind. If you want an unmedicated birth in the hospital and you’re having twins, your provider is really important here and you’re going to want a provider that’s comfortable delivering a breech baby vaginally. 

2. Postpartum tear /laceration, infection symptoms to look for? And any tips?

So this is a really good question. And I actually just read a story. And I don’t remember where this was, or if it was recent or not, I don’t really remember. But it was about a mom who got an infection and wasn’t taken seriously. She went to the ER, and was complaining of pain at her incision and was like, basically brushed off and told “It’s normal.” I don’t remember the details. This is awful. I should really have details before I start talking about things on here and I’m recording. But anyways, she ended up getting sepsis from this infection, and she passed away, I’m pretty sure.

So the reason I bring that up is that I want you to trust your intuition and that if something is wrong, make sure you’re getting the care you need, because it really seems that we’re either over cared for under cared for, and we just can’t be heard. And a lot of times our intuition is just brushed off, and we’re told that we’re wrong. And I just want you to know that you are right. 

And so it’s also good to have that knowledge, right, what would be a sign that maybe there would be an infection. You shouldn’t have any more discomfort after about two to three weeks, it should be healed. So some signs that there could be an infection in a perineal laceration would be red swollen skin. So you would have to look right, and this is where it’s hard, because it is red and swollen initially, because it’s a fresh wound. But if it’s still red and swollen after it started healing, that would be a sign of an infection. Discharge, or pus or any liquid coming from the wound would be a sign of infection, pain that is persisting beyond the initial tenderness and soreness, or any unusual smell like a foul odor coming from the laceration would be also a sign of infection. And last one, a fever. If you anytime you have a fever in postpartum that would be a sign of infection. And that could be not even be the a tear that’s infected, it could be like a retained placenta or somewhere in your uterus being infected. So if you’re getting a fever in postpartum that could be a sign of an infection. It also could be a sign of mastitis so know what the signs of mastitis are. 

Okay. So tips to prevent infection, you just need to make sure you’re keeping it clean. So how do we do that? A peri bottle. Making sure every time after you use the bathroom, you’re rinsing, you’re rinsing it off with a peri bottle and water. Witch hazel is great because that is an antiseptic, any perineum spray like herbal spray would be great because the herbs are going to help keep it clean and prevent infection. And I will link to my postpartum favorites in the show notes. I have all of those things linked in in my Amazon postpartum item list. And then the other thing to consider is the pad versus the diaper. So I see this a lot that moms like the depends or the adult diaper. I’m assuming for the extra coverage because there’s less leaking and with a pad, you can leak lochia, the postpartum bleeding that we have. I’ve always been a fan of the pad more because I would be more likely to change a pad and throw it away versus like the diaper. Like I wouldn’t want to throw the diaper away just for a little bit of blood on it but a pad I would throw it away every other time I went to the bathroom, you know? So a pad and just changing more frequently, even if you’re using a diaper, changing it more frequently is going to reduce bacteria at that laceration site. So that would be another way to help keep it clean. 

3. Is there a website to find doulas/midwives in each state? 

This is such a good question. So midwives are certified by state. With their state that they practice in, they have their midwifery certificate, and they have to go through the state, the state regulates them. So there will be a website where you can find midwives based on your state. So I would just go to Google type in your state, and midwives and it should be one of the like, first ones that pop up- the midwife licensing agency for your state and there should be a directory where you can search by your location.

And then, as far as doulas go, there’s nothing like that for doulas because doulas are not regulated by the state, which is why it’s good to have a doula in your hospital birth because they don’t work for anyone but you and they don’t have any rules on them at all, like the hospital does, or the midwives do.

How can you find a doula? I have five different ways you can go find a doula. You can try a Google search. This is like probably the best bet for finding someone in your area. But it only works if they have a Google business page. So keep that in mind. But I would definitely start there to see how many pop up in your area. Most of us understand Google business and that we need a Google page and that moms are searching online. And that’s the best way to put your location in right. Now there’s going to be some like older doulas, I hate to call them out. And this might not always be true, but the super experienced doulas do not need a Google business because they are getting enough referrals from people. So like, I remember with my second the, the placenta encapsulation specialist. I guess I don’t know if she was a doula. She was not on Google search. I got her information from a friend. And that’s how she ran her whole business was just from referrals like that. 

The second tip is to ask your mom friends, ask your mom friends who had, like home birth, or birth center births or unmedicated birth, because they are going to be more likely to have a doula or have looked into doula. And if you can also ask, if you’re in like a mom’s group at all, ask there or any any Facebook group for local moms in your area. You can ask there too. So getting the intel from women in your area that have had a doula. And there’s sometimes like two types of mom groups. And it doesn’t have to be like a super close knit moms group. So for example, I’m in a close knit moms group, where you have to pay to be a member and there’s events and there’s membership benefits. Those are such great groups to be a part of. But then on Facebook, there’s also other groups that are huge, like they have 1000s and 1000s of women, it might be my town, or also surrounding towns like the greater metropolitan area you can ask in those groups, too. There’s tons of moms in there. They’re on Facebook all the time, and they definitely want to tell you who their doula was. So you can ask there, and you’ll get I’m sure lots of referrals.

The third place to ask is to ask your provider because hopefully, hopefully your provider has worked with doulas and that they’re very doula friendly and they have a favorite doula that they like and this actually would be a great like way to kind of like, test out the vibe of your provider is to ask them if they have any doulas that they like to work with and see what kind of response you get. Now if they just say no, that they don’t have any. I mean, that doesn’t mean anything but if they say anything about not liking to work with doulas, that doulas get in the way, that you won’t need a doula, that is a red flag and you should now be finding another provider.

Okay, the fourth one is to search doula match.com I think it’s dot com, but doula match and other organizations. You can also go to DONA’s website or, gosh, I’m drawing a blank on the other certification companies… but they usually have a directory of doulas there that have completed their course. Now, what I want you to know is that doulas usually have to pay to keep their name on this directory. So if you find a doula on doula match, they pay for that listing. Same with DONA’s listing, they have to be an active member, they have a paying membership to have their name on that list. So just because a doula isn’t on those lists, doesn’t mean that they haven’t been certified by them. You know what I mean? Like I just want you to keep that in mind that it’s not an extensive list. It doesn’t include everyone. For example, I am not on doula match, you can’t find me on doula match at all. You can find me and this is a great one to search if you are having a hospital birth, you can find me on Birth Monopoly’s doula list and they a course called Know your rights. And it’s all about your birth rights. And so if you complete their course you’re on their list as a Know Your Rights graduate. So that would be a good place to look. Because any doula that has taken that course is going to be a great advocate for you because they’re really going to understand your rights in your birth. Yeah, that’s it on number four.

Number five is to ask a doula nearby. So this one sounds kind of weird, but I get this a lot. Very often, I will have moms ask me if I know any doulas in like a neighboring area. So moms who are like located in California, know that I live in California. And that I provide doula services in California. And so even though they’re not in my service area, they’ll sometimes ask me, and I encourage moms to do this because I am in doula groups where we can connect with other doulas to find backups and that sort of thing. And so even if you’re not in my service area, I can very often find a doula for you. So if you know a doula that maybe isn’t in your service area, they may be able to help you find someone with their connections that they have.

So those are the five ways you can find a doula Google search, ask your mom friends, ask your provider search doula match or other organizations directories, and then ask a doula that you do know that maybe is kind of somewhat close to your location. 

4. Are you going to sell mugs??

This is from one of my best friends who is obsessed with coffee mugs, and birth just like me. And I mentioned this a while ago that I wanted to make some merch, like I had some slogans out there, one of them was going to be like “physiological birth first”, as in let’s try physiological birth first, before we interrupt it, and I got some other ideas of sayings that I wanted to put on things. And I did look into one company that does that sort of thing, like shirts and mugs and, and you just upload your design, and then you don’t have to handle any of the merchandise, you know, like I didn’t want another big thing on my list. I looked at that one site, and I wasn’t super happy with the shirt quality didn’t even look at the mugs. Maybe if I just did mugs, or I’m able to find something better. But I was like, overwhelmed by it. I was like, No, don’t like this. And pushed that project like off into the abyss. It’s not even on my like, upcoming project list.  I have 2022 somewhat mapped out, the first two quarters, and it’s not even on next year’s to do list. So I don’t know what’s going to happen about the mugs.. if anyone has any good intel for me on how to do that in a simple way, and you’re going to tell me exactly who to go through and it’s going to be easy and the mugs are going to be cute. Maybe I’ll do it.

5. Is low amniotic fluid a good reason to induce?

I love this one. This is the one that I actually had already answered to my stories but I wanted it to live here on the podcast. Because low fluid is seeming to be the new, like big baby, or the new gestational diabetes, and that we have to induce. And specifically like it’s similar to the big baby, and the low fluid is something that can come up close to your due date. So it’s like you’re so healthy along the whole way. And then they mentioned this one thing, and they mentioned well, we might want to induce because baby is big, or we might want to induce because your fluids are low. And then you’re like, oh, my gosh, it’s, you know, everything’s been so great until now. And now I need to do this to say everyone stay safe, right? 

Well, low fluids alone isn’t a good reason to induce. So I’m going to read to you some of the factors of what can cause low amniotic fluid at term. Okay, so we’re talking about term low fluid, which is when it would be brought up that we would maybe question if it was medically necessary or not, okay? Because if you had low fluids before term, it’s less likely something hour provider is using to push an induction. 

Both mother and baby factors can contribute to low amniotic fluid at term, so some of the mothers factors. If the mother is dehydrated, this may lower amniotic fluid levels, women are more likely to be diagnosed with low amniotic fluid levels during the summer, possibly because of dehydration. If a woman has low amniotic fluid levels at term, and she drinks at least 2.5 liters of fluid per day, she increases the likelihood that her amniotic fluid levels will be back up to normal by the time of delivery. So this is something you can fix. So it could be something that they mentioned and they say, Oh, we’re gonna check on this again. So really make sure you’re staying hydrated. If the mother rests on her left side before or during the fluid measurement, this can increase amniotic fluid levels. So another trick there to make sure your fluid levels look good while they’re checking in during an ultrasound. If the mother’s water has broken, this will lead to a decrease in amniotic fluid. So obviously, that makes sense. If the mother’s placenta is not acting sufficiently anymore, this may lead to a decrease in amniotic fluid. When this happens, it may be because the mother has a serious condition such as preeclampsia or intrauterine growth restriction. So that is when you would consider inducing, not in those other cases, right? Maybe if your waters have broken, but even still, you can monitor, just continue to monitor and wait and see what happens. Because sometimes we can have a fluid leak, and that tear can repair itself and you can go on to be fine, you know you up your water intake. But obviously those last two are the only two right so if your waters are broken, or if you have another serious condition that’s causing the low fluids, your placenta is not functioning, those would be the times when you would maybe consider an induction or consider even more monitoring. But those other things, being dehydrated is totally fixable.

Okay, baby factors. If the baby has a problem with urinary tract or kidneys, this may decrease the flow of urine, which would lead to low fluids. This is something that they can look into if there’s any sort of issues with and this would show up. Again, you know, I’m not the medical expert. But I do know a mom whose baby had has kidney struggles and she had low fluids, and it was known before term and they tried to keep baby in as long as they could. Anyway, so it wasn’t a surprise thing is what I’m trying to get at. In the 14 days before the start of spontaneous labor, the baby’s urine output starts to decrease, so this could naturally cause a little bit lower fluid levels in the later weeks of pregnancy. As the baby gets closer to term, the baby swallows more amniotic fluid, thus leading to a decline in fluid levels. If the baby is post term, after 42 weeks, he or she begins to swallow significantly more fluid contributing to a decline in the amniotic fluid. Again, all things that are physiologically normal. If the baby has a birth defect, he or she may swallow significantly more fluid leading to lower amniotic fluid levels. So those are just some of the reasons why we may have low fluids and the evidence shows that isolated low fluids at term is not a risk factor for poor outcomes. So there’s no evidence that shows that you’re more risky if you have lower fluids at term. And induction for isolated low fluids leads to a higher cesarean rate. I’ll link to this article, the article that I was reading those risk factors from. I’ll link to it in the show notes. So you can read the rest of the article, it’s really good.

6. What would you suggest for first time mom who isn’t dilating fast enough and is past due date, they are inducing me tonight.

So I made sure to tell this mom that they’re probably inducing her tonight, because they want her baby born before New Year’s. So right now, I got this question on December 26. And the days between Christmas and New Year, have a higher amount of births, then Christmas and New Year. So January 1, and December 25, have the lowest number of birthdays out of the whole year. And the days in between are really high, probably due to inductions, because doctors are trying to avoid those holiday days. And obviously this mom that they’re inducing her tonight, her question was not super clear. It sounds like it was a scheduled induction. But she also was worried about not dilating fast enough. So I don’t that also makes it sound like maybe she’s already in labor, and they’re going to augment her if she’s not progressing. I’m not sure exactly.

PSA I want you to know about the holiday induction, this is absolutely a thing.

But something else that I want to mention about the holiday induction, before I get to her to the suggestions, right, is we actually could see less births physiologically on December 25th, due to the stress. So if you’re stressed, do you have a lot of plans, you really don’t want to have your baby on December 25. And you’ve got like all this stuff to do and you’re not relaxed, and then all of a sudden, December 26 comes or maybe not even December 26 because maybe you’re still like high strung because of all the mess and you have to clean it up and put it away. And then on December 27, you finally relax. And your oxytocin kicks up, and then boom, you have that baby. So that could be something that naturally happens too, that would naturally make us have a higher amount of birth in the days after a holiday. But if you look at the numbers,it’s a huge difference, you guys. So I think most of it has to do with the scheduled induction where providers don’t want to be at the hospital on the holidays.

So what would I suggest for the first time mom who isn’t dilating fast enough? Now, I’m not sure again, if this is not dialing fast enough, like labor hasn’t started yet or not dilating fast enough, as in labor has already started, and we’re trying to speed up, right. So that’s the difference between an induction and an augmentation. So an induction is when they start labor with Pitocin, or other medications, or even mechanical induction to start labor. And an augmentation is when labor has already started on its own. And then we use Pitocin to speed it up. So the two things that I want you to take away from this, especially for the first time mom, is you’re not overdue until you’re after beyond 42 weeks. So no 40 weeks is not overdue. 41 weeks is not overdue. 41 weeks and 6 days is not overdue. 42 weeks is not overdue. You’re not overdue until after 42 weeks, and we’ve totally let this idea go. Everyone thinks their baby needs to be out by 40 weeks. Everyone’s tired of being pregnant by 40 weeks, which you know, there’s nothing we can do about that. But it’s becoming so common that moms are like, Oh yeah, I’m just gonna be induced, or I hear a lot of moms say to me, you know, that are in my birth course that want unmedicated births that they can’t believe how many moms can’t believe that they’re not being induced just because they’ve passed their due date. So you’re not overdue til 42 weeks. So you don’t need to be induced. Just because you’ve passed your due date. Your due date is not a medical reason to induce.

And the second thing that I would want to remind the first time mom is that birth can be long, and that’s normal, and that’s okay and your birth doesn’t need saving it doesn’t need to be sped up. As long as you’re doing okay, you want to continue to birth or labor unmedicated. And your baby’s doing okay, you don’t have to agree to Pitocin. And this is just another reason to not go into the hospital too early. If you listen to episode 29, I share my top two tips for the unmedicated hospital birth. And one of them is to not go into early. So tune into that to get a little more information on that, but if you can labor at home, you don’t have any time constrictions on your birth, you’re not feeling pressured to like hurry up and perform which spoiler alert, the cervix doesn’t work that way, you can’t tell the cervix to hurry up and dilate. And then it will, in fact, it might stop if you get that kind of vibe from your provider. So I just want to remind you that birth can be long, and that’s totally normal. A lot of times birth is rushed along, like honestly, they don’t want you there in the hospital longer than 24 hours. And they’re gonna try to get you out of that room and get you done and have your baby born and send you on your way. Because as much as we don’t like to think that, well, maybe, we don’t want birth to be that way. But the hospital birth is a business. They have lots of clients, and it’s about efficiency, and their routine and getting moms in and getting moms out. Not to say that they don’t want the best thing for you and your baby. But it doesn’t feel like that when things are being rushed.

And if you saw the posts that I shared today, on Instagram, I shared a little bit about my story with my second baby where I got to the hospital. This was almost exactly three years ago, at midnight, on New Year’s Eve. And all the nurses were partying, they actually had party hats on. They got me into triage, they got me admitted because my water had broke, they hooked me up to antibiotics, I had GBS and I did do antibiotics that time, hooked me up to that, and then told me to stay in bed. And that I wouldn’t want to have a cord prolapse, and she gave me a scary story to keep me in bed. And I went along. Like, I can’t remember if I felt scared of that or not. But it was midnight. And I knew that I was going to be in for a strenuous labor. So I figured we would rest a little bit. And then once things picked up, like get out of the bed and move around. And so that was at midnight, and then when the new nurse came in about six hours later, she brought in the pit machine and was like, “you’re not really contracting that much.”  And wanted to put me on Pitocin to help me have contractions. And I was like, whoa, whoa, whoa, I’ve been laying in bed, of course, I’m not contracting that much. And so I declined the pit and got out of bed and moving and it was fine. And then I had my baby six hours after that, which 12 hours isn’t that long.. So why was anyone ever rushing me in the first place? Because they want you in, and they want you out.