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Tuesday
Mar082011

THE Video

Oh, my! What a ruckus Rixa’s birth to Inga (“Inga’s birth story, part 1”) has caused these past few days. If you’ve been hiding from blogs or out in space nowhere near a satellite, I’ll give you a very brief synopsis. But, you probably should go watch it first. It’ll help the discussion. 

<insert Jeopardy theme music> 

So, Rixa had the baby with just her man there… the midwifery assistant came in a few minutes after the birth (Rixa has the exact times noted) and then her midwife got there as Rixa and the baby were being tucked into bed. Her unattended birth was not purposeful despite having had a planned Unassisted Birth (UC) with her first baby. (She had a midwife-attended birth the second time.) 

Okay, so watching the birth, you see that Inga had some perking up issues, but Rixa gave her a few mouth-to-mouth puffs and she came around. Yay! Now, around the Net, oh my gosh, the noise is deafening. I won’t even quote the nasties being said, but suffice it to say some people think Rixa was the height of irresponsible and totally ignorant about how to resuscitate a newborn. And that she has a flat affect, which was the most baffling accusation of all, in my opinion. 

There’s been on-going discussions in the comments of both the first and second installments of Inga’s birth (“Inga’s birth story, part 2”), including comments from NICU nurses, midwives and others who regularly attend to newborns in trouble. Today, Rixa wrote a post about “Neonatal Resuscitation,” partly as a defense against the cacophony of criticism; it said (and the experts said) much of what I was going to say in this post, so I’ll be briefer than I was going to be in the first place. 

If we were to use Inga’s birth video constructively (and respectfully), this is what I’d say to others who might find themselves in a similar situation. 

I totally agree that Inga slipped into secondary apnea, which is a place where stimulation no longer works, but some sort of resuscitative efforts must be given (mouth-to-mouth or Positive Pressure Ventilation [PPV]). The question arises, though… if Inga had had more stimulation before she slipped into secondary apnea, would the secondary apnea have been avoided? 

Most of those reading this know there’s been a serious push to remember the sanctity of the newborn by not suctioning, not roughing them up like in the hospital, not flicking their heels or sliding your fingers up and down their back so hard their skin peels off on your fingers. So it’s not surprising to me that Rixa was very gentle with the baby. Could/Should she have stimulated her more? Perhaps, but instead of pointing fingers at Rixa, how about mentioning to others who might find themselves in a similar situation to rub the baby more vigorously… run your hand and fingers around the baby’s legs, rub her butt, rub her back. But, you cannot panic and do this or you can really hurt the baby. Talking to the baby is one good way to disperse the energy of concern/worry/fear. “C’mon, baby… time to wake up. Come be with mommy.” Or anything else that comes to mind. The talking can also help parents who have to helplessly sit and wait when others are doing the resuscitation. 

Much has been made about the baby (perhaps) experiencing cold stress as Rixa was giving the breaths and waiting for Inga to perk up. Rixa was in the birth pool holding Inga out of the water (right above the water line) and at one point, her husband offers a blanket and Rixa, with total clarity, explains how a wet blanket wicks cold all over the baby, causing a great deal of cold stress. She was absolutely right. We used to put blankets on babies in the water, I’m sure because it was a habit to dry and stimulate the baby with them on land. It didn’t take long for someone (Barbara Harper?) to nip that action in the bud. 

I love the article “Neonatal Resuscitation,” eMedicine/Medscape’s detailed explanation of what happens when the newborn stops breathing. In there, when talking about ways the baby can get cold, they reveal that even the most basic assistance can cause the baby enormous stress. 

“Another common source of heat loss in the newborn infant undergoing resuscitation is the use of unheated nonhumidified oxygen sources for the bag-valve-mask device. Inspired gasses that are sent to the lungs are subsequently heated and humidified by the infant, thus resulting in massive heat exchange due to evaporative heat losses and insensible water loss.” 

Lucky for Inga, her mom used a warmed and humidified oxygen source (Rixa’s own breath!), perhaps even balancing some of the stress she might have had from being held aloft out of the water. 

If you birth in the water and your baby needs some help, weighing (as Rixa did) getting out of the pool and drying the baby off versus getting right to the mouth-to-mouth, if you decide to stay in the water, you might try to keep the baby dipped in a little more. However, if it compromises your grasp on the baby, err on the side of standing up, getting a blanket and perhaps having your partner help you hold the baby while you give the breaths. It all sounds like a puzzle piece to remember, but if you play and replay it in your mind, especially if you’re UCing, the replaying can assist in the body memory in case it happens… you’ll have a head start on bringing your baby around. 

The last thing I want to address is Rixa’s peacefulness; what others have described as little to no affect. 

THE WOMAN JUST GAVE BIRTH! 

How anyone can watch and judge that she should have acted <fill in the blank>, must take into account that she’d given birth moments earlier. I, for one, saw a blissed-out mom who was yanked into reality to help her baby come wholly onto the earth. In part 2 of Inga’s story, Rixa says, 

“By the next day, the events of the labor and birth were already feeling surreal and dreamlike. Did I really go into labor and have a baby? Obviously yes, since I'm holding her right now! But it seems hard to believe that it really happened and that it's already over.” 

Could this have been the delayed reaction to the block of time it took to do the resuscitation and subsequent processing of it? That’s certainly possible. That surreal feeling often hits right after the birth and lingers from a couple of hours to a couple of days, but if Rixa had to set her joyous disbelief aside, I would totally expect the emotion to float back to her once the emergency was over. I love how calm she was during the resuscitation. For goodness sake, panic serves no one, least of all the baby. 

As a mother who had a baby in secondary apnea (my UC baby) and who sat immobilized to do anything, I am in awe at the clear-mindedness of Rixa and love the peace she kept as she was the one who kept her baby alive. That she cared enough to share her video with all of us is a testament to her generous spirit of continued birth education, even when she hadn’t planned for that purpose at all. 

Thank you, dear Rixa… and I hope your BabyMoon takes a softer glow soon.

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Reader Comments (27)

Thank you, Barb. She is my friend and I wrote in several of the comment fields to defend her. People SUCK. I dont know what else to say. Maybe they are putting their own jealousy onto her experience, maybe if she had started screaming, climbing bloody out of the water, panicing to her husband, folks would have been better able to watch? Sounds crazy but you know how it is...

Anyways kudos to you for supporting her. I dont know how people can take such a generous woman's willingness to share her private moments so that we may all feel ike we were a part of it and to then go crazy critiquing.

March 8, 2011 | Unregistered Commenterhousefairy

I couldn't agree more. Im a doula and NRP certified too. I thought Rixa did amazingly well. I admire her for doing breathes on the baby right after giving birth. AMAZING!!! I wanted to ask you what you would give as APGAR scores? Totally understanding that we didn't have Inga's heart tones. Im SO glad you wrote about this post!! Rixa is amazing and kudos to her for remaining CALM!! Happy mom happy baby.

March 8, 2011 | Unregistered CommenterTiffany

Isn't it wonderful how tenaciously programmed we are to survive? At the root of it all is a woman's (in this case Rixa's) innate ability to help her baby. She was not some uneducated woman placing her baby at risk. Get over it already!

March 8, 2011 | Unregistered CommenterErika

Hey Barb, just saw this come up on my reader. Thanks for being gentle with me:)

Anyway I wanted to comment on this: "Could this have been the delayed reaction to the block of time it took to do the resuscitation and subsequent processing of it?"

This always happens to me the day or so after...the day of the birth is this magical time, almost suspended from reality. And then the next day feels more ho-hum again and I'm sitting there amazed that it actually happened. It's funny--I don't feel like attending to Inga jerked me out of the space I was in at all. I'm really aware of everything anyway when I am laboring and birthing; I don't tend to get all "spacey" like some women do when they're in labor. Not that that's inherently good or bad--I just am very much aware and present.

March 8, 2011 | Unregistered CommenterRixa

Sorry Barb. This is a showcase of why UC is a horrible idea. Rixa sure looked like she was in post-birth lala land to me, which is understandable and natural. That lala land was not conducive to seeing that the baby did not have a clear airway and needed some more vigorous stimulation. Because of this, baby went into secondary apnea. Of course the right thing to do then was what Rixa finally started doing: positive pressure ventilation (if irregularly/halfheartedly).

This was supposedly an unplanned UC, but Rixa has described it on her blog as "precipitous", which does not jive with reality! She said she had been contracting for hours! She did have a fast second stage. It seems to me that she did not see it as important to have her midwife there, along with an assistant and resuscitation equipment, and so blew off calling her until the last minute.

She played fast and loose with her baby's life. I am glad everyone is ok.

March 8, 2011 | Unregistered CommenterKatie

I definitely thought of the UC connection. Not that we need any more exhibits than Janet Frasier's birth (death of her child), but if I wanted to be mean, I could surely have made this into a tirade about UC.

I did not call the birth precipitous, either. It was just like my birth in the car... the records all say "precipitous," but just because *they* didn't see me labor for 8 hours before doesn't mean I wasn't laboring 8 hours before. I agree, Rixa's labor wasn't precipitous.

March 8, 2011 | Registered CommenterNavelgazing Midwife

I thought Rixa handled the situation BEAUTIFULLY! While I'm on the fence about UC, I believe in a woman's right to choose where she wants to birth and how. Had that happened in the hospital, Inga probably would've been whisked away for hours which, to me, is WAY scarier than a few gentle breaths to get her breathing.

Say what you will. But a strong, confident, educated mom gave birth to a healthy baby and knew exactly what she was doing. More women should be that informed when it comes to their births.

A baby that did that in the hospital would not have been "whisked away for hours."

It is possible that with the vigorous rubbing/wiping with blankets the baby might not have gone into secondary apnea at all. That would have been what would have happened in the hospital.

Baby's that need more than stimulation, *do* get their cords cut right away (stupid, imo) and taken to the warmer. The warmer *does* have an advantage IF the baby needs chest compressions. Chest compressions are not effective on soft surfaces, including mom's bellies or chests... or beds. Floors, warmers or (what I carry) a specially made resuscitation board are hard enough to make chest compressions effective.

But, if the baby simply needs some PPV (bag & mask), that can absolutely be done on the mom, but isn't in the hospital; the equipment is trapped in the warmer.

But, even if they need to do PPV, if it doesn't take more than a minute or two, they do not take the baby out of the room. If the baby needs chest compressions, yes, the baby goes to the NICU (appropriately so).

Please don't be overly dramatic about the hospital when it isn't true. There's enough about them to be dramatic about without adding untruths.

March 8, 2011 | Registered CommenterNavelgazing Midwife

Funny, the one time I really got to hold my baby after the cord was cut (the last birth) I rubbed her just as you said. She was so quiet, I rubbed her legs, back, and bottom, and kissed her head. I was so used to hearing a cry that I kept saying, "come on sweet baby, cry for momma." Now I know that in life babies are born and don't have to cry, but I felt like she did need to cry. If I had a baby at home by accident, I don't know that I'd have thought to give her breaths. I don't know what I would do other than stimulate by rubbing until I realized what was going on. I commend a mom who can think at all. I did watch a video of a supposed accidental UC (not Rixa's) and the mom seemed to just look a bit stunned. She birthed the baby, pulled the baby out of the water and rubbed the head and body, and looked at the baby. She kept looking at the door like someone was coming (as the husband had gone to wait for the midwife by the front door, baby hadn't been born when he had started the camera I guess). I looked at that momma and thought about how she felt, I think she was just instinctively acting. I think Rixa has read and trained, and was acting instinctively but also with training together. She's calm because she's not afraid of having a baby alone and doing what she has to do...and so she just went through the motions. I know I've done this when one of my children gets hurt. I just sort of do things one step at a time and I'm aware of what I am doing, but I am not feeling anything at that moment. It comes later.

March 8, 2011 | Unregistered CommenterDawn

how could anyone see that and say rixa had a flat affect? she was calm, focused, loving and persistent. and you can see by the baby's reaction, that inga knew mama was helping to bring her into her body. inga looked at her, put her hand on mama's cheek...

my own baby took awhile to come into her body. i remember wonderful barbwife telling me to talk to her. i did. i wasn't sure if she would actually make it into her body, but was not frightened either. it was a very peaceful, yet focused few moments. i was aware of my surroundings but there was nothing but me and baby in those moments. that's exactly what i saw in rixa. good job, mama!

March 9, 2011 | Unregistered Commenternolabarb

This may be off topic, but what would you consider a precipitous birth? My first labor was 4.25 hours. She was born 1.5 hours after I got to the birth center (after laboring for 2 hours at home the midwife told my husband it was up to me if I wanted to come in then or wait, I said I wanted to go). I am starting to think about a second and wonder if I fall into the "history of precipitous birth" category and what preparations I should make. I really appreciate Rixa putting herself out there because I don't know if the idea of getting NRP certified myself would have occurred to me.

March 9, 2011 | Unregistered CommenterEmily

The definition (and yes, there is one) of a precipitous birth is a labor, from start to finish, that is 4 hours or less.

March 9, 2011 | Registered CommenterNavelgazing Midwife

I think it's ridiculous to accuse Rixa of playing "fast and loose" with her baby's life. She is pretty much a woman at the (damn near) perfect juncture between reason and intuition.

She has a DISSERTATION, for God's sake, on the topic of Unassisted Childbirth, UC'd with her first baby, then chose midwifery care for her subsequent children...This latest birth, the midwife just didn't make it on time--which actually happens often enough for multiparae.

Should she have called the midwife earlier because she should have been psychic enough to tell that her baby was going to have a bit of trouble getting going?

Let's look at this situation again.
Rixa has done extensive birth research, apprenticed with a midwife (during her years in Iowa), written a dissertation, UC'd previously, had a previous HANDS OFF midwife attended birth, AND she knows neonatal resuscitation techniques.

As you watch her birth and then resuscitate her daughter, the midwife is IN THE CAR on the way.

If Rixa Freeze is playing fast and loose with her baby's life, I don't want to imagine the illogical bends one would have to take to lead a "safe" life.

Another thing--The midwife Rixa assisted in Iowa, before her babies (I believe) was later my CNM for my second baby. Before I had my second son, I attended my friend's precipitous birth, and (a woman with NO training) was the first one there, realizing that the baby was coming RIGHT NOW and hoping the midwife would make it!

That was a home water birth WITH secondary apnea, a little bit of panic, confusion, and a whole lot more drama for the mama and baby than Rixa's birth. The CNM noted the color of the baby's scalp turn blue as he crowned, and she knew there was a problem. She did clamp and cut the cord and move him to her lap, out of the tub for resuscitation. Since the bathroom was cramped, she then moved him to the bed while one of the assistants called paramedics. I stayed with my friend as she sat in the tub and told her what the midwife was doing, and that it was going to be OK (having had one baby who needed resuscitation, intubation and a NICU stay, but no one told me what was going on or if it was OK or if he was dead).

From start to finish, the birth was an hour tops. Then my friend was separated from her baby when he and the dad rode to the hospital, even though resuscitation was successful...When paramedics are called, there's reason enough to get checked out. So she didn't hold her baby for HOURS, and had birth her placenta, get cleaned up and transport with me and the doula to see her baby in NICU.

Here's how I see it--Rixa handled it herself because 1) she had no choice, since the midwife hadn't gotten there yet, and 2) because she was fully qualified and more responsibly prepared for birth than most of us.

I'm not going to use her birth as evidence that people should or should not UC. I'm just going to go get myself educated in neonatal resuscitation, and realize that all any of us can do is to be prepared and do what needs to be done calmly.

March 9, 2011 | Unregistered CommenterLeslie

What about using wool as a blanket for water births? It maintains it's warmth much, much, much better than a cotton towel.

I found it fascinating about how there was so little blood loss, and if there's a reason why, and what does that mean for the lochia later (mine seemed to go on and on....)

March 9, 2011 | Unregistered CommenterTracyKM

The problem, and where i think Rixa unfortunately opened herself up to criticism, is that the video and explanation are being presented, to some extent, as a teaching tool, as opposed to being just some random woman sharing a video of her birth with friends and family. If you're going to serve as an example to other women of how to do something, especially something as important as how to care for a distressed neonate at home, then in my opinion it's pretty important to present accurate information.

It does seem a bit indecent to be talking about these things so close after the birth. I don't know the answer to that problem. If you see something that you believe to be dangerous misinformation, how long should you wait before addressing it?

Just briefly in response to housefairy. Being on the mean side of the conversation so to speak, i'm quite sure jealousy has nothing to do with the negative reactions. The people i've been speaking with feel that Inga was just a few steps away from grave danger. Many of them were in tears watching the video. I think it'd be more relevant for you to say that the naysayers are making a big deal out of nothing. (I obviously don't share that perspective, but it'd hit closer to the real issue, if that makes sense. =)

I am just as puzzled as anyone else by the criticisms of Rixa's demeanor or whatever, so i can't comment on that.

I appreciate reading your thoughts on the subject, Navelgazing Midwife, and Rixa, since you're reading this, congratulations on your new little girl! I wish you and your family well.

March 9, 2011 | Unregistered CommenterS

Thanks for answering my question!

March 9, 2011 | Unregistered CommenterEmily

I guess people are showing up at her blog for just this one blog post? Because if they were a long time reader they'd know Rixa is extremely well trained.

March 9, 2011 | Unregistered CommenterKimberly

I don't think Rixa described her birth as precipitous. I think she said that women should learn NRP in case they have a precipitous birth. And if a birth ends up being unattended because it happened sooner than the woman or the midwife or OB thought it would, it doesn't really matter if it was truly precipitous or not. A baby born in the car or the bathroom is a baby born in the car or the bathroom.

March 9, 2011 | Unregistered Commenterchingona

Everything I've read says a precipitous birth is less than 3 hours, from first contraction to birth.

March 9, 2011 | Unregistered CommenterJennifer Z.

And Emily, you are probably at risk of having a precipitous birth if you have more children. My first birth was 6 hours start to finish, and my second was 2. I did research about it before my second was born and one risk factor is having fast births in the past. Be prepared!

I think the confusion comes in because a lot of people count labor as the time they were in active labor. But with a precipitous birth, you count the entire thing, from your first contraction to the birth.

Barb, what have you seen with precipitous births? In my experience, the contractions were double peaked and would last 2 - 3 minutes, and I would get maybe 1 minute, but often only 30 seconds in between them. My contractions were erratic and didn't follow a good pattern - for either birth, even the 6 hour long one. I think it is unfortunate that with the readership of Rixa's blog, all these people who may be doulas and childbirth educators are getting a very inaccurate picture of what a precip birth looks like. I'm sure Rixa made an honest mistake, but I sure wish she would correct it. Her birth, as far as I know, did not follow the patterns of a precipitous birth. It was over 8 hours long, and they had plenty of time to get their kids off to a friend's house and prepare everything for the birth. I think what happened is that she was just further along than she realized, maybe with the end going faster than it had in her other labors. It is important that people who are involved in birth know what a precipitous birth looks like, and this does not look like one to me.

March 9, 2011 | Unregistered CommenterJennifer Z.

Ironically, my only birth that FELT precipitous was my third which was a little less than 5 hours from start to finish. I've had three births that have been less than 3 hours start to finish and none of them felt like they were precipitious to me.

I will take Rixa at her word that this was not a planned UC. It was a third baby and ime, that is a parity where things can be a bit unpredictable and things can go along at an 'average' pace or can be pretty rapid from about 6 cm to birth. It seems Inga's birth fell into the latter.

It is easy to Monday-morning quarterback this birth and say what she should have done, when she should have called the midwife etc....only Rixa was in her body, knowing what she felt and making her decisions.

I can look back at experiences I had in pregnancy and childbirth and wonder if I made the right decision, right choice too. If I knew then what I know now I am sure I would have made some different choices. Let's take my last birth as an example.
I have had pre-eclampsia...full on...kidney's failing, needing mag..the full court press. This pregnancy had been great but my BP's were rising, I was feeling icky but my labs were fine and I had no protein in my urine. I didn't have pre-e but if left on my own I may have developed it before my baby came on his own. I wanted to avoid mag and the whole strapped to the bed high risk labor scenario. I opted for an elective induction, my OB didn't offer it but because of my parity and Bishop score he agreed to it. AROM at 4, active labor at 5:30, baby at 7:45. Beautiful birth, great looking baby. Everything was sunshine and roses. I took him home. He had two ill siblings with headaches and fever but a little motrin and they were golden and in 24 hours it passed. We tried to keep him separated but that is about impossible. At 4 days old he had a 101 fever. Turned out the illness his sibs had was viral meningitis and they shared with their baby brother. Spinal tap, urinary cath, blood draws and heelsticks, IV's. We spent three days in a monitored unit waiting on cultures. He didn't open his eyes for 48 hours and was lethargic and not eating. He came through it and is now a healthy 9 month old.

I made a choice thinking it was the best thing for me and baby. End the pregnancy before pre-e set in and created a hazardous situation for us both. If I had waited he wouldn't have been exposed to enterovirus.

Did I do the right thing? I don't know. Maybe I would have ended up with HELLP and DIC and all kind of awful things had I waited or maybe I would have gone into labor on my own a week later and had a gorgeous birth and not have had my baby to go through the ordeal that was viral meningitis. I will never know.

My point? Rixa chose a homebirth and chose to call her midwife at the last minute. Inga had a problem but in the end it turned out OK. If Rixa had chosen a hospital birth maybe she would have had the same outcome, maybe a better one, and yes, maybe a worse one. All we can do is own the decisions we make and their consequences.

March 9, 2011 | Unregistered Commentermomto9

Yes, precips ARE defined as 3 hours or less. I could swear I *just* wrote about this and wrote 3 hours and was corrected. Oh well... 3 or less it is. Thanks, Jennifer!

March 9, 2011 | Registered CommenterNavelgazing Midwife

Hmmm, I guess 'slightly sarcastic' doesn't translate well into a blog comment.

I was just trying to show my support to you and especially to Rixa. Sorry if that didn't come across clearly :)

If I had planned a home birth I believe this same thing would have happened to me. It's easy to say that she should have called the midwife earlier, but unless you're there in labor, you can't know what she was feeling.

For my first labor I didn't have strong, regular contractions until 1 hour before my daughter was born, but what midwife (or doctor) would have believed that? From first contraction to baby it was 5 hours, probably would have been less had we not been trying to get to the hospital, and she was very nearly born on my bathroom floor, UC. All I could think about was that it wasn't supposed to happen that fast. I wish that every woman had the option of learning NR so that they wouldn't have to be afraid like I was, and could handle the situation as gracefully as Rixa did.

March 10, 2011 | Unregistered Commentersara

Thank you so much for your explanations and defense of this mama. I had a very similar experience with my fourth baby, first planned homebirth turned unplanned unassisted when I neglected to call the midwife in time.

Watching Rixa I imagined that that was exactly what I looked like - minus the birth tub since my daughter made her entrance on our bath mat. I attempted to stimulate her by sucking out her nostrils with my mouth and then breathing are into her. My midwife arrived sooner that Rixa's and so took over stimulation and my daughter perked up quite quickly. In the moment I just did what I thought needed to be done, but can't even imagine moving from just giving birth to panic mode - it's seems nearly impossible to make that mental transition, especially when you are just focused on your baby.

Later as I processed the birth a then realized how important it was that I was doing what I was doing and how the additional stimulation that my midwife added was necessary. I hope that had she not arrived that I would have seen that need as well and continued with my efforts. When an unplanned situation like that occurs we just do the best we can - whether it is a midwife not arriving in time or a birth on the side of the road trying to make it to the hospital.

I too learned a lot in my own birth moment and took it as an reminder to educate myself for future possible contingencies.

April 9, 2011 | Unregistered Commenterjessica

I thought one of the selling points in midwifery was that the
Midwife and or doula was there with the woman from start to finish. I hear the comments of how the doctors check the patient once or twice and show up for the delivery and leaves. I have read so many blogs where the midwife doesn't show up in time. Rixa even told the assistant to leave, that she wanted to be alone. I wonder, like some, if the UC wasn't really her goal. Glad the baby is okay. I agree, the resuscitation was a little half hearted. I felt like the breaths were random as "if is this even helping?" How can anyone believe the baby was knowing the mother was trying to help her by reaching out and touching Rixa's cheek? That sounds like a Disney movie. I agree, Rixa demostrated some knowledge of resuscitation, efficiency wasn't her strong point. I wonder if stimulating the baby quicker may have helped prevent the onset of secondary apnea. With all of Rixa's credentials, how do you feel about less competent women attempting UC or planned attended homebirths in which they hesitate to call the midwife earlier to come over? Here's to hopes for healthy babies despite our choices of how or where we birth them! That could mean home hospital or wherever.

November 11, 2011 | Unregistered CommenterCaptainObvious66

I've written *extensively* about my (negative) feelings about UC.

Yes, women birthing at home tend to be the polar opposite of women birthing in the hospital with regards to their providers:

In the hospital, women often go wayyyyy too soon.
At home, women do sometimes call the midwife wayyyyy too late.

November 13, 2011 | Registered CommenterNavelgazing Midwife

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