Back in action!

Just a little update:

I finished my 1 year midwifery apprenticeship last fall and then had surgery on my shoulder, so I have been taking time out to heal and regroup. BUT, Now I’m ready to start taking clients again!!

I have updated my availability on my calendar at Doula Match so please check over there for the dates I have open for clients! If for some reason your due date falls on an “unavailable” day please contact me. I may still be able to take you as a client depending on what my schedule actually is.

Don’t forget I also teach babywearing, cloth diapering, and new parent classes! If you have a group of new moms that you think would enjoy learning more about these topics please feel free to contact me!

I really am looking forward to serving families again during this most amazing time in their lives.

Blessings,

Nichol

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A beautiful documentary on what a Doula is and why they are needed.

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Know Your Rights!

Here is a great article written by Dr. Marsden Wagner on The Trusting Our Bodies Website:

Every Mother’s Right to Birth How She Chooses:

It’s best for you to know your rights.  You can birth at any hospital you
choose when you are in labor, they must take you in and treat you if you
request treatment.  A full explanation of your rights are below.

What are my rights?

-  You have the right to decline induction or cesarean section.  

-  You have the right to make medical decisions free from coercion and
undue influence from your birth attendants.

-  You have the right to revoke consent previously given at any time
either verbally or in writing.

-  You have the right to be fully informed before making a decision,
including a diagnosis, recommended treatment and alternative treatment -
the risks, benefits, discomforts and potential disabilities of those
treatments, realistic expectation of outcomes, a second opinion and any
financial or research interests a birth attendant might have in proposing
certain treatments.

Can my birth attendant discontinue care?

No!  Not when you are in labor or are within 30 days of giving birth.

- A doctor/midwife must give you 30 days notice in writing with a list of
referrals to other birth attendants in order to discontinue care.

- During labor or within the 30 days, the doctor/midwife cannot terminate
ongoing care unless the patient has successfully transferred to another
doctor.

Doctors/midwives who fail to follow these guidelines can be charged with
patient abandonment which is grounds for malpractice and loss of license.

(See ACOGs and AMAs ethical guidelines and the federal law (the
Emergency Medical Treatment and Active Labor Act – EMTALA).

Can a doctor go to a judge to obtain a court order to force me to
undergo a cesarean?

Doctors can do this but thanks to a widely cited case Carder v. George
Washington University Hospita
l, they are less likely to do so because this
goes against the ACOG’s guidelines and opens the doctor up to having
their license revoked or other disciplinary action AND if you sue them for
forcing you to undergo treatment by coercing you to consent, then they
will lose this legal battle and they know it!

The ACOG’s ethical guidelines say that doctors must respect the
autonomy of pregnant patients and that using the courts to compel
treatment is rarely, if ever, justified.

Does the pregnant mother have the last say in all medical decisions?

Yes!  The ACOG’s ethical guidelines also say that patient’s autonomy
must be respected at all times and that a doctor must obtain informed
consent for any medical or surgical treatment and that the patient’s
decision to forgo treatment whether it is based on cultural reasons,
religious reasons, personal preference or comfort must be honored.

Do I have to sign the hospital consent form?

No!  You are not required by law to sign the hospital consent form.  In
fact you do have the right to change the consent form to reflect your
wishes regarding specific treatments.  For example, you could write on the
consent form that you refuse a cesarean.  

What if I change the consent form to state I don’t want a
particular procedure or medical treatment and the doctor/midwife
does it anyway?

If you have in writing your wish to refuse a specific treatment such as a
cesarean and the doctor performs the cesarean anyway, the doctor and
hospital are subject to criminal battery charges even if you and the baby
are fine after the procedure.

Does any hospital have to treat me if I come to them in labor
asking for treatment?

Yes!  If you are within 250 feet of the hospital building and are in labor,
the hospital must treat you until you are in “stable” condition which for a
laboring woman means that the baby has been delivered and the placenta
has been delivered and then they can transfer you to another hospital or
follow  normal procedures until you are released from care.

Hospitals MUST admit women in active labor, explain the risks, benefits
and alternatives of all recommended treatments and honor the patient’s
wishes including the laboring mother’s right to refuse treatment even if
you can’t pay for that treatment.

If a hospital is not willing to comply with the laboring mother’s
wishes, what do I do now?

You can file a complaint with the chief compliance officer of the hospital.  
Hospitals must adhere to a set of rules called the Center for Medicare and
Medicaid Services conditions of participation – CMS’s CoP – which require
hospitals to honor patient rights as are stated above.  Hospitals that fail
to adhere to CoP are subject to heavy fines and risk losing their right to
qualify for Medicare and Medicaid funding.

Additionally, you can file a grievance with the hospital and you should have
received information on how to do that upon admission at the hospital.

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After Birth, What a family needs….


From Gloria Lemay:

“Let me know if I can help you in any way when the baby is born.” … “Just let me know if you need a hand.” … “Anything I can do, just give me a call.”

Most pregnant women get these statements from friends and family but shy away from making requests when they are up to their ears in dirty laundry, unmade beds, dust bunnies and countertops crowded with dirty dishes. The myth of “I’m fine, I’m doing great, new motherhood is wonderful, I can cope and my husband is the Rock of Gibraltar” is pervasive in postpartum land. If you’re too shy to ask for help and make straight requests of people, I suggest sending the following list out to your friends and family. These are the things I have found to be missing in every house with a new baby. It’s actually easy and fun for outsiders to remedy these problems for the new parents but there seems to be a lot of confusion about what’s wanted and needed…

1. Buy us toilet paper, milk and beautiful whole grain bread.

2. Buy us a new garbage can with a swing top lid and 6 pairs of black cotton underpants (women’s size____).

3. Make us a big supper salad with feta cheese, black Kalamata olives, toasted almonds, organic green crispy things and a nice homemade dressing on the side. Drop it off and leave right away. Or, buy us frozen lasagna, garlic bread, a bag of salad, a big jug of juice, and maybe some cookies to have for dessert. Drop it off and leave right away.

4. Come over about 2 in the afternoon, hold the baby while I have a hot shower, put me to bed with the baby and then fold all the piles of laundry that have been dumped on the couch, beds or in the room corners. If there’s no laundry to fold yet, do some.

5. Come over at 10 a.m., make me eggs, toast and a 1/2 grapefruit. Clean my fridge and throw out everything you are in doubt about. Don’t ask me about anything; just use your best judgment.

6. Put a sign on my door saying “Dear Friends and Family, Mom and baby need extra rest right now. Please come back in 7 days but phone first. All donations of casserole dinners would be most welcome. Thank you for caring about this family.”

7. Come over in your work clothes and vacuum and dust my house and then leave quietly. It’s tiring for me to chat and have tea with visitors but it will renew my soul to get some rest knowing I will wake up to clean, organized space.

8. Take my older kids for a really fun-filled afternoon to a park, zoo or Science World and feed them healthy food.

9. Come over and give my husband a two hour break so he can go to a coffee shop, pub, hockey rink or some other r & r that will delight him. Fold more laundry.

10. Make me a giant pot of vegetable soup and clean the kitchen completely afterwards. Take a big garbage bag and empty every trash basket in the house and re-line with fresh bags.

These are the kindnesses that new families remember and appreciate forever. It’s easy to spend money on gifts but the things that really make a difference are the services for the body and soul described above. Most of your friends and family members don’t know what they can do that won’t be an intrusion. They also can’t devote 40 hours to supporting you but they would be thrilled to devote 4 hours. If you let 10 people help you out for 4 hours, you will have the 40 hours of rested, adult support you really need with a newborn in the house. There’s magic in the little prayer “I need help.”

For more awesome articles and information on birth, breastfeeding, and babies please visit Gloria’s website at http://www.glorialemay.com/

Reposted with permission.

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Normal Newborn Behavior and Why Breastmilk Isn’t Just Food-By Dr. Jenny Thomas

What is a normal, term human infant supposed to do?

First of all, a human baby is supposed to be born vaginally. Yes, I know that doesn’t always happen, but we’re just going to talk ideal, normal for now. We are supposed to be born vaginally because we need good bacteria. Human babies are sterile, without bacteria, at birth. It’s no accident that we are born near the anus, an area that has lots of bacteria, most of which are good and necessary for normal gut health and development of the immune system. And the bacteria that are there are mom’s bacteria, bacteria that she can provide antibodies against if the bacteria there aren’t nice.

Then the baby is born and is supposed to go to mom. Right to her chest. The chest, right in between the breasts is the natural habitat of the newborn baby. (Fun fact: our cardiac output, how much blood we circulate in a given minute, is distributed to places that are important. Lots goes to the kidney every minute, like 10% or so, and 20% goes to your brain. In a new mom, 23% goes to her chest- more than her brain. The body thinks that place is important!)

That chest area gives heat. The baby has been using mom’s body for temperature regulation for ages. Why would they stop? With all that blood flow, it’s going to be warm. The baby can use mom to get warm. When I was in my residency, we would put a cold baby “under the warmer” which meant a heater thingy next to mom. Now, as I have matured, if a baby is “under the warmer,” the kid is under mom. I wouldn’t like that. I like the kids on top of mom, snuggled.

Now we have a brand new baby on the warmer. That child is not hungry. Bringing a hungry baby into the world is a bad plan. And really, if they were hungry, can you please explain to me why my kids sucked the life force out of me in those last few weeks of pregnancy? They better have been getting food, or well, that would have been annoying and painful for nothing.

Every species has instinctual behaviors that allow the little ones to grow up to be big ones and keep the species going. Our kids are born into the world needing protection. Protection from disease and from predators. Yes, predators. Our kids don’t know they’ve been born into a loving family in the 21st century- for all they know it’s the 2nd century and they are in a cave surrounded by tigers. Our instinctive behaviors as baby humans need to help us stay protected. Babies get both disease protection and tiger protection from being on mom’s chest. Presumably, we gave the baby some good bacteria when they arrived through the birth canal. That’s the first step in disease protection. The next step is getting colostrum.

A newborn baby on mom’s chest will pick their head up, lick their hands, maybe nuzzle mom, lick their hands and start to slide towards the breast. The kids have a preference for contrasts between light and dark, and for circles over other shapes. Think about that…there’s a dark circle not too far away.

Mom’s sweat smells like amniotic fluid, and that smell is on the child’s hands (because there’s been no bath yet!) and the baby uses that taste on their hand to follow mom’s smell. The secretions coming from the glands on the areola (that dark circle) smell familiar too and help the baby get to the breast to get the colostrum which is going to feed the good bacteria and keep them protected from infection. The kids can attach by themselves. Watch for yourself! And if you just need colostrum to feed bacteria and not yourself, well, there doesn’t have to be much. And there isn’t because the kids aren’t hungry and because Breastmilk is not food!

We’re talking normal babies. Breastfeeding is normal. It’s what babies are hardwired to do. 2009 or 209, the kids would all do the same thing: try to find the breast. Breastfeeding isn’t special sauce, a leg up or a magic potion. It’s not “best.” It’s normal. Just normal. Designed for the needs of a vulnerable human infant. And nothing else designed to replace it is normal.

Colostrum also activates things in the baby’s gut that then goes on to make the thymus grow. The thymus is part of the immune system. Growing your thymus is important. Breastmilk= big thymus, good immune system. Colostrum also has a bunch of something called Secretory Immunoglobulin A (SIgA). SIgA is made in the first few days of life and is infection protection specifically from mom. Cells in mom’s gut watch what’s coming through and if there’s an infectious cell, a special cell in mom’s gut called a plasma cell heads to the breast and helps the breast make SIgA in the milk to protect the baby. If mom and baby are together, like on mom’s chest, then the baby is protected from what the two of them may be exposed to. Babies should be with mom.

And the tigers. What about them? Define “tiger” however you want. But if you are baby with no skills in self-protection, staying with mom, having a grasp reflex, and a startle reflex that helps you grab onto your mom, especially if she’s hairy, makes sense. Babies know the difference between a bassinette and a human chest. When infants are separated from their mothers, they have a “despair- withdrawal” response. The despair part comes when they alone, separated. The kids are vocally expressing their desire not to be tiger food. When they are picked up, they stop crying. They are protected, warm and safe. If that despair cry is not answered, they withdraw. They get cold, have massive amounts of stress hormones released, drop their heart rate and get quiet. That’s not a good baby. That’s one who, well, is beyond despair. Normal babies want to be held, all the time.

And when do tigers hunt? At night. It makes no sense at all for our kids to sleep at night. They may be eaten. There’s nothing really all that great about kids sleeping through the night. They should wake up and find their body guard. Daytime, well, not so many threats. They sleep better during the day. (Think about our response to our tigers– sleep problems are a huge part of stress, depression, anxiety.)

And sleep… My guess is everybody sleeps with their kids- whether they choose to or not and whether they admit to it or not. It’s silly of us as healthcare providers to say “don’t sleep with your baby” because we all do it. Sometimes accidentally. Sometimes intentionally. The kids are snuggly, it feels right and you are tired. So, normal babies breastfeed, stay at the breast, want to be held and sleep better when they are with their parents. Seems normal to me. But there is a difference between a normal baby and one that isn’t. Safe sleep means that we are sober, in bed and not a couch or a recliner, breastfeeding, not smoking…being normal. If the circumstances are not normal, then sleeping with the baby is not safe.

That chest -to -chest contact is also brain development. Our kids had as many brain cells as they were ever going to have at 28 weeks of gestation. It’s a jungle of waiting -to-be- connected cells. What we do as humans is create too much and then get rid of what we aren’t using. We have like 8 nipples, a tail and webbed hands in the womb. If all goes well, we don’t have those at birth. Create too much- get rid of what you aren’t using. So, as you are snuggling, your child is hooking up happy brain cells and hopefully getting rid of the “eeeek” brain cells. Breastfeeding, skin-to-skin, is brain wiring. Not food.

Why go on and on about this? Because more and more mothers are choosing to breastfeed. But most women don’t believe that the body that created that beautiful baby is capable of feeding that same child and we are supplementing more and more with infant formulas designed to be food. Why don’t we trust our bodies post-partum? I don’t know. But I hear over and over that the formula is because “I am just not satisfying him.” Of course you are. Babies don’t need to “eat” all the time- they need to be with you all the time- that’s the ultimate satisfaction.

A baby at the breast is getting their immune system developed, activating their thymus, staying warm, feeling safe from predators, having normal sleep patterns and wiring their brain, and (oh by the way) getting some food in the process. They are not “hungry” –they are obeying instinct. The instinct that allows us to survive and make more of us.

Dr. Thomas

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Affirmations for Pregnancy

Affirmations for Pregnancy

Affirmations are statements that you use to help instill a sense of positivity in your mind about a particular subject. You use these short phrases and sentences to help your mind hear a positive message that you wish it to remember.

You can write your own affirmation, to use whenever you like. Remember they should be in the present tense, as if what you wish to happen is already occurring. For example, a friend of mine who was trying to get pregnant and having difficulty, would say, “I am a good parent to my child.” She said this every morning, even during infertility treatments. She says she remembers visualizing it as she would wait for procedures and tests. She feels it really helped her from falling into despair. And when she became pregnant, she switched to daily pregnancy affirmations.

If you choose to write your own affirmations, start with phrases like:

  • I am
  • My mind is open to
  • My body is open to
  • My baby is
  • My labor is
  • Breastfeeding is
  • I know
  • My body knows

Some women use positive affirmations to help them overcome fear, to get pregnant or to simple remind themselves that pregnancy is not an illness. While affirmations are simple and easy, they are also effective for many women.

Here are some samples:

  • I know how to take care of myself in pregnancy.
  • My body knows how to give birth.
  • My baby knows the true birthday.
  • Birth is safe for me and my baby.
  • My baby will be born at the perfect time.
  • My body knows when to give birth.
  • I am a good mother.
  • My baby will find the perfect position for birth.
  • I love my baby.
  • My baby loves me.
  • I am a strong woman.
  • Contractions help to bring my baby.
  • I will make the right decisions for my baby.
  • My pregnant body is beautiful.
  • My baby senses the peace I feel.
  • I accept the help of others.
  • My baby’s head fit snuggly into my pelvis.
  • I accept my labor and birth.
  • I am surrounded by those who love and respect me.
  • I trust my body.
  • I know how to take care of my baby.
  • My baby feels my love.
  • I will make plenty of breast milk for my baby.

You can use index cards to write your affirmations and place them in locations to remind you to say them. Consider using your affirmations as a part of your relaxation routine as well. They also make really nice mantras for labor!

If you’d like to have daily pregnancy affirmations emailed to you, you can sign up for the daily Pregnancy Affirmations delivered straight to your inbox.

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Pain in Labour: Your hormones are your helpers

Pain in Labour: Your hormones are your helpers

© Dr Sarah J Buckley 2005 http://www.sarahjbuckley.com

First published in Australia’s Parents Pregnancy, Autumn 1999, as “Your Hormones are your Helpers” This version updated July 2005
Imagine this. Your cat is pregnant, due to give birth around the same time as you are. You have your bags packed for hospital, and are awaiting the first signs of labour with excitement and a little nervousness .

Meanwhile your cat has been hunting for an out-of-the way place — your socks drawer or laundry basket — where she in unlikely to be disturbed. When you notice, you open the wardrobe door, but she moves again. Intrigued, you notice that your observation, even your presence, seems to disturb the whole process. And, wish as you might to get a glimpse into the mysteries of birth before it is your turn, you wake up the next morning to find her washing her four newborn kittens in the linen cupboard.

Why does birth seem so easy to our animal friends when it is so difficult for us? One obvious difference is the altered shape of the pelvis and birth outlet that is caused by our upright stance; our babies need to twist and turn to navigate these unique bends. Even our nearest cousins, the great apes, have a near-straight birth canal.

However, in every other way, human birth is like that of other mammals — those animals that suckle their young — and involves the same hormones: the body’s chemical messengers. These hormones, which originate in the deepest and oldest parts of our brain, cause the physical processes of labour and birth, as well as exerting a powerful influence on our emotions and behaviour.

Researchers such as French surgeon and natural birth pioneer Michel Odent believe that if we can be more respectful of our mammalian roots, and the hormones that we share, we can have more chance of a straightforward birth ourselves.

Labour and birth involve peak levels of the hormones oxytocin, sometimes called the hormone of love, and prolactin- the mothering hormone. These two hormones are perhaps best known for their role in breastfeeding. As well as these, beta-endorphin, the body’s natural pain-killer, and the fight-or-flight hormones adrenaline and noradrenaline (epinephrine and norepinephrine) play an important part in the birth process. There are many more hormonal influences on birth that are not well understood.

All mammals seek a safe place to give birth. This “nesting” instinct may be due to an increase in levels of prolactin, which is sometimes referred to as the nesting hormone. At this stage, as you may have observed with your cat, interference which the nest — or more importantly with the feeling of safety — will stall the beginning of labour.

Even after labour has started, there are certain conditions that will slow, or even stop the process. If the fight-or-flight hormones are activated by feelings of fear or danger, contractions will slow down. Our mammalian bodies are designed to give birth in the wilds, where it is an advantage to postpone labour when there is danger, and to seek safety.

Many women have had the experience of their labour stopping when they entered the unfamiliar surroundings of a hospital, and some women can be as sensitive as a cat to the presence of an observer. Giving birth away from our natural environment can cause the sorts of difficulties for humans that captive animals experience when giving birth in a zoo.

Michel Odent cautions that even hunger, which also causes the body to release fight-or-flight hormones, can stop labour from progressing. He advises women to eat- if they are hungry- in the earliest stages of labour; many hospitals, though, have a policy that prevents labouring women from eating once they are admitted.

Oxytocin is the hormone that causes the uterus to contract during labour. Levels of oxytocin gradually increase throughout labour, and are highest around the time of birth, when it contributes to the euphoria and receptiveness to her baby that a mother usually feels after an unmedicated birth. This peak, which is triggered by sensations of stretching of the birth canal as the baby is born, does not occur when an epidural is in place. Administration of an epidural has been found to interfere with bonding between ewes and their newborn lambs.

Synthetic oxytocin is often given by drip- that is, directly into the bloodstream- when labour contractions are inefficient. Oxytocin given in this way does not enter the brain, and so does not contribute to the post-birth “high”, and in fact can lead to desensitisation to the mothers own oxytocin production. Nipple stimulation is sometimes used to stimulate contractions because, like breastfeeding, this causes oxytocin levels to increase.

Oxytocin has another crucial role to play after the birth. Oxytocin causes the contractions that lead to separation of the placenta from the uterus, and its release as the “after-birth”. When oxytocin levels are high, strong contractions occur that reduce the chance of bleeding, or post-partum haemorrhage.

Putting your newborn baby to your breast is the easiest way to increase oxytocin levels, but Michel Odent also emphasises the importance of privacy during the hour following birth. This gives the opportunity for uninterrupted skin-to-skin and eye-to-eye contact between mother and baby – conditions that optimise oxytocin release.

Oxytocin helps us in our emotional, as well as our physical, transition to motherhood. From the first weeks of pregnancy, oxytocin helps us to be more emotionally open and more receptive to social contact and support. As the hormone of orgasm, labour and breastfeeding, oxytocin encourages us to “forget ourselves”, either through altruism — service to others — or through feelings of love.

The fight or flight hormones- also called catecholamines (pronounced cat-e-kol-a-meens), or CAs- can interfere with oxytocin release during labour and after the birth. However they do have an important role to play in the second stage of labour, which is when birth actually occurs.

Early in second stage, when the cervix is fully open but the urge to push is not yet strong, a woman can feel the need to rest for some time. This is sometimes known as the “rest and be thankful” time. After this, she may quite suddenly experience the dry mouth, dilated pupils and sudden burst of energy that are all characteristic of high levels of CAs.

This burst of CA’s gives a mother the energy to push her baby out, and Michel Odent observes that, when unmedicated, women usually want to be upright at this time. Some traditional cultures have used this fight-or-flight effect to help women having difficulty with the delivery by surprising or shouting out at this stage. It makes sense, at this point-of-no-return, for fear or danger to speed up the birth, so that a mother can gather up her newborn baby and run for safety.

CA levels drop quickly after the birth, which can make a mother may feel cold or shaky. At this stage a very warm atmosphere is essential, according to Michel Odent, to keep CA levels low and to allow oxytocin to work effectively to prevent bleeding.

The other major birthing hormone, prolactin is most noteworthy for its effects after the birth. Prolactin is the major hormone of breast milk synthesis. Suckling by the newborn baby increases prolactin levels; early and frequent suckling from the first days makes the breast more responsive to prolactin, which in turn helps to ensure a good long-term supply of milk.

Like the other hormones, prolactin has effects on emotion and behaviour. Prolactin helps us to put our babies needs first in all situations by increasing submissiveness, anxiety and vigilance.

When prolactin is combined with oxytocin, as it is soon after birth and during breastfeeding, it encourages a relaxed and selfless devotion to the baby that contributes to a mother’s satisfaction and her baby’s physical and emotional health.

Beta endorphin (pronounced beet-a en-door-fin) is one of the endorphin hormones which are released by the brain in times of stress or pain, and is a natural equivalent to painkilling drugs like pethidine.

During labour, beta-endorphin helps to relieve pain, and contributes to the “on another planet” feeling that women experience when they labour without drugs. Levels of beta-endorphin are reduced when drugs are used for pain relief.

Very high levels of beta-endorphin can slow labour by reducing oxytocin levels, which may help to “ration” the intensity of labour according to our ability to deal with it. Moderate levels of beta-endorphin help us to deal with pain in labour, as well as encouraging us to follow our instincts. As part of the hormonal cocktail after birth, beta-endorphin plays a role in bonding between mother and baby, who is also primed with endorphins from the birth process.

Beta-endorphin also switches on learning and memory, perhaps explaining why we remember our labour and birth in such amazing detail. Like oxytocin, endorphin hormones can induce euphoria and are also released during lovemaking and breastfeeding. In fact endorphins are actually present in breast milk, which explains the natural high that babies can get after a breast-feed. Beta-endorphin helps the body to release prolactin, underlining the elaborate interplay between these hormones of labour, birth and breastfeeding.

So there you are, at the door, with your bag in your hand and a strong contraction. You remember the oxytocin and endorphins, which you also carry with you, and with your next relaxed breath, you breathe out fear and tension. You’ve packed your new nursing bra, and you know that prolactin will come to your aid as well. As you take a last look around the house, you notice your cat.

She’s lying down as her kittens attach to her nipples, and as you catch her eye, she winks at you.

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