Episode 1: What they said
Michelle Gabrielle Caldwell, Childbirth Educator and Doula, Owner of Baby, Please Birth Services Agency (MGC)
Nicola Pemberton, MD, FACOG (NP)
Chidera Chima, ND, Certified Nurse Midwife (CC)
Host: How do I know, as a patient, what early labor is?
NP: *sigh* Well, early labor can start with…contractions. Right?
MGC: Right
NP: I mean that’s really that’s…people don’t understand what labor is. Labor, by definition, is contractions and cervical dilation. That’s labor: contractions plus cervical dilation…
MGC: Cervical change
NP: …equals Labor. So, if you break your water… that does not mean labor. You can break your water and not have a contraction. Contractions may start later, or it may not start at all, and we may have to trigger that. But…by definition, labor means, contractions plus cervical change or dilation. But, for early labor patients, that labor can last for what? 12…18…24 hours?
MGC: For the first, for first-time moms?
NP: Yes, it could last a while.
MGC: …it could average about 27 hours and a lot of people aren’t prepared for that.
NP: This is true.
MGC: They don’t realize that that is the possibility. That it could take that long to have a baby.
NP: Correct
MGC: And mostly it’s because what are they saying? In the movies, somebody jumps up…
Host: after their water breaks.
MGC: …after the water breaks.
NP: and then the baby is coming within minutes because they have to keep that 30-minute epi…no, just kidding. *laughs*
MGC: The episode is timed to a minute…
NP: The episode lasts 60 minutes, if it’s “Grey’s Anatomy” or something; 30 minutes, if it’s a sitcom. Um…and the baby comes right after that, which is absolutely unrealistic. So…
MGC: Completely unrealistic
Host: So, if I start getting contractions, that doesn’t mean I’m in active labor.
NP: No. It just means you’re getting contractions.
MGC: You’re in early labor; maybe even in prodromal labor.
NP: Correct
MGC: Which could be days, or weeks…
Host: …of contractions.
MGC: …of cramping.
NP: Yeah, so people might say, “I was in labor for 5 days!!” Not necessarily. You were experiencing contractions or cramping.
MGC: …and discomfort.
NP: But that doesn’t mean that your cervix is changing. It doesn’t mean you’re making progress. It means your body is trying to do something. But it hasn’t transitioned into that “now I’m going to start dilating your cervix, so we can get this baby out”.
Host: What is the difference between contractions and Braxton-Hicks? Because you hear that a lot, right?
NP: Correct…correct. Well, first and foremost, location, you know…location on your body. A lot of people would describe Braxton-Hicks as a tightening of the muscles, and…it feels like a wave…and it’s going from the upper to the middle part of the abdomen. Where they might describe contractions more like, ”I feel like my period’s coming”… ”I feel a little crampy.” It’s all the way in the bottom, which is where it wants to make/effect change for the cervix to start to dilate. Would you agree?
MGC: Right. So, in class, basically, I start telling people that it’s really just practice…it’s practice for the uterus, it’s practice for the baby. Just so it’s not like a massive shock for either one of them. So you’re feeling some movement and tension of the uterus so that both of you kind of know what’s to come. There are sometimes when Braxton-Hicks or “practice” contractions can actually cause some change in cervix, but not really a lot…like it’s not really going to move the needle so far where we’re about to have this baby today. So, um, when we’re looking at “practice” contractions, and I like to say “practice”, instead of Braxton-Hicks,
NP: Pre-labor
MGC: …because they’re just named after a dude, and I don’t care about that.
NP: *laughs*
MGC: So, you know, it’s “practice”, and I let them know your body’s doing what it’s supposed to be doing…it is getting ready.
NP: We used to call it “false” labor contractions, which is inappropriate. It’s not “false”, it’s “pre”. It means, “I am about to kick off something, but I don’t know when that might be”. It could happen for days, it could happen for weeks, but it’s “pre” labor, meaning, they’re just giving you, as Michelle was saying earlier, an introduction to what you might feel, before it starts to kind of say, I’m gonna transition to the “real deal Holyfield”…where it becomes a little more intense, a little more crampy, and feel you’re having your period, and your period don’t want to stop and…*laughs*
MCG: You asked me the difference between “practice” and the real thing. So “practice”: you can walk, you can talk, you can eat, you can drink, you can do all of those things through those contractions. If it’s the “real deal”, and you are really in active labor, you have to stop, and have that wave. You have to stop, and really pay attention to what your body is doing.
NP: Right. You gotta…you gotta concentrate on getting through the contraction.
MGC: Right
NP: So you might have to breathe, you might have to shift positions, you might have to…but whatever it is, you’re not like “lemme go have that chicken leg”. You’re not thinking about food at that moment, don’t really feel thirsty in that moment. You’re just going…*breathes, then holds her finger up*…. “give me a moment….”
MGC: Yeah, you forget. You’re like, “Stop talking to me…I gotta have this wave”. *laughs*
NP: “I gotta go through this… I gotta go through this.” Um, and so when we talked about that, when you’re saying getting into active labor, what we understand our current definition or guidelines for active labor is anything 6 centimeters and more. So, a lot of the times when people get to 4 centimeters, they’re thinking *claps hands* this is it. And, back in the day, they used to be that way even in hospital settings. People used to use that as a guide as to say if the patient wanted pain medication…
MGC: Yeah, that was the time.
NP: …if they want an epidural, they can’t get one until they’re 4 centimeters, but that’s still early labor and they could be 4 centimeters for hours before they kick into an active labor setting.
MGC: …or days.
NP: Whoo…boy.
NP: There was a question asked earlier about whether or not there’s a concern when a patient is contracting every 2 minutes. We talk about…we give instructions to patients when it comes to notifying their practitioner or their provider, or their doula, when they’re contracting, and granted, we give the basic “5-1-1”. You can contract every 2 minutes, but it’s also…it’s not just how frequent the contractions are, it’s how long each contraction has lasted.
MGC: …the duration.
NP: So, frequency, duration and then also, how long those contractions are actually going on for. Some people…
Host: What does “5-1-1” stand for?
CC: So, it’s basically having contractions every 5 minutes. The thought is that each contraction lasts 60 seconds, which is a minute, for an hour or longer. So that’s the “5-1-1” rule.
MGC: So, it’s not like this random, “Oh, I’ve reached 5 minutes.”, and then the next contraction is not happening for 7 minutes or 12 minutes.
Host: So, it’s consistently 5 minutes.
MGC: It’s the inconsistency of 5 minutes apart, lasting a minute, and doing so for at least an hour.
NP: Right.
MGC: Yeah. And, so when you’re talking about that person coming in at 2 minutes apart, thinking, “Oh I’ve reached this goal”, but if the contraction itself is only 15 or 20 secs…seconds long, then, it really…we’re not in active labor.
NP: …and we’re not dealing with effective contractions as yet. It’s the same thing when people, umm…I guess, use techniques, and I’m not going to mention natural labor techniques yet, because that’s something we could go into in a couple seconds, but when people use the induction agents, such as, castor oil. *smiles*
MGC: Um, no. We don’t want to do that.
NP: Big…big, big…eeee. There are ways to do it, and there are a lot of labor professionals out there who know how to do it safely. But, unfortunately, a lot of people who might go on the internet and say I was told, or maybe a family member says to try this…
MGC: …there’s come concoction that they’ve been given and it’s too aggressive.
NP: It’s aggressive…and not realizing that they are creating some many fluid shifts or changes in their body that can lead to some sort of dehydration picture.
MGC: Completely.
NP: …and as a result, you can get contractions *firmly taps the counter* back-to-back, sometimes, 1 to 2 minutes apart, but they’re not effective, they’re not efficient, they’re not lasting long for each one and they’re certainly not changing the cervix, and all you look like as if you were in the desert, like dry, like “Tyrone Biggums”- I mean, sorry. I mean just look, just dry and crusty and dehydrated.
Host: So, is that…is that…castor oil…is that a…is that an effective way of like a normal intervention? Is that a natural intervention?
MGC: It’s still medical induction.
CC: Correct.
MGC: …because it is a medicine. Whether it’s not a prescription or not, but there…it’s still medicine that you’re giving to your body to actually try to change the trajectory of labor…or maybe even spontaneously induce.
Host: Got it. Okay. So, here’s my question: I want to distinguish what the difference is…I.. I hear a lot about birth centers, and, I guess after COVID, a lot of people didn’t want to go to the hospital. What is the difference between a birth center and a hospital?
NP: I think we could all answer that.
MGC: We could.
CC: I feel like a birth center is kind of like the perfect medium between, you know, the hospital system and like, interventions, and then the home birth where you kind of just want to do as least interventions as possible. It’s kind of like the perfect medium to say that, “Hey, I want to let my body do what it needs to do, as natural as possible”, quote/unquote, whatever ‘natural’ may mean to the patient, but still having that reassurance that if anything may happen, that would require like a higher level of care, for in between where we can get you to that hospital that’s close enough or to someone who can help you with whatever is happening at that point that may need an intervention.
Host: And how does that differ from a hospital? So, if I want the benefits of a hospital, why wouldn’t I just go to a hospital?
MGC: Absolutely. You can go to the hospital and have those benefits, for sure. The difference, I think, is really focusing on the individual who wants a low-intervention space…who wants time to labor…who doesn’t want to be on the clock…who wants to have freedom of movement…who wants to be able to do this without an anesthesiologist present, right? So, really focusing on normal, natural, physiologic birth, and that person has to be low risk though. So, those options are only for individuals where they, or the baby…and the baby, are healthy, right? So, there can’t be any issues with either one of them, and that would provide for them more options. So, a person who’s low risk, can have a choice. They can have a birth at a hospital. They can have a birth at home. They can have a birth at a birth center. And it’s really about what they want. So I think what’s beautiful about a birth center, is that it encompasses all of those values of providing the space, the warm sacred centeredness of what birth really should be in that space, with a little level of kind of ‘Oomph’ of support and care from a midwife, or an OBGYN, or a nurse in that space too.
NP: I just think that birth center/home birth is very similar, except we do the cleanup. *laughs*
MGC: *laughs*
CC: Basically.
NP: We do the cleanup at the birth center! *Taps counter* Um, also another there’s another thing that you mentioned when it came to freedom. Freedoms to eat…drink. You know there’s a lot of umm…stipulations around what you can and can’t do when you are in a hospital setting, especially if you get an epidural. It’s very clear. You cannot eat. You cannot drink. Maybe you’ll get some ice chips. That’s just the standard, and you’ll automatically always get an IV. That just comes with this territory. That’s hospital policy, and there’s nothing against that. That’s part of the policy. The goal is to be safe in that situation that might high acuity, especially if you’re dealing with higher risk patients, or a patient that was low-risk and became a little more high-risk, meaning they had to either be risked out of the birth center prior to coming to the birth center, or they risked out while they were at the birth center, or they had a great delivery, but required a little bit of follow-up or evaluation in a hospital setting. These are the things that come with the hospital policies. So, you’re going to need an IV. They want access. They want to make sure that if we have to deliver medications, we want to make sure that we have easy access, because if you don’t want anything to happen so urgently or emergently, and you don’t…you’re not having access to the patient to give her what she needs in that moment. So, that…whereas at the birth center, you’re not going to be inundated, per se, with an IV. There are times where an antibiotic might need to be administered, and that’s something that comes with the normal screening that we do in our prenatal care setting, like an antibiotic to, kind of, protect the baby from any bacterial exposures during the vaginal delivery, but they still are free to be able to move around, eat, drink, walk…whatever that might be, and, you know.
Host: So, what are the benefits of eating during labor?
*pause*
MGC: Sustainability
NP: *laughs*
MGC: …and energy, so that you can get through that labor. Just think about doing anything that requires a lot of work without eating. A lot of people hit a wall. They can’t get through it. Even people with the intentions and a desire to want to have a natural birth, usually get into a space where they just can’t go anymore, because they have not had the opportunity to fuel themselves. So, it’s important to be able to eat, because it is a human right and a human necessity.
Host: So, what disqualifies you as a candidate for the birth center?
NP: I would say, first and foremost…twins. *laughs* Multiples. We’ve had multiples…patients come in saying, “I had 3 vaginal deliveries, and I’m having twins. I had all normal deliveries. Can I come to the birth canter?” And we’d be like,
MGC: “We’re so sorry.”
NP: “We would love you to be at the birth center, but we cannot. It’s only one baby at a time.” You know, we can only take care of one baby at a time. That’s not considered a low-risk situation, not matter how low risk the mom may have been in her previous deliveries. Having more than one baby is not considered low risk. Umm…as we discussed…diabetes. Diabetes that might be acquired in the pregnancy, we may call ‘gestational’ diabetes. Low risk…a patient that can remain low-risk even if they have gestational diabetes, as long as it’s a diet-controlled, and it has to be well-controlled on diet. But once we have to initiate medications, such as either oral medications or insulin, or if you had diabetes prior to the pregnancy that required insulin, then, in that situation…no, that’s not considered a low risk pregnancy. #1) Unfortunately…blood pressure. Whether you had it before, even if you had low-risk deliveries, even if you have the best-controlled blood pressure, if you walk into the pregnancy with blood pressure, whether you’re on medication or not, it’s not considered low risk. If you acquire blood pressure in the pregnancy, or preeclampsia, which is what our biggest risk factors are, unfortunately these days…especially among women like us, black and brown women, that is considered immediately risking out of the birth center. Umm, what other things we can think of that say, ‘Hey…this is not a good candidate.’
MGC: Someone who’s already had a cesarean the first time and is looking to have a VBAC.
NP: …for the first time.
CC: …for the first.
NP: Right. Vaginal births after C-sections are all right at the birth center, as long as they’ve proven their pelvis, meaning they’ve had a vaginal birth after C-section. It gets a little tricky when you’re talking about people who’ve had a vaginal birth after C-section, and then had another C-section, and now we’re talking about 2 C-sections. Things get a little…we wouldn’t want to have a patient even though she’s had a vaginal birth or VBAC, to have 2 previous sections and then come in and try to attempt another VBAC, that’s not considered a low risk.
Host: Now can I go to the hospital and have a natural delivery with no intervention?
MGC: Absolutely.
CC: Of course.
NP: Again, it’s your choice. As was said before…when you’re low risk, you can choose to deliver anywhere you want…even on Garden State Parkway. No…just kidding. *laughs*
Host: Are you able to have a birth plan in a hospital?
All: Yes
Host: …and have that followed?
CC: I think it’s important to go over it with your provider that your seeing, just so you can set realistic expectations, because…it is right that it’s your birth, and we like things to go according to how we plan them, but there are, like Dr Pemberton was saying, there are policies that certain hospitals do follow just because of that’s just how it is and certain things can’t be done in a hospital, and it’s important to just, you know, educate your patient on why that is and alternatives if that’s possible, and the things that are okay as part of the plan.
Host: What is the importance of a birth plan?
CC: To give the patient autonomy. To let them know that ‘Hey, this is what you would like to happen’, and, I mean, it’s your body…it’s your pregnancy…it’s your child, and this is something that going to follow you throughout the rest of your life. So, it is important to each family that how they want things to proceed is respected and followed, because that’s just your right as a human.
MGC: I like to, um, when I’m teaching classes and I’m talking about birth plans, I’d like to have my students kind of think of about their top 3 “non-negotiables”. Like what are these things that absolutely have to be present for their birth experience? And it could be whatever it is personal to them…doesn’t necessarily always have to be a medical situation. It could be who they want in the room. It could be music that they want to play. It could be, you know, sounds, um, food…whatever like, those type of things might be more important to them. Some people want exclusive freedom of movement, right, so wanting to wait to the absolute last minute to get that epidural, if that’s something that they’re looking to do. So, based on those ‘non-negotiables’, then that’s where I help them create and craft a plan that makes sense to their health, their baby’s health, and their birthplace. Because, where you birth matters, like how you make that decision, and what you want to put in that plan, has to be specific to where you’re going to give birth, and who you’re going to give birth with. So, like Chidera said, we’re talking about realistic expectations. You can’t…there’s specific things you’re not going to be able to do in a hospital space. But if you have the wherewithal to go, “Okay…well, I know that I’m not going to be able to do that, but I want this instead…that’s usually great. Right? Like you can work around those things. But it’s really about putting that plan together that makes sense for everybody, and the doctor needs to be in on it.
NP: Yeah.
MGC: Like…it’s…
NP: Your whole provider team should be in on it.
MGC: Yeah. It’s like a script.
NP: That’s the biggest thing is, especially if you’re going into a hospital setting. If your practitioner/your provider knows, whether it be your midwife or the OBGYN, knows what your desired plan for your labor, for your delivery, for your birth, this is where you are, hopefully, getting the people who you have trusted and trusted to care for you to be a part of your plan. And in being a part of your plan, it allows them to also be your advocate as well….to see if those plans can be followed. Again, sometimes, as Michelle was saying, you’ve got to make sure expectations…they’re not always going to be steeped in reality, sometimes. But here’s ‘expectations’ *raises hands and brings them together*, and here’s ‘reality’, and we’re going to try to work with you to bring something in the middle. We kind of bring it all together, if we can. Sometimes, things might change a little bit here and there, but we’re trying to prevent it from going ‘left’. Umm, and so letting us know what your desire can help us to be able to say, “Hey, let’s educate on where that will be, you know, true, that we can follow through with that, where that might be kind of false, where we may not be able to, and where we can be able to have alternatives and be able to have options and plan B’s and plan C’s, but then also trying to say if we can keep that within the realm of what you desire for your birth.
MGC: But it’s key to have that flexibility in the plan…the plan. A lot of people don’t like the word “plan”, right? Maybe thinking that it’s ‘preferences’ or ‘the landscape’, or I had somebody who gave me, what they called it, “birth vibes”.
NP: *laughs*
CC: *laughs*
MGC: …and I thought that was super cool. I’m like, yeah, this is the vibe we’re at. Like this is where we’re chilling, you know? But having that level of flexibility to say if something shifts and changes, right now…now we can’t birth at the birth center, now we have to go the hospital, so how do we how bring this birth plan to the hospital? Right? Or we’re a home birth…how do we bring it to the hospital? You know like, whatever that transfer looks like, needs to be part of the plan too.
NP: I’m glad you made that point too, because a lot of the times, people will have a misunderstanding that even though home birth is the ultimate low risk and the type of birth you can have in your home, they think that birth center is ‘intermediate’, and then, hospital. So, they think, “If something happens at my home, and I’m not doing well when it comes to my home birth at home, can I come to the birth center?” We’re like, ‘No…you cannot’. Because home birth and birth center, as I said, are pretty much on the same…they’re ‘on the level’. The only thing is we do cleanup…I said that before…that’s the only difference. Otherwise, if there is something out-risking you from a home birth, it’s already out-risked you from the birth center, and whatever is the next step, is usually the hospital.
MGC: A lot of the times I’m asked, “If I don’t have a doula, will my midwife support me?”
NP: *looking at Chidera* So, what say you? *laughs*
MGC: *laughs*
CC: Yes, of course. That’s what we’re here for. Umm, we’re all a part of the labor team, right? So, we’re here to be of service to you. There are a lot of parents who don’t know what they don’t know, um, and as much as you can prepare, you don’t really know what you’re going to go through, until it starts to happen. So, of course, we’re here for you, you know, to assist you through all the questions, position changes, non-pharm labor mechanisms to help with pain. Of course…yes. Short answer.
Host: You guys rocked it.
CC: In closing…you know, we should do this more often.
NP: Yeah, we should. Next time with wine. No, just kidding.
MGC: No, I’m not.
NP: *laughs*
CC: *laughs*
MGC: Umm, we should have glasses in front of us and, next time, I want you guys to join us.
CC: Just mugs. *laughs*
NP: Feel free to submit any comments, topics of discussion you’d like to…or questions you might want to ask…things that we can clarify to give you some real-life situations, experiences. Give you some good information…good education.
MGC: What do wanna know from a doula, a doctor and a midwife?
NP: There, you go…walk in a bar. No, just kidding.
All: *laughs*
NP: And we’ll have the wine.
All: *laughs*
Fade to black…
Episode 6 Part 2
What they said….
0:09
Us women have different type of nipples
0:11
and when do you feel like it's a concern
0:14
um I feel like I've seen patients who
0:16
have inverted nipples have flat what
0:19
would they do in that
0:20
situation there are exercises to release
0:23
the FR
0:25
fulum right so you can do some ex some
0:28
of its hand expression some of it's like
0:31
actually there's a like a little tube
0:34
that you can use to kind of pump and get
0:37
the nipple out wct first before you
0:39
latch the baby on so they may have to do
0:42
like a little bit of work before the
0:44
latch um the goal is to give baby
0:47
something to latch on to and if we can't
0:49
get that to happen then you can use a
0:51
nipple shield that has a l that has a
0:53
nipple and then the baby can learn I I
0:56
always say use that as a crutch a nipple
0:58
shield a nipple shield until because now
1:01
every time the baby latches on it's
1:03
pulling on the nipple same like
1:05
releasing releasing the the fulum and
1:09
now the you know the nipple can come out
1:11
a little bit more and the more now you
1:13
know since the mom can just tossed the
1:17
The Shield the and you have to get uh
1:20
the nipple shield sized right like you
1:21
have to have like it's it size for say
1:24
size but I think you could try different
1:26
sizes to see what works they're really
1:28
not that expensive target has them you
1:31
know I always start off with zero and
1:34
then you know they unless you're really
1:37
nursing an older baby um you don't
1:40
really want to move to like two yeah but
1:42
it's like zero to one sometimes double
1:44
zero is actually even even nice too just
1:47
enough to get baby to latch on and feel
1:51
comfortable and Mom Mom's like oh yeah
1:54
that's better yeah they have nipple
1:56
cream for like crack nipples and things
1:58
T has like actually lot of stuff for um
2:01
lactation I feel like when I when I saw
2:04
what is this crave of this rage about
2:07
like all of these brownies and
2:09
cookies I was I was waiting for that
2:12
question but like and the tea and the
2:15
and the the the powders the juice so
2:19
they're all called Galactic
2:21
gos and just means stuff to make milk
2:26
flow or whatever and some of them can be
2:29
hon honestly like just mental mental
2:33
like I'm eating this cookie and I'm
2:35
going to have more
2:36
milk and so if that works then it works
2:41
um but yeah I mean you know the thing is
2:43
is is
2:46
nourishment you're going to buy all
2:48
these things to
2:50
eat because okay I'm not I'm not going
2:52
to like add more milk to my to you know
2:56
to the process here but you just need to
2:58
feed yourself yeah right and
3:01
snacking every time like we say you're
3:04
breastfeeding your baby feed yourself
3:06
too so you have water you have a snack
3:10
you have something on the side it's
3:11
super dehydrating I tell patients all
3:13
the time treat your body like when you
3:14
the baby was still inside you the same
3:16
thing when you talk about having good
3:18
nutrition being well hydrated eating the
3:20
healthier foods getting you know calcium
3:23
rich St whatever it might be treat your
3:25
body like you still pregnant and drink a
3:27
lot of water yeah because you have
3:30
you have to I I felt so dehydrated and I
3:33
felt like I had the toughest workout
3:37
after I breastfed I was like wow I'm
3:39
like really thin right now or
3:41
something's going on I feel good I'm
3:43
looking at myself I'm like am I getting
3:45
skinny another benefit yeah right like
3:48
you're dropping weight right it's
3:50
beautiful because you are burning
3:52
calories to to make milk and into
3:54
breastfeed start have to consume the
3:57
calories bre you use it's for way like
4:00
five is it 500 calories but what gets me
4:03
is that sometimes women get get so I
4:05
don't know overwhelmed with everything
4:08
sometimes we just transition into the
4:10
whole new mom thing that they might the
4:12
typical things I forget to go to the
4:14
bathroom I forget to take a shower I
4:15
forgot to sleep today I forgot to eat
4:17
and those are the things and then they
4:18
say why am I not milk making yeah I feel
4:20
personally attack let's go back we're
4:23
not trying not you but it just I feel
4:25
like that's how you feel when you it's
4:29
overwhelm come home and you're going
4:31
through postpartum it's like all your
4:33
attention is there and then you forget
4:36
to eat you for you're like I have to do
4:38
this I have to and and me it was like I
4:40
have to pump I have to do this and oh I
4:43
I didn't even shower today the pump
4:45
stuff but I didn't forget that coffee
4:47
cuz there was no way I couldn't deal
4:48
without that coffee um and I felt at
4:52
first that was what was challenging
4:55
because I wasn't producing because I
4:57
wasn't you weren eating
5:00
you or was hydrating myself and you
5:02
weren't hydrated and you probably
5:04
weren't sleep sleeping yeah
5:07
all it's super important and it sounds
5:10
like oh yeah that's really easy just eat
5:12
it's not go ahead just eat go it's it's
5:14
not it takes that's why you need to have
5:16
like everybody has a birth plan we
5:18
talked about this before very few people
5:20
have a postpartum plan who's going to be
5:22
there to help you particularly if you're
5:24
trying to breastfeed yeah you need you
5:27
need support support you need support
5:29
you need somebody bringing you meals
5:31
every time you're eating uh you're
5:34
feeding the
5:36
baby good you don't need to be prepping
5:38
that stuff for yourself yeah that's a
5:40
lot meal prepping is good
5:42
before before you deliver I hear it's a
5:45
good idea to have
5:47
that
5:51
um why is it insurance is does insurance
5:55
cover like lactations like if you were
5:57
to come out when would insurance cover
6:00
that insurance would only
6:03
cover wouldn't cover me because I'm not
6:06
an
6:07
ibclc right so I'm not an international
6:11
breastfed
6:14
breastfeeding oh my God certified
6:16
liation consultant that's a lot ibclc so
6:21
those are typically like um you know
6:25
sometimes they their their nurses or
6:28
their midwives
6:30
um who get this um certification so
6:33
because it's under that medical umbrella
6:36
then they then insurance covers it but
6:40
um you know meetings from a certified
6:43
liation consultant or a certified
6:45
lactation educator or a breastfeeding
6:48
counselor or any of those things would
6:50
not be covered by Insurance okay so it's
6:53
good to even just call your insurance
6:55
and see if they have those benefits and
6:58
if they can give you like a referral
7:00
and it' be great because if they do you
7:02
usually get like six visits oh nice with
7:05
an
7:06
ibclc nice and also even though we try
7:09
to encourage breastfeedings for those
7:11
who do have to consider the pump I was
7:13
one of those people because going back
7:15
to work was tough and I had to find a
7:19
way to try to continue the breastfeeding
7:21
Journey but go back to work so the
7:24
breast pump is also something that
7:26
patients should always look into their
7:28
insurance companies and find out
7:29
covering breasts inste y get a most
7:33
times I think for the most part I think
7:36
most of them are covered what's the
7:37
difference between the hospital grade
7:39
and then the regular ones you see in
7:41
like a department store the power the
7:46
motor usually hospital grade it's just
7:50
that it has to it has to withstand
7:53
hundreds of uses every day right it's
7:55
got you know they don't want to keep
7:56
repairing a motor so it's it's usually
7:59
just
8:00
the intensity of the motor got it are
8:02
you a fan of those like to- Go bumps the
8:04
ones you kind of like put in your breast
8:06
th are
8:08
cute I look I would have loved I'm
8:12
not that would have allowed me to breast
8:16
work and your I a breast F longer I'm
8:18
not going to lie to you I just didn't
8:20
have accd I'm coming back to work going
8:22
okay I just did a full office hours and
8:24
then I had to do that C-section and now
8:26
it's about midnight and my breast are so
8:28
inor and then looking for a a pump
8:32
somewhere in a hospital just to to get
8:34
relief but then by doing it over and
8:36
over again my breast milk supply started
8:39
to decrease because I I know from my P
8:42
from just what I do I I tend to punish
8:45
my myself I punish my body I don't
8:47
hydrate on a regular basis throughout my
8:49
workday so I was decreasing and it was
8:52
getting discouraging because I really
8:53
wanted to continue but I didn't have
8:55
access to I would have loved that I
8:57
would have AB why do we put such such
9:00
pressure on ourselves um because we're
9:03
women I
9:05
was I feel I have patients who are so I
9:10
am not getting anything and it's like a
9:13
the world is coming
9:14
to and I'm just like yeah seriously and
9:17
that's that's literally what I get from
9:19
them it's it's just like I can't do what
9:22
I and you know that I have a lot of dads
9:24
who are like super supportive but we
9:26
really like come down on ourselves like
9:28
when we can't breastfeed and what do you
9:30
what do you say to your patients who who
9:32
just that's not the journey for
9:34
them if you've done anything you you've
9:38
breastfed your baby yeah right so if you
9:41
gave them even a week two ounces you
9:44
breastfed your baby so if that was your
9:46
goal
9:49
tick right so and they did just
9:53
go yeah okay I yeah you did that you did
9:58
what you could and in those moments and
10:00
you know let's we can talk about trying
10:03
to do more if you want to do more I can
10:05
I can really work on different ways to
10:07
kind of getting that Supply back you
10:10
know we can do that but some people are
10:11
just stick a fork and yump on this was
10:14
too much for me ADV manage and I need my
10:17
mental yeah and for me if I if if I see
10:21
you know mental health over you know
10:23
breed breastfeeding then it's mental
10:25
health it's mental health every day how
10:28
long can I go with without breastfeeding
10:30
and then say you know what I want to try
10:32
it again and see if I can I don't think
10:34
if your body is breasted your body is
10:36
breastfed you can kind of go back to it
10:38
because we had that epidemic when
10:40
formula was super low and couldn't find
10:42
Formula some people were trying to
10:44
revert after month or even a year
10:47
of so don't laugh at
10:51
me I was going to
10:54
bre
10:57
really bre for the last 18 years and
11:01
it's possible to
11:03
like yeah it takes work yeah you you
11:07
have to be very diligent at doing it but
11:10
yeah you can if there's any hormone
11:15
left that's there yeah you we got we got
11:19
a chance we got a chance so there was a
11:21
there was a um I worked uh with a
11:24
48-year-old mom who was very worried
11:28
about you know her age and pregnancy and
11:30
the whole thing and you know she was
11:32
like I I want a breastfeed like this is
11:37
this is the thing I have to go like with
11:39
in life and this is this is it I'm like
11:42
all right we're going to do what we can
11:44
and I don't know if you know that
11:46
there's this system called supplemental
11:48
nursing system it's called SNS and so
11:52
it's like a little tube that's I guess
11:55
taped that's get taped right and there's
11:58
like a little you either wear like a
12:00
little pouch or there's a little
12:02
pocketbook full of milk it's either your
12:04
milk that you've expressed or it's
12:06
formula but whatever it is this baby is
12:09
now because what happens baby will not
12:11
latch on if they're not getting anything
12:14
of course right of course right they'll
12:16
be upset they'll be like mad and yelling
12:18
so you're constantly flowing something
12:21
into their mouth and they're getting
12:22
rewarded for the job that they're doing
12:24
and then what does this do it's
12:25
stimulating your breast to start
12:27
breastfeed to breastfeed and rest for
12:29
that baby until he was five
12:32
nice yes so it so then you are basically
12:36
saying so those who get discouraged from
12:39
age alone yes it's still possible it's
12:42
still possible don't use that as a as a
12:44
reason how would you even start that
12:48
journey I I mean it would just have to
12:50
be you know making it a plan to say I'm
12:53
going to spend x amount of hours a day
12:56
doing this like it's it's work yeah you
12:59
know I saw this episode on working moms
13:02
where there was like an older her kids
13:05
were like 21 and she was selling them
13:09
off but she was over producing to the
13:12
point where she was like I can't stop it
13:15
I can't I was like wow this is really a
13:18
thing yeah so okay that's good at least
13:20
you have women who can still try and I
13:24
and I want to say that it's not even
13:27
just you know um women like there's you
13:30
know individuals who've been trans or um
13:33
people who've adopted their babies right
13:36
yes and they want to experience they
13:38
want the experience of breastfeeding
13:40
that can happen with that that system
13:43
I've seen it work yeah more more times
13:46
than not can you say that that system
13:48
again what is supplemental nursing
13:50
system SNS nice to know okay sounds good
13:55
and how would I um store my breast milk
13:58
that's another question question I
13:59
usually get like how long is it in the
14:01
fridge if I'm pumping um can I leave it
14:04
out and for how long and for how long it
14:08
again
14:09
yeah okay so again there's a rule yes
14:15
there's like a rule of thumb um it's
14:17
kind of like you know 4 hours out like
14:21
you know just room temperature you just
14:24
pumped it it can hang out for 4 hours um
14:28
then I think it
14:31
ooh what I'm going to be wrong I think
14:34
it's three days in the
14:37
refrigerator and then the freezer is up
14:39
two
14:40
years 6 months in the regular freezer
14:44
and then year in a deep freezer deep
14:47
freezer okay okay cool cool but if it's
14:51
thaw right so if you've thought out
14:54
milk um it can't sit out again for 4
14:57
hours so it's just one 1 Hour 1 hour for
15:00
Tha milk yeah so we got to use it right
15:02
away yeah you got to use it right away
15:04
but fresh milk up to four hours fresh
15:06
yep got and I hear a lot from midwives
15:10
breast milk is great for everything oh
15:12
my God it's the miracle everything yes
15:15
my son had like the baby acne I just
15:18
said in the bath water I promise you
15:21
next day it was like they were like
15:24
almost gone I was like what is in this
15:29
wow you know like they're like oh he has
15:32
a little bit of red put some breast milk
15:35
put I'm like it's all the antibodies and
15:38
the antiviral application inside of the
15:41
breast the natural neor is amazing the
15:44
natural steroid so a milk bass is a
15:47
thing milk bass is a thing heck whenever
15:50
my kids look like they had a cold I
15:51
would shoot breast milk in their
15:54
eye and their ears for ear infections
15:58
that's because
16:01
bre was
16:03
gone I need hey you got some breast milk
16:06
yeah cuz I think I'm having like a ear
16:07
infection I want to go to my primary
16:11
today he's they don't have an
16:12
appointment
16:14
you anything you know you see your baby
16:16
like tugging on their air you just be
16:19
like
16:20
[Music]
16:25
it I mean it's yeah it's so funny
16:28
because people like I don't
16:30
know people don't look at what a breast
16:33
can do and what it what it looks like
16:36
when you're breastfeeding and if you
16:37
were to hand Express you know every
16:40
thinks there's supposed to be like one
16:41
little string it's like a shower head
16:43
it's a shower head and it's just this
16:45
beautiful stream come I and I would yeah
16:48
me I would I would hit my husband all
16:50
the time with
16:52
it just just to be
16:55
funny oh God he's like I can see so much
16:59
better
17:02
now uh but cradle cap also oh good help
17:06
dissolve a cradle cap oh nice good just
17:09
breast milk there little hair brush
17:12
you're good to go yeah when do I know
17:15
when should I consult look for a
17:18
laxation
17:19
consultant yeah so whenever you know
17:23
your baby's dropping
17:24
weight um and you're breastfeeding
17:27
consistently and you know you're still
17:29
not getting um any kind of good weight
17:32
gain any kind of recovery there's
17:33
there's going to be a normal about 7%
17:36
loss of weight um just just because the
17:41
first milk is colostrum and then the the
17:45
you know we're going to wait a couple of
17:46
days for the other milk to come through
17:48
yeah so you know there's going to be a
17:51
little bit of that dip and sometimes it
17:52
can go as deep as 7% up to 10 sometimes
17:56
right it depends on the pediatrician
17:58
whether or they're okay with it but um
18:02
if you're if they're not recovering from
18:05
that then you know check a lactation
18:07
consultant to see if the latch is okay
18:11
if you know um if there any lip or
18:13
tongue ties or cheek ties or any of
18:16
those things that are impeding you know
18:19
a good latch you know for good
18:22
feeding and then if there are any you
18:24
know other obstructions with the boobs
18:26
if there any um still have painful Ates
18:30
and or you know the types of nipples
18:32
things like that like we mentioned
18:33
earlier on postpartum do you get a lot
18:35
of patients who ask you like hey I've
18:38
been trying to breastfeed it's not
18:39
working what what do you say on your
18:41
your six we postpartum because that's
18:42
usually like when they discuss these are
18:44
all my what's going on and what do you
18:47
end up telling them like if they're
18:49
having issues with breastfeeding in
18:50
general yeah like kind of first start
18:53
with what they're doing already at home
18:56
like what their regimen is what have
18:58
they been bre beinging is this a new
18:59
issue where like a lot of patients will
19:01
say I had great Supply and then all of a
19:03
sudden it dropped down a lot of moms
19:06
going back to work or did go back to
19:08
work so that could have been an issue or
19:10
a lot of them were like the baby's
19:12
sleeping I'm sleeping I'm not really
19:13
doing anything and like Michelle was
19:16
saying like not hand expressing can
19:17
decrease the milk sply not eating which
19:20
a lot of them don't eat cuz they don't
19:22
have time to
19:24
understandably biggest thing I get is
19:26
it's easier said than done people tell
19:28
me to eat but I can barely sleep I'm
19:31
always up staring at this baby so I know
19:34
what I need to do but I'm not doing it
19:36
so starting from the issue yeah the
19:39
support system starting from there
19:41
before you just say
19:42
Okay lactation you got a problem usually
19:46
that so we know what to do it's we just
19:49
don't do it sometimes right yeah
19:52
sometimes you don't you know what to do
19:53
or other times you're being told what to
19:55
do but then it feels overwhelming when
19:57
you say this is what I have to do to
19:59
achieve what I want to achieve it's like
20:01
I got a lot on my plate you know and
20:03
again sometimes even and this even from
20:04
a personal perspective sandwich
20:06
generation we have a lot of patients who
20:08
are doing that battle where they might
20:10
be taking care of of of of parents
20:14
elderly you know elderly person in their
20:16
home and they have this newborn and so
20:18
they I always say caretakers don't take
20:21
good care of themselves yeah um and
20:23
that's something I've lived so I can
20:25
understand that that battle of this baby
20:27
needs me and I'm going to do everything
20:29
I can for them and then I have my
20:31
elderly parent and I'm going to do
20:32
everything I can for him or her and they
20:34
are now out of the equation of what they
20:36
need to do and then say but then now
20:38
this is not happening and now I'm
20:40
experiencing these things and what do I
20:42
need to do well unfortunately you you
20:44
can't po from an EMP they come correct
20:46
you're taking care of all these people
20:48
in order I always say in order to give
20:49
to your your your your baby you got to
20:51
give to you and that's a hard concept
20:53
when you feel like you're running with
20:55
all these other things in a life be
20:56
Legend sometimes and so that's a little
20:59
frightening how do you give you know
21:01
information to things that they know
21:03
they need to do and what they can
21:04
improve when it comes to their
21:06
breastfeeding Journey but then executing
21:09
that and a lot of the times it's just
21:11
support okay well we got a lot of good
21:14
information here um it was a pleasure
21:17
talking to all you ladies uh we need to
21:19
do this more often yes
21:21
wait frequently right um and thank you
21:25
for for all that information for mamas
21:29
who are either had a baby or about to
21:32
have a baby or planning to have a baby
21:34
um another baby or planning to have
21:36
another baby
21:37
right um tune in to our next episode
21:40
thank you for watching and please
21:41
comment and subscribe on our Channel
21:47
[Music]