I Do Not Consent

After you finish reading this post, please head on over to the sequel to get the full picture here. And remember, this (or any other blog) should not be taken as medical advice- it’s just my opinion. I know it should be common sense, but I’ve gotta post it anyway! Thanks!

If you are in a birthing situation and you find that your caregiver is about to do something you don’t want (e.g. an episiotomy, pulling out the forceps, putting pit in your IV, etc.), you may want to remember these four little words:

“I do not consent.”

Saying, “I’d really rather you not cut me,” or, “I don’t want a vacuum delivery if the baby is still ok,” or “Please don’t up the pit” may or may not work. However, if you say that you do not consent to a certain procedure, then the doctor or midwife cannot legally proceed wth it.

I only say this because I have heard many, many horror stories of women being on the receiving end of what in any situation other than a birth would be considered assault. Make sure you are absolutely clear with your intent and tell your caregiver if you do not consent to a procedure. I will say, however, that this phrase should probably not be taken lightly. Weigh your caregiver’s experience against your own intuition. Is your baby still ok? Are you still ok?  Find out whether the caregiver is recommending a procedure out of medical necessity, or because of convenience or a hospital policy.

If nothing else, you can always say, “Wait. I do not consent yet.” Go on to ask these four questions:

1) Is this an emergency? (If no, move on.)

2) What are the benefits of this procedure?

3) What are the risks of this procedure?

4) What happens if we do nothing?

Remember that it is never, ever too late- even in the middle of labor- to change your caregiver or birth site. If a nurse is trying to do something you do  not want, request a different one. If you are home with a midwife who has suddenly turned sour on you, it’s okay to leave and go to the hospital. If you are at the hospital and there is no acceptable caregiver, it is okay to leave the delivery room and drive to the next hospital. Again, these actions should be taken only with real cause, not at the drop of a hat.

Remember, it is YOUR birth. Yes, doctors and midwives are trained for birth. But sometimes procedures, liability issues, and yes, even sometimes the convenience of the caregiver can get in the way of letting your body do what it does best. You should always be treated with respect and dignity. Remember, with careful consideration, it is okay to utter those four words: “I do not consent.”

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49 responses to this post.

  1. Posted by dac on May 27, 2011 at 11:08 am

    Very well said. We should make it our business to to well informed about any medical procedure. A friend battling ovarian cancer once reminded me, “YOU are in charge of your treatment.”

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  2. Posted by dac on May 27, 2011 at 11:09 am

    Sorry… *to be well informed*

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    • Agreed! Whether it be birth or otherwise, we should be informed about what is being done. If the caregivers aren’t telling us, then we need to firmly ask that we be told and/or find out ourselves.

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  3. [...] be rather busy at that point!). Remember, you can always remind your caregiver that you do not consent to an episiotomy if it is very important to [...]

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  4. Posted by Jessica on April 18, 2012 at 7:10 pm

    Love this!! Thank you!

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  5. Posted by Jessica on April 18, 2012 at 7:16 pm

    Ok, I have a question… what about the “consent for treatment” form they make you sign when you’re admitted. Does that make it to where you can’t just take consent away with certian procedures? I plan on having a very proactive, natural hosptial birth in June and need all the tips I can get! Also, if I’m starting to push and the doctor is doing things I don’t want him to do and is just being a jerk, do I have the right to kick him out and catch the baby myself?

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    • You’d have to ask your individual hospital about the “consent for treatment” form to understand exactly what it says. I’m pretty sure they couldn’t give you services at all if you didn’t sign it, so you’d probably not be having a birth in the hospital if you decided you didn’t want to sign it. Check with them to be sure.
      Do you have the right to kick your doctor out? I suppose you could try it, but I would recommend trying to develop a pleasant and open line of communication at the start of your labor so that you are less likely to end up in this situation in the first place. Going into the hospital “up in arms” will probably get you the type of reaction you’re expecting- “jerk” doctors, because they won’t appreciate the attitude that you don’t respect them. However, if you go in with respect and a smile, but be quite clear about your preferences, they’re a lot more likely to work with you. Straight up refusal should be a last effort, not a first policy.

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      • Posted by Jessica on April 20, 2012 at 5:24 pm

        Someone advised for me to make some notations on the consent form of specific things that I do not consent to… As far as the relationship with the docs go, I 100% agree with you, and this is what I always do. I am very polite and nice and give the doctors a lot of respect. I couldn’t imagine having the job they have… My relationship with my doctor is great and I just love him! There’s one specific on call doc that I’ve heard so many bad things about… I’ll of course try if I end up with him, and hope for the best, just looking at worst case senario I guess. Like if I tell him I need to be in one position, and he just refuses for no medical reason, or I tell him to delay the cord being clamped and he laughs at me and says that’s not going to happen… things like that. I doubt it’ll happen, I really do love the hospital I go to and I’m sure everything will go just fine, just like to cover my bases and know my rights! :) Straight up refusal is a last resort that I’ll use. Unless it’s an emergency, I’ll try saying “no thank you” with a smile on my face first…

      • I’m glad you have a good relationship with your regular doctor- but its probably difficult not knowing who you will get for the labor! I always have high hopes, but you’re right that the stereotypical “anti-natural” docs do exist. (I just discovered one last week in my own area.) It sounds like you are getting well prepared, and I do think it’s good to prepare for whatever scenario you may find yourself in, including knowing your options and rights. I hope I wasn’t “jumping” on your comment- I’ve just heard of so many hostile situations that could have been smoothed over or prevented with kind interactions at the start. It sounds like you’re on the right track, though. I hope you have a beautiful birth!

    • Sign nothing. That is tactical intimidation when you think of it. What will they do if you dont sign? Ask you to leave?

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    • Posted by Donna on April 21, 2012 at 12:31 pm

      Anything you sign in the hospital while in labor doesn’t hold up on court anyway. It’s considered legal coercion while under duress.

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    • Posted by michelle on April 25, 2012 at 5:36 pm

      yes, that waiver you sign basically says that the dr can make any choice they want for YOUR birth and they can do it WITHOUT your consent. a truly natural labor is not possible in a hospital.. i know because i’ve given birth in one twice before… laying on your back to push is not a natural position to give birth in. it actually closes your pelvis by about thirty percent. most hospitals will not allow you to refuse the IV and once they give it to you, you are not allowed to get up anymore. a nurse will offer you drugs approx every 15 minutes until (most women) give in. they will not allow you to trust your body and they will treat your birth experience like it’s a crisis waiting to happen (which, by the way, it’s not.) we are doing a home birth with midwife assistance this time so i can do a truly natural labor the way it was meant to be. i hope that you will look into a free-standing birth center at least if home birth is not for you because it’s the only way you’ll get a truly wonderful birth experience.

      Reply

  6. Posted by kimberlymoore on April 19, 2012 at 4:02 am

    You might be interested in a new Documentary to empower dads at birth as well… It looks amazing …http://www.kickstarter.com/projects/babykeeper/the-other-side-of-the-glass-a-birth-film-for-and-a?ref=live

    Reply

  7. I did all my research before my VBAC and made all my choices then, no continual monitor, no IV in unless it was needed, etc etc, they didn’t like it, but I knew my rights and stood by my choices and got the VBAC I dreamed of!

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  8. Posted by SungaiKecil on April 19, 2012 at 7:36 am

    I’d add another question between #3 and #4… What are the alternatives?

    Otherwise… yeah, what you said!

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  9. Posted by Fuck off on April 19, 2012 at 7:40 am

    And if you leave remember you are the idiot that leaves and something goes terribly wrong remember to sue these people who told you it was OK to leave the hospital.

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    • Indeed. Exactly why I made a point to say that this decision should not be taken lightly, and why I recommended keeping open communication with your doctor/midwife. As I said above,
      “If nothing else, you can always say, “Wait. I do not consent yet.” Go on to ask these four questions:
      1) Is this an emergency? (If no, move on.)
      2) What are the benefits of this procedure?
      3) What are the risks of this procedure?
      4) What happens if we do nothing?”

      I am not recommending anyone take “idiotic” measures against common sense and sound medical judgement. Let it be known, however, that there ARE situations that sometimes occur (though certainly not the norm) that are nothing less than an attack on the birthing mother and her child. In this case, the option of refusal should be left available. Thank you for your input.

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  10. Posted by Karen G on April 19, 2012 at 8:25 am

    One is always free to say “I do not consent” about a treatment for themselves. When you have your child involved though, it’s a very different situation. If someone in the medical community believes you are making a decision that is not in the best interest of your child, they can/will contact a social worker and possibly petition a judge to take temporary custody of your child, at which point they can/will do with your child what they want to do – against your wishes. So, while I fully support a person’s right to refuse treatment and I fully support a parent’s right to make medical decisions for their child, every parent needs to know that when they involve themselves with the medical community – they are risking potential governmental involvement in their family, social workers, child protective services and unwanted medical procedures. Just an FYI.

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    • Good point. Thank you for commenting. This needs to be remembered, for sure. Ideally, one should not be refusing to consent if a procedure or treatment is, in fact, what is needed for the health of their baby, regardless of how they feel about it. This exactly why the family needs to have a relationship of trust with their provider beforehand so that they are not found in a corner, guessing whether or not something is really in their or the child’s best interests.

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      • Posted by Karen G on April 22, 2012 at 9:21 am

        The problem with not consenting when something is needed really does hinge on the understanding and belief of “need”. A well informed mother can easily find herself in a situation where she knows she is making correct decisions for her medical care but the medical system disagrees. Many interventions in labor are truly unnecessary at best and damaging at worst. For example, antibiotics in labor for GBS positive women. Many make a well educated decision to decline them and while the mother can decline them for herself, when that baby is born, the hospital staff can (and have) admitted babies for observation and or antibiotic treatment (without symptoms and against the wishes of the mother). This is an example of making an educated medical decision that lands your baby outside of your control. You can sign yourself out of a hospital against medical advice (AMA) but try to do that with your infant. I don’t know that you will succeed.

      • Thanks so much for your input, Karen. Moms definitely need to filter this in to their decision making. I appreciate your comments!

  11. Posted by Shades of Grey on April 19, 2012 at 9:29 am

    One thing that seems to be over looked in the comments here is that you should never discount your providers education, training and experience. There are times during birth when a caregiver must make life and death decissions and may not have time to offer a 30 min. consult on the pro’s/con’s of their decissions. I am not saying that there will be an emergency in every situation, however, If you do not trust your provider and their judgement to do what is best for you and your baby, you should find a different one! Yes, be well informed. Ask lots of questions PRIOR to the birthing room when there is time to go over all the nuts and buts of why things are done a certian way – but waiting to be informed until you are in the middle of your birth is…well, negligent on your part. And no, I am not a provider, just a mother of three who did LOTS of research, and was in control of my birth, but who trusted her provider to do what was best at a time when I knew my judgement might be comprmised due to the simple fact that I was busy giving birth.

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    • Exactly, Shades of Grey. You have to be informed BEFORE going into labor. Which is exactly why I stress so much finding a provider who you can develop a working relationship with built on trust, so you can eliminate the majority of unpleasant surprises during labor. But, even in the very best of situations, it’s still always possible to find yourself in a spot where something is happening against your will that you know is not an emergency situation. That’s why I tell mothers to keep this in mind. You’re right though, it’s always a balancing act between your level of being informed, your intuition as a birthing woman, and the expertise and experience of your caregiver. Only you and your family can decide which should take precedence during a crucial moment in birth. (Note: I don’t think there’s an all-the-time-Right-answer to this question.)

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  12. I have just done a course about self hypnosis in childbirth (I am a hypnotherapist but for 10 years was lead pharmacists at a local maternity hospital) Our trainer kept on emphasising to us that we need to emphasise to the women we train…… Your body – your choice.

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  13. I went to another hospital during labor because I could’t get the care I needed at the first. The first hospital would allow a c-section only. I had a safe vaginal birth at hospital 2. It is worth taking the time to be informed.

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  14. Thank you so much for this post! I’m due in July with my third child, and my first two children were born 15 and 12 years ago. At that time I had no clue that I even mattered when I was at the hospital much less did I know I had a choice!! I hope you don’t mind, but, I have created a link in my latest blog article to this post…

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  15. The problem with this is that many doctors downplay the risks. I even hear about doctors who tell the women asking that there are “none”. It’s very hard to weigh their expertise against your intuition when you are in the moment and don’t know if you are being lied to. It would actually be far simpler to educate yourself on birth physiology and go from there. 2/3 of Ob/Gyn practices are NOT based on scientific data, but on anecdotal opinion. Since most practitioners have never witnessed true NATURAL birth, this leaves them in a very narrow, biased place to be forming anecdotal opinions.

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  16. Posted by Richie on April 19, 2012 at 3:22 pm

    Should I leave in the middle of my Caesar?

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  17. Posted by cathi on April 19, 2012 at 6:22 pm

    However, i do know of at least one cesarean done at 33 weeks, that the parent said, I do not consent, and the doc said, See? she consents!, and proceeded with the operation. This was a very knowledgable person, too… It’s better to not even place yourself in a building that is designed for intervention and surgery, if that isn’t what you want…(if you need to go there, that’s one thing. But make sure you’ve exhausted other options first, like a good homebirth midwife….)

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    • Posted by Karen G on April 22, 2012 at 9:25 am

      I agree. I knew i never wanted to argue in labor and I know that the medical system in the US would never support the birth I would insist on. I opted for an independent free standing birth center with a midwife for my first baby. I used hypnobirthing and I had a totally pain free birth. I went on to have two more births at home with a skilled midwife, those were easy and pain free too!

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  18. Posted by Heather on April 20, 2012 at 4:27 am

    With my first child the doctor was trying to force me into a c section because he was leaving on vacation as soon as he got me delivered. My nurse explained that the baby was fine and if I didn’t want a c section I didn’t need one. She then called in another doctor for a second opinion and then help me change to him. My son was born 4 hours later with out the need for a c section and perfectly healthy! I was young and scared and the nurse was there to help me and stand up for me!

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    • Posted by Karen G on April 22, 2012 at 9:26 am

      How fabulous! There ARE good care providers in the medical community who really listen and understand what patients need/want. You are very blessesd to have had one.

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  19. Great . Look up Mary Cronk phrases on google and practice them in the mirror until they roll of your tongue. Im sure you will never need them , but its great to be prepared in case you meet an authortarian midwife or doctor. Always ask . Is my baby OK? Is mum ok? If so you have time to discuss and ask them. BRAINS What are the benefits of your advice? What are the risks? What are the alternatives? Whats my intuitions saying? What if I say NO? and lastly SMILE. Always be courteous but firm.

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  20. Thank you for sharing! All that you have said is very true.

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  21. Posted by Ridiculous on April 21, 2012 at 7:43 am

    Things like this terrify me. As much as you are encouraging well informed women to make well informed decisions you are also encouraging idiots to argue with their doctors.
    As a doctor, aside from the c-sec holiday story above, I have never known anyone to knowingly try to force a woman to have something they didn’t deem 100% necessary to protect the baby and the mother.
    You seem to have put “weigh your caregiver’s experience against your own intuition” as a “safety-net” here, but what place does intuition have? Can you tell me that during your birth you intuitively knew if your baby was having late decels, or if the umbilical cord had prolapsed? Any doctor who is delivering your baby (unsupervised) has had at least 5 years of medical school training, followed by 2years of hospital training, and then however many years of residency. How many babies do you think they have delivered in comparison to you?
    I’m not saying that there isn’t a place for patient choice, but that place is not in a high stress situation with two lives at risk. This is a reckless article.

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    • Thank you for your input. Due to the large amount of traffic this article has received in the past few days, I was considering writing another addressing some of the very same issues you have brought up here. I in no way want to suggest women fight their doctors or refuse treatment when it is truly a medically necessary situation.
      “As a doctor, aside from the c-sec holiday story above, I have never known anyone to knowingly try to force a woman to have something they didn’t deem 100% necessary to protect the baby and the mother.”
      I agree that this is usually the case. If you are a regular reader of my blog, you will know I don’t believe caregivers are out to get women. I really do try to stay away from that extreme. However, I have seen and heard enough cases where this simply isn’t true to feel the need to keep the option of non-consent available. For example, a co-worker of mine whose doctor intentionally ripped her perineum with his hands when she asked him not to cut her if he didn’t have to. Or a friend who had a previous cesarean because she fell while laboring, causing the monitors to come unplugged and flat-line. The doctors rushed in, telling her they were ready to perform the surgery. She explained the situation to them, and they told her then she had no choice. Why? First they told her it was because her water had been broken too long (16 hrs at that point, no signs of infection). Then wrote failure to progress on the paperwork (even though she was at 8cm and having an urge to push). The baby was fine, the mom was fine, she was progressing. They told her she didn’t have a choice, so she went in. I could go on with examples, but I won’t.
      Now, I don’t usually tell these stories. Why? Because I agree with you that most doctors REALLY and truly want the best for their patients, and I don’t want to encourage the mindset that doctors are doofuses. If you read my posts regularly, hopefully that should come through. I believe that women and their caregivers should ideally have a partnership, a good line of communication, and trust. Unfortunately, situations can and do arise that are far from that ideal, and in that case, the option of non-consent should be available.
      You’re right that doctors have tons of experience and training. I truly respect that. I am not advising women to stay away from them or to deny care all together. The safety of any birth has been shown to depend upon the presence of a skilled and qualified care provider. But we also cannot ignore a birthing woman’s intuition, if she is truly in touch with what is going on. I do not say to rely on it soley- that is why we need caregivers in the first place. However, I do think there is far too much watching of the machines and not the mother. Mothers are not idiots. This is just as harmful a position to assume as thinking the doctors are idiots.
      Birth should ideally be a partnership between birthing mother and caregiver. Only when the mother is being coerced or attacked for non-medical reasons should refusal be resorted to. I am sorry this didn’t come across more clearly in this article. I will work on another to clarify, because you’re right- I don’t want to encourage recklessness. But I do firmly stand behind the protection of a woman’s intelligence and dignity during birth, and that means that she has to still have her rights in the birthing room.

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      • Posted by Karen G on April 22, 2012 at 9:40 am

        What an excellent reply, thebirthbug!
        The problem I see that is inherent in medical treatment of normal birth is summed up perfectly in the choice of words that this doctor uses:
        “I’m not saying that there isn’t a place for patient choice, but that place is not in a high stress situation with two lives at risk. ”

        Doctors are taught that birth is high stress and high risk and that two lives are at risk. When you believe that about birth, it’s easy to believe that you must intervene and control everything because you believe there is great risk to two lives. I find it very sad that so few OBs have seen a truly natural birth – the uninterfered with natural process. So many births end in c-sections that were never necessary because of medical management and protocols designed to protect the doctor/hospital from a liability standpoint. Medicine in America is so profit based. One cannot deny that this all factors into how labor/birth is handled.

        I find it very arrogant to hear a doctor say that birth is not a place for patient choice. That is a very telling statement of this physician’s belief system.

    • i have to take issue with this for you are not listening to what women are saying. If forced means being manipulated, bullied and being denied the whole truth then forced they are. I fully believe in women being given information of the risk/benefits of any action in labour. They are only being given the risks though. I have never heard a doctor when giving the risks related to post maturity also give the risks of induction.
      Are you suggesting that doctors dont have fashions in their policy. If we believe that every thin g a doctor says is true, then any woman who went along with policy in 1980 will have had an episiotomy as they were told it prevented a prolapse and was help up baby’s birth causing fetal anoxia.
      Please be aware, no one is saying one should question doctors when either baby or their life is in danger, but surely you accept women should be given a choice to question a doctors wisdom. The doctor should be there to give advice and be prepared to question his own doctrine.

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  22. [...] wrote a post almost a year ago now entitled “I Do Not Consent,” and I noticed it was getting a lot of traffic (for my blog, anyway!) the past few days. As [...]

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  23. [...] wrote a post almost a year ago now entitled “I Do Not Consent,” and I noticed it was getting a lot of traffic (for my blog, anyway!) the past few days. As [...]

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  24. [...] this time around. With that being said, I’m linking to an article called…”I Do Not Consent“. This is one of many articles I’ll be linking to as well as one of many topics [...]

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  25. Posted by Loraine on April 29, 2012 at 2:55 am

    I wish so badly that my labor had not gone so fast and I could have said, I DO NOT CONSENT to that for soooo many things!! Especially when the nurse completely violated me by shoving her hand inside during a ctx with NO warning or explanation and would not listen when I screamed, cried and yelled at her to STOP!!!!!!

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  26. Posted by Amanda on May 1, 2012 at 2:32 pm

    Thank you for this. I had my girl 8 months ago and it was sort of frustrating. It was me and my hubby and we were as informed as we could be so we thought. The hospital was very understaffed. After She was born the nurse came in with a bottle and said Hospital policy is that a baby has to have a bottle before they could breastfeed if you had gestational diabetes. I was bummed because I wanted to only breastfeed, so I gave her part of the bottle and stopped half way through, come to find out the nurse was told to go to lunch so instead of being there to help me breastfeed, she had us do that!! I was livid!! It took almost two weeks for my baby to get how to do it right! She pretty much had told us we didn’t have a choice, and us being uninformed and no one around to know otherwise we were compliant. We couldn’t get a nurse to come in the room for 2 hrs after she was born, and our family couldnt come in for 3 hrs!!! I had a regular vaginal birth! It was crazy! My next child it will be different, and it will be at a different hospital as well.

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    • That’s nuts! Those are the types of stories that make me livid for parents’ sake. I’m so sorry you were given such a difficult time because of one nurse’s lunch, and I hope your next birth is beautiful and that you have supportive staff surrounding you. Thank you for sharing.

      Reply

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