PREGNANCY/BIRTH FAQ


Questions:

 


Answers:

  • What are some Care Provider options (OB, FP, CNM, DEM, Doula, Unassisted)?

    • An obstetrician is a surgical birth specialist. This does not mean an obstetrician does only surgical births, it means that obstetrics is a surgical specialty in med school. OBs are able to conduct a variety of tests and perform a c-section if necessary. OBs mainly deliver babies in hospital, though some do birthing center births and a very few will do homebirths. Information about obstetrics can be found here http://www.acog.com.

    • A family practitioner is a family doctor who does births. FPs are qualified to conduct testing, and use any intervention except a c-section. If a c-section is required an obstetrician or general surgeon will be called in. FPs deliver in hospital settings, a few in birthing centers, and a few do homebirths (mainly in the UK).

    • A certified nurse-midwife is a midwife who has completed a nursing degree and a masters program in midwifery. CNMs are able to conduct all testing and perform any intervention short of a c-section. If a c-section is necessary an OB or general surgeon will be called in. A CNM gives a more personalized level of care in general and most are more oriented towards natural birth (in the US at least). CNMs can do hospital births, birthing center births, and in a few states and provinces homebirths. Please see http://www.midwife.org for more information.

    • A Direct Entry Midiwfe is a midwife who has had training through the apprentice model and/or through a 3-4 year school specifically for midwifery. Direct Entry Midwives do homebirths, some birthing center births, and in a few places are granted hospital priveleges as well. DEMs are natural birth advocates and in general do a minimum of interventions. DEMs are often able to arrange testing but many work from the philosophy that overuse of testing is unnecessary and potentially harmful. http://www.socalbirth.org/ has information about Direct Entry Midwives.

    • A doula is a Labor Support Person. This is not to take the place of a partner or husband but to aid in the physical aspects of labor support (such as back rubbing, ideas for pushing positions) leaving the partner to do what they do best, loving the mother. =) Please see http://www.dona.com to learn more about doulas.
    • Unassisted Childbirth is sometimes referred to as "do it yourself homebirth" or "husband wife childbirth" or "purebirth" or "sovreign birth". This is birth where the woman and sometimes the partner are the only attendees. The mother can either follow regular prenatal appointments with an OB or midwife and choose to birth alone if all tests indicate things are going well, or some choose to shun testing all together and provide their own prenatal care, watching for signs and symptoms, getting medical help when warranted. Unassisted Childbirth is not a decision to be taken lightly and people should be aware this is the highest form of responsibility to take, to be completely and soley responsible for one's own birth and newborn. For more information on Unassisted Childbirth, please see http://unassistedchildbirth.com.

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  • Where do some women give birth?

    • Hospital: This is where most women in the western hemisphere give birth. A hospital can provide the security of all the emergency equipment being immediately available. It can also lead to power struggles and interventions because those security options are there. Always check to make sure your care provider's philosophy matches yours.
    • Birth Centre: This is becoming a popular option for those who desire the intimacy of a homebirth but are not comfortable with the lack of hospital safety equipment, or do not feel comfortable birthing in their own home/apartment for whatever reason. Birth centres are either on hospital grounds or within close proximity in case of emergency transport.
    • Home: This is where most women outside the western hemisphere give birth. Homebirth has been proven safe repeatedly for low risk women and children, and in many instances is even acceptable for "high risk" situations like VBAC, twins, or breech births. Hospital birth has never been proven to have better outcomes than a homebirth for healthy women with healthy pregnancies. Giving birth at home usually eliminates unwanted pushing of medication and authoritative medical personell conflicts, but as always make sure your care provider's philosophy matches yours. In case of emergency situations, the mother is transported to a nearby hospital. To learn more about homebirth, please see http://www.midwiferytoday.com/articles/homebirthchoice.htm and http://www.geocities.com/Heartland/Hills/2510/joinring.html to look at web sites of families in the Homebirth Web Ring.

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  • What tests did you take during pregnancy? Why did you choose them?

    • I had the 18 week test where they test for neurological disorders and down's syndrome. It seemed like it would be better to be prepared. I have spina bifida, and while it's not hereditary, I just wanted to know if everything was OK. With my current pregnancy, I do not intend to have any testing done beyond urine, glucose and iron unless the midwife suspects a problem. I'm not sure why I've changed my perspective on it - I guess it's just that it wouldn't really change anything to know ahead of time.
    • I got everything the OB/GYN recommended or said was "routine." Just for safety's sake. I was a first time parent and I believed in "better safe than sorry."
    • [I had] usg X3 as well as genetic usg, afp, gtt, amnio I was 39, was taking medications, including lithium which was a known teratogen. I would have aborted a genetically abnormal child.
    • Amniocentesis. We wanted to know if the baby was okay.
    • I had several early sonograms. The doctor did the first one to verify the due date, and I asked for it anyway, because I've had endometriosis and was therefore at risk for an ectopic pregnancy. A sonogram is the only reliable way to rule that out. The other sonograms were, in my opinion, unnecessary; the doctor did them because the equipment was right there in his office. He didn't charge me extra for it, but when I asked him why he was doing them, he just said, "Oh, I just want to see the baby." He didn't do any more after that. I switched to midwives at 30 weeks.
    • I took the triple test for Down syndrome/neural tube defects, because it wasn't invasive. I was tested for toxoplasmosis, I believe (although this might have been done when I had a prepregnancy checkup and asked that certain things be tested). I had two glucose tolerance tests, because I switched late in pregnancy, and the midwives didn't accept the doctor's results. I had several nonstress tests, because my daughter was past due. I also had a biophysical profile for the same reason.
    • Maura: US for dating purposes, AFP, US for development check [20 weeks], glucose tolerance test [1 hour], standard bloodwork set [iron, cell counts, HIV, Hepatitis], non-stress tests [several], biophysical profile.
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      Reason: they were the "standard set", and the last 2 [NST, BPP] were done because I was post-dates.
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      Aidan: US for development [20 weeks], GTT [1 hour], NST, BPP.
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      Reason: US was encouraged by midwife, regular urine tests at appt came out showing sugar, NST & BPP because post-dates.
    • The only prenatal tests I had were blood tests for iron, the one hour glucose test, and the strep B test. These were the ones that were recommended by the midwives and that I felt were in my and the baby's best interests. Also, because I am overweight and wanted to feel a little more secure about not having gestational diabetes.
    • amnio - age over 35 (36 yrs old) ultrasound - had an early one to determine due date (period has not returned after birth of 1st child) non-stress test - they thought the baby was too small.
    • I tried to only do tests that I could do something about to help the baby.
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      Ultrasound at 22 weeks - I was planning a homebirth. I wanted to know if there were any conditions (spinal bifida, certain heart conditions) that would make a hospital birth safer. We also were thrilled to see our baby, but we wouldn't have done it just for that reason.
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      Glucose Tolerance Test - again, to benefit the baby. It was negative, but if it was positive I would have changed my diet.
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      Group B Strep test - If it was positive, I would have considered getting IV antibiotics in labor. This wouldn't have affected my ability to have a homebirth.
    • I had level II u/s (gentics history), stress test (hi bp and early contractions). refused the afp on grounds of uselessness! various other stuff. Nothing really unusual. Opinions on amnio, etc. (Oh, and I refused a test for tubal pregnancy, given routinely at four months -- isn't *that* ridiculous!!!)
    • 1) All the run of the mill tests. Blood tests, glucose drink (diabetes), US at 7mo gestation. Can't remember all of them.
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      2) AFP, glucose, US at 5mo gestation. Again others I can't remember.
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      3) Again all of the regular tests. I had 2 US this time because the first caught a slight placenta previa and a possible kidney problem. By the second US, both problems had resolved. I also had a non-stress test when Joseph was about a week overdue.
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      I got all of these mostly because the doctors or midwife wanted to have them done, and they were completely covered by insurance. If they hadn't been covered, I probably would have nixed a lot of them.
    • I had the AFP with first preg only. I had 2 amnios with the first preg only (the first because I got a flase positive with the AFP, the second to check lung development because we knew she would be preterm.) I had countless non- stress tests with both preg. I had several level 2 untra with the first preg.
    • So far, we've not opted to do any testing.

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  • Did you have false alarms as a result of tests performed during pregnancy?

    • The false positive with the AFP was terribly stressful. It was not explained to me properly in the first place. The results were not properly explained to me (I thought for several excruciating days that it meant there was something definitely wrong with the baby). The fact that the test was taken in the wrong week, and the fact that that scewed the results, was not properly explained to me. For 2 heart-wrenching, gut-wrenching weeks, I did not know if my baby was ok. I had to have an amnio, which i dreaded. It turned out to be not that big of a deal. Not that painful. The baby moved around a lot that day though. they said it was normal. The second amnio was necessary so I have no problem with that one. It prevented her from being delivered before her lungs could handle it. (She ended up being born spontaneously a couple days later anyway, with immature lungs, but at least that bought her a couple of days.) The non-stress tests were no biggie...they actually gave me peace of mind that my babies were doing ok in there. I had months of preterm labor with both of them, incidentally.
    • Yes, I (or rather the baby) was diagnosed with IUGR (Intrauterine Growth Retardation). This turned out to be false and caused me to go through 2 failed inductions and a lot of unecessary stress.
    • The first glucose test came back with elevated numbers, I refused the more in depth test and modified my diet according to someone who may have had diabetes. Since I took the test so late in my pregnancy, I thought it was futal to sit for 3 hours only to be told to do something that I could easily do without sitting for the test.
    • I had a positive screening glucose tolerance test which caused worry on my part, and time out of work. A pain in the neck.
    • At the amnio, they did a whole lot of sonograms to be sure the baby was away from the needle insertion point. I was glad because my baby was in the farthest corner possible away from where the needle went in. We got some good pictures. One pic made me feel a little bad though because Julian's arms were up over his head, as if motioning 'no more'. They did push him around a lot taking the sonograms. I'd be bent out of shape too if it were me. But to answer the question, they said two of the ventricles of his head looked too large and scheduled me to come back so they could check the measurements again in one month's time.
    • With the biophysical profile, the technician scared me and my husband by telling us that the baby's bladder was very large. She got her superior, and when he checked it, it had gone down in size--my daughter had peed. Interestingly, after she peed at birth, she didn't pee for another 30 hours. In light of what happened during the biophysical profile, this was extremely alarming for my husband and me!
    • On Maura, almost every thing came out false:
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      - dating US came out 2 weeks different than I *KNEW* my dates to be [sex once during cycle kind of makes the dates certain, irregular periods or not]. Result to pregnancy/birth: I got 2 extra weeks before they induced. This was good at least.
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      - AFP came out high. HOWEVER, it came out accurate if they based in on *my* conception estimate. So I ignored it. Didn't worry the rest of pregnancy, though I was pushed to get an amnio, which I refused.
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      - BPP indicated that baby was in distress [scored 3 of 10 points], forced an induction.
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      With Aidan, the US showed no heart chambers and no kidneys. I spent two weeks in hysterics before a better sonographer/radiologist read it and said that they WERE all present. And the BPP showed low amniotic fluid, again causing induction.

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  • Was your care provider an OB, Perinatologist, Family Doctor, Naturopathy Doctor, Chiropractor, Certified Nurse Midwife, Direct Entry Midwife, or was your birth unassisted by choice? Why would you choose or not choose this kind of provider again?

    • If I were going to have a homebirth I would want a midwife.
    • First I had an OB, but because I realized I wouldn't get the drug-free, episiotomy-free birth I wanted with him, I switched at 30 weeks to a birth center with midwives (CNMs). I would do it with a CNM again, if possible.
    • My care provider was an OB/gyn. If we decide not to have a homebirth, I could see going to the same OB dr. however, I would hire a doula, and I would be better informed during delivery. I allowed many interventions that I would not allow in the future, ie., induction, ROM's, epidural etc.
    • 1) OB - Never again. He was horrible and thought he was god. I had no clue that I could find something better.
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      2) CNM - Absolutely *wonderful* experience. I would definitely choose a CNM again. They were much more in tune to what I was going through and were very non-inerventionist. I felt I could trust them to do what I wanted. During the birth, the CNM was there the whole time and not just flitting in and out like the doctors do.
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      3) Family Practice Doc - Depends on the doctor! This one was highly recommended by my Bradley teacher. He was great about all the prenatal visits and told me over and over that he was just there to catch the baby. I was the one who had to do all the work and make all the decisions. I would definitely go back to him again, but I would make sure to have a doula the next time. That was the only thing I missed this last time was having female support and having someone other than my DH be there the *whole* time.
    • I would stay with a medical doctor. My daughter was born with no respiration and a heartrate of 40--even though there were *no* signs of distress *at all* during labor and pushing. She had to be rescusitated by the nurses and a ped. who arrived in seconds from being paged--I don't believe she would have made it if we had been in a birthing center and she definitely would have died had we been at home. She made it with no brain damage becuase she was "bagged" with oxygen from the second they realized she wasn't breathing--they also had to do CPR--her 1 minute and 10 minute APGAR score was 1 and 3--she was finally OK after about 12 minutes.
    • Maura: OB. Aidan: CNM.
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      I won't go to an OB again. I didn't like the impersonal attitude and controlling that they tried.
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      I would use the CNM group again -- I liked them, trust them, and knew that I was working *with* them.
    • I had a regular OB, plus a Direct Entry Midwife. What I would choose next time, though there will be no next time, is a midwife and doctor who work *together*.
    • I had a midwife (CNM) and an OB. This time I am having a lay midwife and a homebirth, w/ a backup OB in case of emergency.
    • My care providers were Certified Nurse Midwives. I would definitely choose this type of care again because I felt secure and well-supported by their care. They were wonderful. Since I was so far from family and friends I needed this type of support.
    • I had OBs both times. I would consider a midwife next time IF she was associated with a high-risk OB. Having had one preemie was enough for me. I have had enough problems with both pregnancies to warrant close specialized medical attention. I would not consider a home birth for me because of that.
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      *****I am aware, rereading this, that I sure don't sound AP and "natural." Both of my births were totally unmedicated. I have nursed for a total of 6 1/2 yrs. I strongly believe in attachment parenting. BUT I had a lot of problems with both pregnancies, and I feel confident that while my care was not "perfect", it saved the lives of both of my babies and me. Thank God for my medical caregivers. Thank God for the interventions they offered me. If I had chosen to disregard their advice or their very unnatural testing/medicine/procedures, my babies would not be here, and I might not either. I do not have the opinion that most pregnancies are illnesses or medical crises, but mine were.
    • Direct Entry Midwife. I would choose the same midwife again. I feel that I had the highest possible level of medical care, from one of the most experienced practitioners in the area. I was fully informed of my options at every stage of my pregnancy and birth. They obtained informed consent for *everything* which as a survivor of childhood emotional, physical and sexual abuse was very important to me. And I had a great birth experience.
    • CNM for all visits, except one with an OB, and an OB looked at a later ultrasound to determine that the baby looked too small (actually he was born 10 days early at 6'2oz, very healthy) yes, i am very happy with kaiser. all the decisions are up to you, the patient. the birth was also exactly the way i wanted it (luckily the baby wanted to slip right out, not in any unusual position).
    • My care provider is a direct entry midwife (actually a pair of them) at an out of hospital birth center. So far I have been extremely satisfied with my care. I feel like I am being given adequate information to make decisions regarding my care. I believe that I have the greatest chance to have the kind of birth I want.

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  • What are some drawbacks of vaginal exams during labor?

    • Vaginal exams are used to asses dialation of the cervix. It carries a risk of infection which is why most caregivers keep them at a minimum, especially after membrane rupture. While knowing you've made progress can be comforting sometimes finding yourself dialated less than you thought can be devestating. It also enables labor to be tracked, and if your labor does not fit a curve of generally 1 cm to 1.5 cm per hour it can open the door for more interventions.

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  • What is fetal monitoring during labor?

    • Fetal monitoring is a good thing. It enables everyone to know how the baby is tolerating the labor. Unfortunately fetal monitoring usually means a mother lying down in the bed with a machine on her for 15 minutes of every hour. The same results can be had from a midwife, montrice, or nurse with a fetoscope or doppler. This enables mom to stay upright and mobile. Internal fetal monitors are electrodes screwed into the baby's scalp. This enables the baby to be monitored continuously, and is generally only used after a scare with the regular monitor. Keep in mind though there is absolutely nothing this machine can tell you that a caregiver with a fetoscope or doppler can't. This machine has a serious con, once you have the monitor on it doesn't come off until birth. That means in bed on your back or side from then on.

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  • What are some pain medications used during labor?

    • There are many different pain relieving medications for labor. However, none are without risk, even the highly touted epidural package insert reads "crosses placenta readily". Be aware of risks. Consider looking into natural pain relieving options such as water, jacuzzi, movement, massage, accupuncture, and hypnosis. Also consider even if you are sure you want medicinal pain relief, your choices may not be available, and you may find yourself forced into natural childbirth without preparation. Some hospitals give only epidurals for pain relief. Some only narcotics like nubain and stadol. Many women report the narcotics do not reduce the pain, but make it so you don't care, or more specifically are too stoned to properly communicate the pain you are in. Even if an epidural is available as an option, there may not be time to get one if you have a precipitous birth or if there is no anasthesist directly assigned to the L&D unit. If there is not an anasthesist assigned directly to the unit it could take a while to get one from another part of the hospital. See the epidural section for more information. Only in rare circumstances are medicinal pain relievers available at a birth centre, and not at a homebirth.

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  • What is an epidural?

    • An epidural analgesic is the most common medicinal pain relief used in childbirth today. The epidural is actually just the procedure, the needle and tubing to get the drugs in. Once in a mother can have a variety of different drugs. A thin, sterile plastic tube is placed in the patient's back by an anaesthetist/anasthesiologist. Local anaesthesia is inserted through the tube, providing pain relief. Sometimes pumps can be used to give continuous epidural drugs, unseful in the hours after a c-section.

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  • Does it hurt to get an epidural?

    • Local and regional anaesthetic techniques involve using a syringe and needle to inject drugs in the correct area. Most women report that yes, it does hurt to get the epidural put in and it hurts afterwards as it heals as well. The site of the injection will be swollen and bruised after the birth. During the operation, patients may still be able to feel touch and pressure or occasionally tugging. But patients should not feel pain during the child birth or in the case of a c-section, the operation.

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  • Do epidurals provide effective pain management during labor?

    • In any regional anasthetic, when the right amount of the right drug is injected in the right place, it usually will eventually work and provide good pain relief. The problem areas are usually putting the drug in the right place and waiting long enough for it to work. In some cases, the correct spot is easy to identify (e.g. spinal anaesthesia) while, in other cases (e.g. epidural, sciatic nerve block), it is harder to find the correct spot. Most blocks take 5-20 minutes to work. One of the worst potential side effects though of the epidural is *it may not work or may provide spotty relief*. This can be doubly devestating for a woman who has planned and counted on the relief of epidural analgesia in her labor. Not only is she shocked by not being able to get medicinal pain relief, she is completely unprepared to deal with a natural childbirth.

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  • What are some possible side effects of epidurals during labor?

    • The potential for side effects or complications exists with any form of anaesthesia. In general, local or regional anaesthesia is very safe, and usually safer than a general anaesthetic. The most common side effect is a temporary weakness or paralysis of the affected area. This usually wears off after a while. Complications may usually occur when the local anaesthetic is injected in the wrong place. If a large volume (10-20 mls.) of local anaesthetic is injected into a vein by mistake, it may cause convulsions and even cardiac arrest. This is why the anaesthetist always inject drugs slowly, sucking back on the syringe to check the local anaesthetic is not going into a vein. In fact major nerve blocks must be performed in an area equipped with oxygen, suction, drugs, and other resuscitation devices.
    • Some more benign side effects may include temporary weakness in the legs, difficulty passing urine (hence the catheters most women with epidurals need), and/or a decrease in blood pressure.
    • It is well documented that the incidence of c-sections, forcep deliveries, episiotomies, vaccuum extractions increase with the use of epidurals. One study found 8 times as many c-sections in mothers who chose epidural analgesia over natural childbirth. "Obsetetric Myths versus Research Realities" by Henci Goer has detailed studies showing the risks of epidural anasthesia and should be required reading for anyone planning an epidural. One of the most common reasons for interventions such as c-sections to increase after an epidural is that a mother often cannot feel to push or is unable to get in positions more conducive to pushing since she is numb. Her labor can slow requiring pitocin augmentation which can cause problems with the baby's heart rate. There is debate on whether an epidural can cause fevers. Some studies show yes and it is the most common side effect. Some anasthesiologists say it is impossible because an epidural is not in long enough to cause a fever. Regardless, women with epidurals tend to have more fevers than women without.
    • An epidural *can* speed a labor when a mother is stuck for a long time and has exhausted all other options. Many times when an epidural is administered and the pain is gone, a mother will progress rapidly as the "pain-fear-tension" cycle is broken. Also, in a mother with PIH an epidural can allow a vaginal delivery without the added trauma of a surgical delivery.

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  • Will drugs in the epidural reach the baby?

    • Put simply, yes. Despite widespread urban legend to the contrary, the package insert clearly states "crosses placenta readily." Babies born under epidural analgesia though are not as affected as babies born under traditional narcotics such as Demorol or Stadol. However, it is shown in countless studies babies born under epidural analgesia have harder times nursing and are more "sleepy" than naturally birthed babies.

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  • Can epidurals cause paralysis?

    • Paralysis after epidural anaesthesia is extremely rare, but it is possible. To illustrate the rarity, it is even rarer that death after general anaesthesia. The mid-lumbar spine location for most epidural techniques is chosen because of it reduces the likelihood of nerve damage. In this area of the back the spinal cord has finished and has divided into a bunch of nerves which float in an area filled with cerebrospinal fluid. A needle entering this area is unlikely to damage these nerves. Other risks include injecting the wrong drug, and the formation of a blood clot or abscess in the back. Careful attention to detail, and to patient selection, minimise these risks, making it safer than general anasthesia. This is why the epidural is the anasthesia of choice for caesarean deliveries.

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  • Who should not have an epidural during labor?

    • Women with back injuries or scoliosis may not be able to get an epidural. This depends on the skill of your anasthesiologist and extent of back injury/abnormality. Although rare, women with HELLP syndrome are also often unable to have epidurals or c-sections due to the lack of blood coagulation.

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  • Why is vacuum extraction used during labor?

    • Vaccuum extraction is used when the mother is having trouble pushing her baby out. It is a suction cup applied to the baby's head and then the vaccuum pulls the baby out. This is gentler than forceps and can help avoid a c-section. It can also cause head and neck trauma to the baby. Squatting or a hands and knees position for pushing can sometimes avoid the need for this. Only in rare circumstances can a care provider use this without an episiotomy.

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  • What's wrong with using forceps during labor?

    • Forceps were invented in a time when c-sections meant certain death for the mother. The idea was to knock the mother out with ether or strong alcohol, and after cutting a large episiotomy pull the baby out with the salad tong like forceps. Usually this also meant turning a transverse baby or a poorly presenting baby around, since at the time forceps were invented (16th century england) They weren't likely to do something unless they *had* to. However, now there are much better ways to assist a difficult delivery, either through change in position of the mother, vaccuum, or in some cases a c-section is even gentler than a forceps birth. The forceps tend to leave large bruises on the baby and can cause such drastic things as facial paralysis from the force.

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  • What are some common birthing positions used during pushing?

    • Pushing positions are very important both in the aid of delivering the baby as well as the ease with which the baby can pass. Some to try are hands and knees, squatting with aid of a squat bar, supported squat, or semi sitting. Laying flat on your back with knees by your ears does nothing but offer a backache. Remember pushing is often compared to having a very large bowel movement. Would you have a bowel movement on your back? A doula or midwife can help show the proper positions to move a posterior baby or improperly presenting baby.

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  • What is an episiotomy?

    • An episiotomy is an incision in the perenium to enlarge the vaginal opening. A midline episiotomy (more common in North America) entends from the vaginal opening towards (and sometimes through) the rectum. A mediolateral episiotomy (more common in Europe) extends to the side. Midline's are easier to heal and less painful, but can extend into the rectum. A mediolateral is more painful and harder to heal, but does not extend into the rectum.

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  • Are episiotomies ever necessary?

    • Yes, but not as often as they are performed. The myth is that a straight cut is easier to stitch and heal than a jagged tear. Unfortunately the idea that one doesn't need to tear, and that cutting makes the tissue more tearable, seems to have been missed. An episiotomy can be helpful and necessary in cases of very premature babies (to ease pressure on the head) or in cases of fetal distress to increase speed of delivery. Sometimes when forceps or vaccuum extraction is necessary, an episiotomy is necessary.

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  • What can be done to prevent an episiotomy?

    • Many people report tear reductions with use of perenial massage, kegel exercises, and warm compresses during labor. As usual, finding a car provider who's philosophy matches yours is critical. Avoidance of epidural analgesia can also help, because then the mother is able to get in positions to aid gentle delivery over an intact perenium.
    • For more information about episiotomy, including scientific references and aids in healing tears and episiotomies, please see http://childbirth.org/articles/epis.html

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  • What is a c-section?

    • A c-section is a surgical birth. A low transverse incision is made on or about the bikini line, except in cases of emergency when a doctor may choose to use a classical vertical incision if time is of the essence. Several layers of muscle and tissue are cut through before the uterus. The uterus is cut open to remove the baby. Mother is then stitched up after the uterus is removed for cleaning and replaced. Most c-sections are done under epidural or spinal anasthesia. In rare cases an emergency might create the need for general anasthesia.

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  • How can one avoid a c-section?

    • You can usually avoid a c-section by choosing a provider and birth place with a low c-section rate, taking prepared childbirth classes, obtaining good nutrition throughout pregnancy, and avoiding pain relieving medications.

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  • What are some reasons for c-sections?

    • There are many unnecessary c-sections performed today, but sometimes we forget there are necessary reasons. Some of those reasons include certain breech presentations, a transverse lie, placental abruption, certain cases of multiple birth, and of course true fetal and maternal distress.

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  • If a c-section is necessary, how can this be made into a good birthing experience?

    • Some ways to insure a good experience for mother and baby during your c-section are to be a part of all decision making. Consider going into labor to be sure your baby is ready to be born. Ask that your arms not be strapped down (sometimes a way to get out of this is to say "my partner will hold my hands"), ask to see, hold, and breastfeed your baby immediately, ask that your partner and any other support person you may have be with you (except in cases of emergency under general anasthesia this should be standard). Sometimes only one person is allowed to be in the room at a time during the operation. Many women have found asking their partner to go with the baby to be weighed wrapped and assesed while having a doula or friend come in to wait out the finish of the surgery with mom is an excellent solution. Be sure to have adequate help when you get home as you will be recovering from a major surgery, and giving birth, as well as having to get used to and know your new baby.

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  • If you had a c-section, what was your personal experience?

    • 1st c-section - baby never engaged properly, but labored for over 30 hours and then after no progression, c-section. 2nd c-section - tried VBAC, baby posterior and after 18 hours of labor, I was dilated but epidural was not working properly and a c-section was decided upon.
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      I have to say that I was and am very dissatisfied with both labors and deliveries. I was very overwhelmed the first time around, not really knowing what to expect and then having a c-section on top of it. The second time I really thought I would have the baby vaginally. It was a great disappointment after seeing the nurses preparing the warmer and everything else for a vaginal delivery and then having to have another c-section. I really feel if it wasn't for a faulty epidural (it was bad from the start, could feel legs the whole time, made me sick- vomiting) I could have had him vaginally.
    • My child was breech. Actually, it later turned out that she was doing the splits (one leg down and one up near her head), and that the cord was wrapped twice around her neck. She could neither turn nor descend; the doctor could not even get her out without first cutting the cord.
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      I did not go into labor. I had a a scheduled c-section two days before my due date (we knew the *exact* conception time, so there was no fear that the dates were wrong). I did worry about going into labor before my scheduled surgery, because I feared that my c-section would then turn into an emergency. That didn't happen.
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      In hind sight, I was relieved that I had not undergone a trial of labor. Because the cord would have prevented my daughter from descending, it could have been a disaster.
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      My husband was with me during the surgery. My parents waited for me in my recovery room. The whole thing was so quick, I didn't really have time to make or even think of any requests. My parents said good-bye to me as I was wheeled into the surgical suite, and they saw their granddaughter coming back the other way ten minutes later. My husband stayed with our child the entire time. I spent two nights in the hospital, and our child roomed in with me. My husband changed every diaper, and I handled all the feedings. I was surprised to see that they billed us for her care.
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    • There was extremely heavy meconium present when my water broke; as soon as that happened CJ's heart stopped completely every time I shifted position, even so much as to jiggle my leg when it fell asleep, or lift my head to look at the wall clock. When they ran me down the hall to the O/R I was 6 cm with a very strong urge to push.
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      I was scheduled to be induced on the 18th. I went into labor on my own the night of the 17th. We left for the hospital (two hour drive) when my contractions were three minutes apart and lasting a full minute. Remarkably, I really wasn't worried about making it in time. I was still in labor 10 hours after we arrived! ;)
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      They had to put me under general anaesthesia to do the C-sect, as I didn't respond to the epidural or spinal. I missed CJ's first breath and cry, and they refused to allow Chris into the delivery room. He was forced into the whole "father in the waiting area" deal. We had planned on a normal, unmedicated, vaginal birth.
    • I had my first one due to failure to progress after two failed inductions with Pitocin - the inductions were done because I had PIH and things were getting worse for me every day I went without delivering. My second child was born after two failed inductions with failure to progress and it appeared that the baby's head would not or could not drop down at all.
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      With my first, the only thing we insisted on was rooming in as soon as it was "allowed". With my second, we were able to recover as a family in an LDR. My husband held my daughter up to me while they closed me up and then he wheeled her down the hall beside me as I was wheeled down too. We also called my mom who was staying with my son to share the news as sson as we got in that room. I was allowed to hold and nurse her immediately once we were in there. It was so much better than my first experience where I was wheeled into a cold recovery room all alone to spend a couple hours before even going to my room and then not seeing, holding, or nursing my son for several more hours there.
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    • With my first, water broke, was put on poticin, after 8 (wow can you believe that time) hours with absolutely no progression, and Patrick's heart rate fluctuating Dr.. decided on c-section.
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      My family was hard pressed to even come to the hospital. Why bother, I was going to be home in a few days anyway. DH even showed up with a hangover and threw up all over my bed on day two.
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      They went along with BF, but were hard pressed to let me do the job. Patrick was feeding too much and losing weight. Scared the poop out of me. Luckily the weekend Ped. said how stupid, all babies loose weight the first few days. They did do some sugar water feedings, against my better judgment.
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      Baby #2 Molly Elizabeth 6/19/96
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      Tried for a vbac, but had placenta abruption. Very scary. Long birth story.
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      My mom still could not be bothered to come for 2 weeks, even though we both almost died. but DH was there every second possible (trying to make up for throwing up on my bed for #1 c-section) and brought Patrick with him on all visits. Molly was in neo-natal ICU for 24 hours, but one SIN bottle was given. (messed up orders)
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      Did not have any special requests. Just glad we were both alive. Luckily no problems with latching even though she was feed with a bottle in the nursery.
    • My cervix didn't dilate. We felt worried. Went to hospital 17 hours after water broke. After 24 hours infection becomes a concern. Plus we were in the middle of a big heat wave with temperatures over 100 degrees and the heat in our apt. was stifling. We knew the hospital would be comfortable and cool.
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      We had my midwife and her assistant there. They acted as my doulas at the hospital. Husband was with me every minute from the time my water broke till Julian was born. It was way, way different than when I had my first baby.
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      I hated my doctor, but the hospital was really good. A nurse helped me start breastfeeding within 30 minutes after Julian was born.
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    • My child was Breech - tried inversion with no movement. (regretted all of this later)
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      We actually scheduled around the doctors conference plans - (I now call myself crazy. I thought the ob was the best... probably I'd say still is - but....) I'd do it very differently now.
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      My husband was part of the entire process and sat right by my head. He had the choice to watch the surgury and the baby etc. but he just looked over at the critical moments.
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      I wanted to hold the baby right after delivery - This was not "hospital policy" - this was before I was even tuned very strongly into consumer driven birthing (bradley). It just made sense to me that since it was not an emergency - that I should have as much normalcy as possible. I had to talk to a lot of people before I agreed to this delivery. Even as we were in the room during the surgery, one of the nurses was telling me how they would take him away for a while... I told her not - and I did hold him - all bundled up - far from the picture of skin-to-skin I'd imagined... but we gazed at each other for quite a while before I felt ill from meds. My husband then held him right next to my head. It was as beautiful as it could be. Then after 1/2 hr they "rushed" him off... With my husband in attendance - They still gave him the eye ointment against my request - (they don't think out what they do at times - but the ointment which is not needed at all except in V.D. cases in the birth canal is certainly not necessary in a c-section birth.)
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      I had wanted to breastfeed on the table - but in retrospect - I wasn't in the "position to" - just to top off my already windy story - in the recovery room - they came screetching in stating "he has low blood sugar - feed him!!" - and the nurse put him to my breast very roughly.... anyway - long story - it didn't take at THAT second... then she huffed away with him again. I could have been shattered - but thankfully was not - it was a while before we fed - had flat nipple issues - which we worked out eventually - but I have issue in the back of my mind. I can't help but think how this affected my son's development...
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      IDEAL SITUATION - (aside from the breech c-section which I would prefer not to have now...) the hospital or ob could have been MUCH more sensitive to the BF and initial bonding issue and worked with / guided me on this - It really always falls that we must demand these points. - The more I type this now, the more I see it clearly.... You have to be defensive to truely have the birth you want. The bottom line, I feel, is that most (shall we say mainstream or unenlightened??) don't realize that it is their experience to drive... I will draw my brakes now...
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      Anyway - At the time - I had no where to turn for other advice on the breech issue. I read as many books as I could find - but there wasn't a lot out there. I didn't have personal connections into alternatives. Now is a different story with the internet... (just think the difference of 3 years!!)
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      There is a wonderful group out there to support post-c-section women - called ICAN - international cesarian awareness network - do you know this one? - It helped me tremendously in preparing for my next birth - but first labor.
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      Okay - other stuff about the experience - the staff was good, they gave me a topical number so I wouldn't have pain with the IV going in. They put the catheter sp?? in after the meds which is nice. Overall, for my first ever surgery - technically I think it was alright.
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    • We had true fetal distress. After 40 hours, I'd dilated to about 4 cm, and Aidan was really really sick from Group B Strep.
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      I did go into labor, yes. My water broke, and since I was only at 35 weeks, I needed to be checked. My contractions began about 10 minutes after my water broke.
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      We'd worked out an extensive birth plan, and I had a fabulous OB, whose wife had had a water birth a few months earlier, so he understood our needs. The nurses at the hospital were difficult, but between the OB and the doula we'd hired, we were pretty much left alone to do our own thing, till things became critical. I think communication before the time comes is the key!
    • We had Compound transverse position.
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      My health provider and I had not discussed what would happen at the onset of labor. We were still at the stage of trying to get the baby to turn, feeling that we still had sufficient time to discuss the alternatives if the baby failed to turn. My estimated due date was two weeks earlier than the office's estimated due date. Four days before *my* estimated due date, I went to the hospital to have another external version attempted (the first had failed to turn the baby......later we found out that the placenta was unusually large and had prevented him from being able to turn). The morning of the version, I arrived at the hospital to find that I was already in labor.
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      Labor started at approximately 3:00 am (I knew I would be getting a version at 6:00 in the morning and was unable to sleep) and the doctor didn't perform the section until 5:00 that evening. While we were at the hospital, we proceeded as if it were a normal labor and delivery. The birthing center at the hospital was very nurturing and supportive.
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      I was able to initiate bfing in the recovery room. As a result of not having the birth experience that I had planned for, bfing became even more significant to me and I spent the next three days with virtually no sleep in order to ensure that the baby was with me and was able to nurse on demand.
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      The LC in the hospital told me that waiting until onset of labor to section and allowing time to experience contractions and labor facilitated the success of establishing a milk supply.

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  • What are some things that can be done immediately after giving birth?

    • Babies should be breastfed immediately. Prior to bathing, prior to weighing and measuring, prior to everything. Basically a baby should be born, and placed immediately to breast. This is to ensure the rooting reflex and sucking reflex have a chance to go to work before things occur that could distract the baby. Mother's skin can keep the baby perfectly warm, and a bath is not necessary for a newborn. Wiping with soft blankets to remove the blood and the vernix can be rubbed in to soften the skin.
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      To make the post partum a more gentle experience, consider delivering the placenta naturally (as opposed to pitocin to speed things up, or manual removal), Forgoing the newborn bath or doing it yourselves, delaying shots or testing until mother and child have an hour or more to just bond and connect, disposing of the placenta respectfully through a ceremonial burial, tree or flower planting, or preparing the placenta to be eaten by the mother.

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  • Is it normal to have mixed feelings after giving birth?

    • Mixed emotions after childbirth are entirely normal. From elation at acheivement, fear of the baby, to a let down that all the excitement is over, these are all normal. Many women feel a slight let down the 3rd - 5th day post partum. If your depression lasts longer than two weeks, if you feel suicidal or want to hurt yourself or your baby, please contact a mental health professional. You are not alone, you are not a bad mother for seeking help, this can be fixed, and your baby will not be taken away if you get help before you do something drastic.
    • Mixed feelings after a c-section are common and normal. From relief at not having to go through labor and childbirth, to sadness over missing a "rite of passage", in addition to the regular mixed feelings after childbirth!
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      For more information on c-sections and VBAC please see International Cesarean Awareness Network (ICAN) at http://www.childbirth.org/section/ICAN.html

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  • What if something goes wrong?

    • We do realize that not all pregnancies end up perfect, despite how much we may prepare and hope. This is an answer a sah-ap member gave when asked the question: what if my baby dies?
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      12/3/91 Jonathan was stillborn at 24 weeks. Induction, meds, epidural. *not* a good experience.
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      12/6/92 Nathan was born via emergency c/s at term after a wonderful labor, heart rate decels necessitated c/s with general anesthesia(after we were told half truths about his blood gas levels, but that is a different story). Cord was around neck, under arms. He was put to breast while I was still unconscious. Section was done so quickly, I still had my street clothes on, which probably contributed to the post op infection later....
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      12/7/92 I start my descent into pretty serious depression. Fight it through information....read, read, read, talk, talk, talk
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      8/20/93 get pregnant with baby #3, find wonderful midwife, plan vbac, get fired from her backup doc becasue I refused a heparin lock during labor, hire a lay midwife for home birth, suck up to backup doc to "be allowed" back with cnm in case we need to transport.
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      5/20/94 Rosa is stillborn. A wonderful, empowering vbac, my body worked just exactly the way it was supposed to. We delivered in the hospital becaue, knowing she was dead, I couldn't bare the thought of delivering at home and then taking her to the hospital and leaving her. A very respectful delivery. nathan got to meet her and kiss her goodbye, we got pictures, bathed and dressed her, arranged for a friend to do the autopsy to ensure she would be well treated. Although we didn't get the baby, we had an overall good experience otherwise. It was a wonderful birth, albeit sad. It would have been much worse had the birth experience been stolen, as that damn backup doc tried to do, which I found out later. Seems my midwife was out in the hallway arguing with him when he wanted to use suction to speed things up. She was willing to lose her job that night. Cord was around her neck 3x.
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      8/25/95 Aidan was born, totally intervention free birth, no vag exams, no monitor, 21 minutes after arriving at hospital after starting to push at home (40 minutes away). Cord around neck 2x. First apgar was 4. Second 10. He looked deader than Rosa did at first. Left hospital asap. Tandem nursed the placenta out.
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      I know all about stress during subsequent pregnancies. Nothing is 100% gauranteed. Nothing. The baby could die. The mother could die. The fatehr could be hit by a drunk driver in the parking lot and die. That is part of the circle of life.
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      The best we can do is to decide how we want to approach life and death, as something to be respected or something to be feared.
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      We must seek to educate ourselves on all of our options. We must strive not to settle for less.
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      To that end, find a caregiver that holds as close to the same philosophy on life, death, birth as you do. Work with that person. Pay whatever cost is needed. If something is important to you, find a way to get it. Don't settle. If you want a homebirth but your insurance won't pay, work out a payment plan or something. If you want a particular doc who isn't on your policy, do what you need to do to get her.
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      Make your plans prior to getting pregnant, if at all possible. Establish your support systems early.
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      Welcome the fear. Work with it. Make it a power that will drive you to seek answers to your questions.
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      Analyze your previous experience, minute by minute if necessary. Decide not only what you want to do differently the next time, but know and understand *why*.
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      Plan on alternatives if plan A doesn't work out.
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      It will be stressful. Accept that and make it work for you.
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      I most likely won't be the magical pregnancy that your first was.

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Information for this FAQ was gathered and compiled by Wendey

 

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