Saturday, February 28, 2009

Hospital tour

Today I went on a tour of my local hospital's maternity center with another couple. He is a colleague of my husband's, and his wife is expecting their first a few weeks after me. We are both planning to give birth at home, but we wanted to check out our local hospital to see what it's like if we needed to transfer. We didn't specifically mention our home birth plans to the nurses giving the tour, since we wanted the tour to focus on the hospital's policies. I would have mentioned it if they had asked, but they assumed that we were seeing one of the hospital-based midwives or OBs.

Some numbers and stats:
Our hospital serves a town of 15,000 and any neighboring communities. It sees at most 300 births per year. The hospital doesn't have a NICU. The physicians and anesthesiologists are both on-call rather than in-house. There are two OBs and one nurse-midwife who rotate call, so you have a 1:3 chance of having your care provider present at your birth.

The hospital has six LDRP suites. They all have about the same setup and decor, but some of the rooms are larger than others. If they're really busy, some women will be shunted off to another area for their postpartum stay.

Between 90-95% of the maternity patients labor with epidurals, and almost all of those women also are on Pitocin. I asked the nurses what the hospital's c-section rate was, and they said it was definitely higher than average--"higher than ACOG standards" was what one nurse said. They couldn't give me any specific numbers, though. The second nurse explained that they are more likely to cut than not if they see anything funky on the monitors since they don't have a NICU in the hospital. They do not allow VBACs anymore, and a high number of the patients have elective inductions. The nurse said the hospital is trying to lower its c-section rate, but agreed with me that the no-VBAC policy and the high rate of inductions makes that difficult to change. They also see a lot of scheduled cesareans (I assume for women with previous c-sections, since VBACs are not allowed). Breech presentations are an automatic c-section.

I asked the nurse what would happen if a woman with a previous cesarean presented at the hospital in labor and refused a repeat cesarean. The nurse said, "Well, you can't do surgery without her consent. That said, we'd probably try to talk her into a c-section." They've never faced this particular situation, though.

Both the physicians and anesthesiologists live close by the hospital. I asked the nurse about their decision-to-incision time for an emergency situation, and she said it's 30 minutes or less. However, they can do it in less than that. For example, she remembered a recent cord prolapse that took 10 minutes from decision-to-incision, and that was with both the OB and the anesthesiologist having to travel to the hospital. That's pretty impressive for a small rural hospital, considering that neither the OB or the anesthesiologist are in-house. It makes me wonder why they won't allow VBACs with the ability to assemble an OR team that quickly. I mean, I know why--ACOG's 1999 policy of "immediate" availability that was interpreted to mean 24/7 in-house availability--but still...

Admittance and labor policies:
I asked the nurse what were the standard admittance procedures, and she was fairly vague. 20 minute admission strip? It sounded like it's a standard routine, and I wasn't able to get a good answer if it's easy to decline it or not. IV/saline lock? She said that's something to discuss with your midwife or OB and put on your birth plan. They do try to work closely with a woman's birth plan, so if it's signed off, it shouldn't be too much of an issue. That said, 90% + of women have Pit & epidurals and/or IV pain medications, so it's pretty rare that a woman won't have an IV. Monitoring? They do intermittent monitoring if the woman requests it and, obviously, if she doesn't have Pit or an epidural. They do not have wireless monitoring (telemetry) or waterproof telemetry. Eating and drinking in labor? Both nurses said "don't let me see it, and don't tell me you've done it!" Sounds like we have a "don't ask, don't tell" policy here! They can't provide the laboring woman with anything but ice chips and popsicles (and IVs, of course). But they said to go ahead and eat/drink when they're not around; that way they won't have to report it to the anesthesiologist, who doesn't like women to eat or drink during labor. They emphasized that they encourage women to eat freely for as long as they're home, since food intake is restricted in the hospital.

LDRP room.
Infant warmer & fetal monitor to the left of the bed.
Notice the spotlights on the ceiling--those always creep me out for some reason.

View from the bed.

The hospital has birth balls and (smallish) jacuzzi tubs for laboring in. The first nurse we talked was very encouraging about laboring unmedicated. I got the feeling that she likes working with moms who want to be upright and mobile, especially with the high rate of epidurals at this hospital. She said that if you wanted to go without drugs, they'd encourage you to use the birth ball or the tub, to walk the halls, and to move around. You have to get out of the tub once you're pushing, though. The tubs are fairly small: standard length and perhaps a bit deeper than a typical tub, so there isn't a lot of room to stretch out and move around. Showering might be a more comfortable option at this hospital.

Jacuzzi tub & bathroom
(tub is to the left on the bottom photo)

The nurse-midwife is more used to women laboring and pushing in non-conventional positions, whereas the two OBs will likely request that you lie on your back, especially as the baby is getting closer to being born. I asked about how often they do episiotomies, and both of the nurses said "we don't do them any more." One of the nurses got a piece of paper and did the standard demonstration of how it's so much easier to tear once you already have a cut. (She also teaches the hospital's childbirth classes.) Instead, the OBs and midwife are fairly hands-on with the perineum. The nurse said the OBs will typically apply pressure to the baby's head and the woman's clitoral area, while "ironing out" the perineum. (Doesn't that sound fun!? I'd rather have nothing done to me at all, thank you very much).

They have Stryker maternity beds, which are my least favorite among the varieties of maternity beds. Some of the other brands such as the Hill-Rom can adapt into a nearly sitting position with a U-shaped cutout, so it's almost like a birthing chair. The Stryker, though, is pretty much only set up for the stranded beetle position. The first nurse got out the squat bar and also mentioned that unmedicated women often like to labor on their knees, resting their arms on the elevated back of the bed.

Baby care:
Right after the birth, the baby is taken to the nursery for weighing and measuring, then brought back to the mother. The baby spends a few hours with the mom, then goes to the nursery for about 3-4 hours for glucose heel pricks, blood pressure checks, bathing, etc. After that the mother can request either rooming in or nursery stays for the baby. This is an improvement over the mandatory 24-hour nursery stay that the hospital used to have several years ago, but the mother is still separated from her newborn twice in the first several hours.

Things I forgot to ask about:
- What happens to baby & how long is it separated from the mom if she has a c-section
- If they have TENS units for laboring or for post-cesarean pain relief
- If they have lactation consultants available
- Breastfeeding policies (do babies get sugar water, bottles, and/or pacifiers while in the nursery?)
- Number of people allowed in the room while the woman is laboring
- If photographs/videos are permitted during the birth

Overall impressions:
A woman's labor experience at this hospital will depend on several variables, some of which she controls (whether or not she chooses an induction or epidural) and others she does not (which nurse is on duty, which OB or midwife is on call). There was a noticeable difference even between the two different nurses we talked with. The first one we met seemed a lot more accommodating of individual women's requests, while the second one who joined us halfway through our tour kept saying things like, "well, safety does need to come first" and "we feel that a healthy mom and baby are more important than a vaginal delivery." Of course, you can request a different nurse if you don't mesh well with the one you're assigned to (assuming there's more than one on duty, which might not be the case in such a small hospital), but most women don't know that.

The hospital still has room for major improvements in its baby care policies, especially its initial separation of mother and baby and the later 3-4 hour long nursery stay (which you can refuse, but it would take some negotiating).

I was glad to know that the decision-to-incision time can be fairly rapid, even though the OB and anesthesiologist have to be called in to do a c-section. If I were needing to transfer for something like a prolapsed cord or placental abruption, we'd call the hospital and tell them to assemble an OR team while I was en route from home (5 minutes door-to-door going the speed limit). I'd make sure someone remained on the phone with L&D as we were driving in (or taking an ambulance, but transporting ourselves would be faster).

The hospital's high induction and cesarean rates are concerning. It's partly patient-led (via elective inductions) and partly hospital-led (via its no-VBAC policy and quick-to-cut approach). Small rural hospitals generally should have lower-than-average cesarean rates, since they transfer high-risk patients to larger teritiary hospitals that are better equipped to deal with certain complications of pregnancy and birth. If you're interested in avoiding an unnecessary cesarean, this might not be the best hospital for you, especially since they mandate that you have repeat cesareans after your first one.

With a 90-95% epidural/Pitocin rate and a higher than average c-section rate, I would be concerned that the staff is not used to working with unmedicated, spontaneous labors. Only 15-30 women give birth without anesthesia per year here, so the hospital is perhaps not the best place for women wanting to give birth without Pitocin or an epidural. Still, it is doable, if not optimal. Going into labor spontaneously, laboring without Pitocin or an epidural, hiring a doula, having a signed birth plan, laboring at home for as long as possible, and requesting a nurse who is supportive of your wishes will all increase your chances of a vaginal birth at this hospital.


  1. im always amazed at how just looking at those hospy birthing room always freak me right out...they make me feel really protective and angry and Im not even pregnant. You must have blown those women away with your questions!

  2. My hospital birth (unmedicated, the only real intervention was that I asked them to break my water) was really pretty nice. I've attended several homebirths although this was my only delivery of my own... I wanted to comment though on the spotlights. They left most of the lights off as per my request, but they did turn on the spotlights right at the end, and honestly I hardly noticed...but in retrospect I'm very appreciative that my dr had good lighting to do my stitches.
    I think sometimes we get very caught up in all the negatives about hospitals, and forget that it's not ALL negative.

  3. oooh that bothers me so much about the separation there. The hospital I work at now has NO separation for vaginal deliveries. There is no nursery for those babies, they stay at the desk with the nurses if the mom needs to shower :). There is a small nursery for c-section babies, where the meds are done asap and the baby goes skin to skin and breastfeeding asap when mom gets in recovery. Nothing else is done, nothing, until baby decides to be done breastfeeding, even if it's an hour. Then the baby is bathed while the mom is transferred to her room, and another glucose check done at that time if needed. The in-hospital breastfeeding initiation (for well babies) is around 94%.
    They don't allow vbacs here either, which drives me nuts... I agree with you. If a hospital is equipped to handle cord prolapse, placental abruption, and stabilization of a VLBW infant, they are equipped to handle a VBAC.

  4. If they are only doing 300 births a year I would be afraid their skills are rusty. For example: Iv insertion, foley placement, epidural placement. I don't know how they can stay open with 300 births a year.

  5. Interesting tour, Rixa.

    My first child was my only hospital birth and it was a very good unmedicated, hands-off experience. I drank Gatorade and did not even have an IV or a saline lock, labored and pushed in the positions of my choice, and had intermittent monitoring (the 30 minute initial strip, then 15 min/hour or handheld Doppler, depending on what position I was in when it was time to check on the baby). It was in a small hospital like that one, also. The rooms were very small and no tubs, only showers.

    Sounds like with the right midwife and doula (like I had) an unmedicated birth there is totally doable.

    The separation thing bothers me A LOT, though. The hossy I birthed at did not even have a well nursery and baby and mom were NEVER separated (well, the nurses could watch baby at the desk if mom wanted a nap). I do NOT want my baby out of my sight for newborn procedures; we do not do any vaxes until our children are well over two years old and then we only do certain ones and the Hepatitis ones are NOT on our list of vaxes we do. So I would be freaked that they would vax the baby for Hep B without my consent because they are so used to parents just accepting whatever. I also would be afraid of them giving bottles of water and whatnot; that still goes on in some hospitals.

    If my husband would be allowed to be with the baby every minute in the nursery, then fine, otherwise I would probably request no separation at all if I were birthing there.

  6. Pinky,

    The hospital where my first child was born at saw less than that. They had less than ten births a month most of the time.

    Of course it was a military hospital overseas in a semi-remote location so that is why. There had to be SOMEONE there to catch all the military brats born on that base :)

    My daughter asked me the other day what state she was born in and I had to explain to her that she was actually born in another country. She looked so confused, bless her! I love seven year olds!

  7. I'm with Kel. Just looking at hospital delivery rooms makes me feel itchy and nervous. Bad memories I guess.

    I bet you were the most inquisitive "client" they have ever talked to!

  8. Thanks for sharing your views so openly Rixa!! As a new follower of your blog, I've learned a lot about childbirth and how I would like to have our children one day. Thanks for all the great info!!!

  9. They take away the baby for 3-4 hours? No thank you! I'd much prefer to have a crappy birth, but have my baby beside me the whole time in recovery. It's so important to me. I can't imagine how high my blood pressure would be if they took my newborn, who had been an intimate part of me for 9 months, away for 3-4 hours so soon after birth.

    I don't like them to take away the baby at all, even for 30 mins. I've always sent my husband to go too, and even then, it just feels so unnatural. It's such an important bonding time, to smell your baby and examine them and have them get used to being in mommy's arms.

  10. I've thought about doing a hospital tour just to see what it's like. I guess sometimes I feel like UP/UC means you miss out on the birth culture and I just want to be a part of that. But then, a part of me is afraid that if I do that, then I'm setting myself up for a transfer by exposing myself to those vibes. But then part of me wants to be exposed to all the possibilities.

    Hmm. One of those UC conundrums, huh?

    And then another part of me wants to go just to ask lots of questions to encourage other moms to ask questions.

  11. hi it's the canadian again :)
    so interesting! you are very thorough. excellent idea, scoping out your backup plan in case.
    I had a beautiful hospital birth, attended by my 2 midwives, so I know they are possible! Though I fully endorse home births too and would want one if I have another baby!!
    And I'm totally with you on the spotlights--they look space age electric spooky things!
    I'm a more recent addition to your followers. Have you posted regarding why you are choosing to have a midwife assisted birth this time, while your daughter was born via U/C? I read your daughter's birth story and it was so beautiful. Thank you for sharing! And for all your thoughtful posts. I really love your blog!

  12. p.s.
    jeepers, i'm bad for the, eh?
    I was shocked and angered by the 3-4 hour separation for WELL babies?! Not that sick babies need separation either, but it's easier to justify... But I'd be refusing that one right off. IF it were insisted upon I'd be in the nursery driving everyone nuts with my baby skin to skin and breastfeeding monitors or no.
    My son needed resuscitation and after they were done and he was active and stable, they gave him back to me. They did the entire resusc in the warmer at my bedside. Granted, that is unusual after a resusc but I made it pretty clear that's what I wanted and I had a good support system so the pediatrician didn't insist on any nursery time. I was very grateful, as my bottom was VERY sore and sitting up in the nursery for hours with my baby on my chest didn't sound that appealing.
    Not to mention the fiddling with the natural bonding and 'ownership' process that happens between mom and baby--if hospital staff 'know best' or need to monitor for long, it interferes with that natural taking responsibility bond that moms are meant to develop in those first hours.
    Now I think I'm rambling, so I'll go!

  13. Sounds like a run, do not walk, to the nearest exit, kinda place. Yum.

  14. I think it is a great idea to tour the hospital prior to having any type of birth.

    I think the opposite is true about transfer. IF you are ready for anything, usually nothing happens. I usually get a problem when I am not ready for something. Once you are ready, you can sit back and let it happen.

    I also find that the easiest births are the births that the Mother is ready to let birth happen no matter what that entails.

    Good luck with your second Birth Rixa.

  15. I enjoyed doing the tour in a subversive sort of way (what I imagine it feels like to be a mystery shopper)--plus I feel that knowledge is power and I really like to know the specifics of what is going on in my local hospital. In addition, I wanted to know more about the maternity center so that I can give other women accurate information about it. Most concerning to me are the high induction, epidural, and C/S rates and the routine separation of mother and baby.

  16. Even though I think you're really sensible to scope out your backup plan, even the thought of going back to the hospital where I had my first (unnecessaryEmCS) sends shivers down my spine (actually I'm going tomorrow for our 20wk scan). It did even before I had my DD tbh! Nice that you can put on your 'professional' hat on and not be the emotional wreck that I would (and will) be!!

  17. Interesting information. The birthing rooms there look very similar to the hospital (with a midwife program) where I delivered. Gives me a few things to ask/think about next time I'm choosing a hospital to deliver in (we've moved since our firth birth).

  18. This hospital and it's set up and staffing sound similar to mine, although the epidural and cesarean rates are a lot different. We do about 230 or so births a year, and manage to stay pretty competent without much difficulty. We have 1 full time OB, 1 semi-retired OB, 3 family docs, and 2 OBs in the next town that also deliver here some. We all cover our own clients the majority of the time, though, rather than sharing call. Our anesthesiologists are mostly in-house (we have a group that comes from another hospital and usually the covering anesthesiologist sleeps in the building, but sometimes they are at a local motel.) Our epidural rate is lower than your hospital's, I'd guess 40% probably. Our cesarean rate is typically below the national average - although still higher than I'd like (around 25% usually) We unofficially ban VBACs, although a woman coming in labor demanding to labor would be respected I believe (I've had 3 VBACs since the ban went into place, 2 planned repeat VBACs, and an unplanned VBAC mama who showed up in labor prior to scheduled repeat cesarean) We have no NICU, but I don't think that leads any of the providers to be quicker to move to cesarean.
    I always tell my clients that one of the big advantages of birhting in a little hospital like mine is that we don't have a lot of births going on at once - we one-to-one every labor client (each has her own nurse who has no other laboring clients) In my hospital, the nurses are very used to caring for women without epidurals or other pain meds. We have the same tubs as your hospital, though - and an official no waterbirth policy, although I've had an accidental waterbirth also.
    The OBs pretty much insist on the stranded beetle position for actual birth, but I'm the busiest birth attendant (attending around 70 births a year) so the nurses are well used to births in more physiologic positions as most of my clients birth squatting, hands and knees, or standing, in or out of the bed.
    I use the space-program-like spot lights only for repairs. I don't turn them on for births except for a rare vacuum assist, but I find that the spot lights are less obtrusive than big overhead lights if I need to do a repair - mama can snuggle her baby is relatively dimmer light and I can work with bright light.
    I was trying to imagine how my nurses would have answered your questions, and I think they would have said that much depends on your individual provider, as far as intervention rates and comfort level with more un-interfered with births. The one thing that is pretty constant at my hospital is that there is an overall climate of respect for clients' wishes. I can't imagine any of providers doing something a client specifically said "no" about, but most providers in my place are practicing pretty standard modern US obstetrics.

  19. I can't BELIEVE they routinely separate well babies from their mothers! It's like, "Hi, we deliberately disrupt the bonding process and the establishment of breastfeeding".

  20. Gosh, I can't even imagine giving birth under this kind of 'guidance'. Just looking at the pics of the room. Wow. I can't imagine.
    I also noticed the room looks great for the 'viewers', but that the 'foot end' of it did not look cozy for the mom to look at! Kind of an interesting juxtaposition to me.

    I know I am sitting on the edge of the bed on this one!

    31 weeks already! Looking forward how your birth plans unfold, Rixa!

  21. I have a question, Rixa: is requesting a different nurse a legal right? I was happy with everyone but one nurse during my son's birth, but I never even would have thought about asking to switch - even though my nurse and midwife were not getting along. I loved the nurse who came on duty for the actual birth, but it would have been so nice to escape the 7hours I spent with the unpleasant one.

    I can't believe how high your hospital's epidural - and even more, pitocin rates are!

    I had my son in a US hospital, but I was allowed to nurse him before he got weighed, and the two times he was out of my sight I sent my husband along. They also encouraged rooming in, although I did get chewed out for letting him sleep on my chest...

  22. I don't know if it's written into law or not. In any case, it's my understanding that if the nurse you have is really not working well with you, you can talk to the nurse manager and request a different one.

    Doctorjen? MomTFH? Pinky? is this true where you work?

  23. I would guess not a law, but a generally understood option. Also, I think fairly frequently nurses are also aware they aren't getting along with a particular client and will sometimes switch around on their own, but if not, asking to speak to the nurse manager and requesting a different nurse is always an option.

    I forgot to say before, that we have the Hill-Rom beds and I agree I like them much better than the Strykers. Ours don't have the "Easy-Glide calf guards" that are on the one you linked to - I have no idea if we even have stirrups in the building except for the operating room table (where they are pretty much only used for D&Cs.)

  24. haven't read through the comments yet, but just wanted to add re. the nurse's comment "we just want a healthy mom & baby so we go to caesarean..." yeah. A mom who has just had major surgery is not healthy, she is recovering from surgery. There is no other surgery for which we label the patient "healthy" immediately afterwards just because they don't happen to be dead. Drives me wild. Recovering from surgery is not healthy - especially a surgery that might have been avoided by not initiating the interventions cascade.

  25. Wow, thanks for that description! I am an American who recently gave birth in Germany, where I live. It sounds like a hospital birth experience in the US would be VERY different than what I experienced here.

    Just to give you an idea, my daughter was born breech, naturally (no IV or drugs of any kind), in a dimmly lit birthing room. I delivered her on my hands and knees, and she landed on the soft table (more like an elevated chair). I was the first to person to hold and touch her. She laid on my chest for over an hour nursing before anyone touched her. My husband and mother assisted me throughout the labor while the midwife was in and out of the room. She stepped in toward the end to help me slow down a bit as the baby was racing to get out. A doctor was present for the birth because that was the hospital protocol for breech births, but she sat passively at the end of the table and watched the birth.

    It was a really amazing experience considering all that I have heard about hospital deliveries for breech babies around the world.

    I might consider a home birth for our second, but the only thing holding me back is that I am VERY vocal, and the nice, sound insulated rooms helped me feel as though I didn't need to hold back. The sound definitely helped me through my labor.

  26. TammyB--how awesome to hear about your laid-back breech birth! Was it by any chance with Dr. Loewen of Frankfurt? I know he does a lot of breech births, like 400 in the past 4 years, and he's coming to Ottawa this fall for a breech birth training conference. Oh nevermind, just remembered that your doctor was a she, not a he. Anyway it's funny about the making noise thing; I always think of being much less inhibited at home, but of course I live in a single family home, not a townhouse or apartment.

    Was your breech experience fairly typical for breeches in Germany? In other words, did you have to go out of your way to find someone to attend the breech, or was it just considered a "no big deal" kind of thing? I'd love to hear more about it!

  27. Rixa,
    I delivered in Regensburg. I don't even remember the name of the doctor because I only met her at the birth (and the details are a bit fuzzy now). I worked with a team of four midwives who have a holistic approach to birth and also knew that a natural birth was very important. They had led the birthing classes and had been involved in my prenatal care. The midwife who attended the birth (one of those four) also knew that I am a yoga teacher and had done some good preparation for birth. I used a vaginal dilator (called the Epi-no - I wrote a product review here) to help prepare the perineum, and so she expected that tearing would not be an issue.

    I can't say that this was typical of a breech birth experience here. The hospital I attended was the only one in Bavaria that does a lot of vaginal breech births - it was just pure luck that we live 10 minutes from it. From what I understand, many other hospitals here recommend c-sections for breech presentations. I had an appointment with the head OB at the hospital at 34 weeks (as they didn't do my prenatal care - it works differently here), and she began to monitor me closely as the due-date approached. Mostly, they just made sure that the baby was small enough to make the vaginal delivery a safe option. They took some repeated measurements of her head and torso with ultrasound, and they were really very close to her actual size. With that info in hand, they expected that the vaginal birth would be the best option (as did I). Two of my friends also had breech babies here. One had a c-section because of her gigantic girl, and the other had an experience similar to mine. The midwives actually used video and photos from our births to help educate the medical staff about good positions for non-epidural breech births. My butt will be shown in many lecture now!

    In general, the approach in Germany seems less invasive than in the US. They are much more encouraging of natural births and really encourage the mother to be as active as possible. If they do induce, they have a much gentler, homeopathic approach. Only if that fails, to they whip out the pit.

    Only one woman in my birthing class had a negative experience, and it sounded like it had a lot to do with a very hard birth and a very arrogant doctor who was on call at the time. She was begging for a c-section, but the doctor told her, basically, to tough it out. She felt disempowered, and as a result, she is still dealing with the trauma. Though the midwives do just about everything for normal births, there is a doctor on call for complications. At the end of the day, the doctors are the one with the real power about how to treat a patient. I had heard about this one doctor at our hospital, and I was grateful that he was not around for my daughter's birth.

    The doctor who came to me just minutes before delivery was kind and not intrusive. She did the vaginalexam after the birth, showed me the placenta and described the different parts of it, and also told me I did a great job - it was nice to get the little extra support from a stranger.

  28. Very interesting to hear your experience. I gave birth to all three of my children there. Two were completely natural births; the first was an induction 48 hours after ROM. I did a saline lock with the two natural births, and I walked around the outside of the hospital for several hours during the second birth. The three practitioners operate together, so you see all three in your prenatal care unless you request one in particular (and then they suggest you meet all three before making the decision). They asked specifically if you were planning to breastfeed, and if so, they did not offer pacifiers nor give sugar water or formula. I don't remember the three hour nursery stay, but with my second I was in surgery for that time (no fair delivering naturally then needing a D&C to get the placenta out--and yes, they waited over an hour before talking about it). I know the most recent baby stayed in my room for several hours after birth.

    I'm surprised I was in such the minority. I think the high rates of epidurals is more a reflection on the population served by that hospital than the hospital staff.

  29. Oh and just fyi, the spotlights were never on, and all the nurses said they had never seen them used. The midwife did my last delivery and she was very supportive of my natural birth. But maybe I'm just an anomoly...


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