Elizabeth Petrucelli

Author, Blogger, Educator

Author: ElizabethPetrucelli (page 1 of 17)

The Struggle to Go In – When Baby isn’t Moving Regularly

I specialize in pregnancy loss. I have been working with women for six years now, in differing capacities as a perinatal loss specialist and bereavement doula. In my childbirth education classes, we review fetal kick counting, fetal movements, and I share that it’s a myth that babies “run out of room” the farther along in pregnancy women get. We talk about being intuitive with the baby and knowing what is the normal pattern for the woman’s individual pregnancy and baby. Each baby may not fit the pattern of X number of movements per hour but if you know how your baby moves and what you can do to get your baby to move, then it’s easier to tell when things are “off.”

If you didn’t know this, as of the writing of this post, I am 30 weeks pregnant with my 5th baby (hopefully 3rd living). Yesterday, I had a scare with my pregnancy and it was very interesting for me to see how my mind was responding to this scare. I know I had been little more anxious this past week but I chalked that up to a few new clients with stillbirths and a few stories that popped up in my Facebook feed about late losses. It had me on edge more than usual and I was listening to baby more than usual on my home doppler. That always brings me reassurance but I had found I needed the reassurance more often.

I was having periods of contractions the last few days as well. These were not typical contractions. My belly was tightening but I was also experiencing cramping and some pressure. Knowing my body, even though they were uncomfortable, I did not think these were contractions that were dilating or effacing my cervix. On Wednesday night though, I was very uncomfortable so I took a bath; which helped for a few hours but then things picked up again.

I decided to try to get some sleep and listened to the baby just before I fell asleep. She had an episode where her heartrate was really high and then dropped but then she stabilized and all seemed fine. Throughout the night, I was not feeling her. I get up often, roughly every two to three hours, because my bladder calls and when I return to bed she usually “tickles” the side I am laying on before we drift off to sleep. I briefly noted that this was not happening.

By morning, I figured my cup of coffee would rouse her. Nothing.

I took my son to his dentist appointment and didn’t feel her at all so we went to the store and I got a donut. The worst kind, a frosting filled, maple iced, long-john. Surely this amount of sugar would get her moving. Nothing.

I wasn’t worried at this point but just noted that she wasn’t moving much. I thought I had felt a few punches earlier so I rationalized that I had felt something but really knew I was feeling nothing.

I sat outside with my youngest while he played in the driveway. It was a nice warm and sunny day. I lifted my shirt to expose my belly; which was something that usually got her moving. Nothing.

After a few hours outside, I returned inside and sat at the table and did some work on my computer. I leaned forward to sort of “smush” her hands because that would usually get her moving. Nothing.

I grabbed my doppler at this point and listened. THUMP, THUMP, THUMP, THUMP, THUMP. Her heart rate was in the 130’s. Normal for her. But she didn’t punch or kick the doppler like she always does. Ugh!

I had to go to an appointment at the church. I figured I would start to contract and get her moving because it was “that” time of day where my uterus liked to pick up and do something. Unfortunately, on the drive there, my uterus was silent, but so was she. As I got closer to the church, I decided to feel for her. She always moves her foot away when I push on it. I located her foot and pushed. Nothing.

When I arrived to the church, I parked and sat for a moment. I talked to her and told her she needed to move. Nothing.

I hummed and sang; which usually got me a kick. Nothing.

Then I located her butt and pushed down on her. I could feel her whole body move down into my pelvis. I felt the pressure of her head on my cervix. Nothing. She was still. I was now worried.

I called the OB office and demanded to speak to someone. I was lucky because they actually transferred me directly instead of “sending a message.” I told the nurse everything I just wrote above and she said I should be seen. I wanted to go to the clinic but it was 3:30 on a Friday afternoon and even if I got there before 4, the doctors wouldn’t be there long enough to read the strip. She said I had to go to L&D. Oh how I wish there were more options with my HMO. It’s very frustrating.

I texted my mother-in-law to see if she was available to watch the kids and went into the church for my appointment. It was quick and I returned to my car anxious about the baby. She wasn’t moving at all. I was going to leave straight from the church but I kept feeling like even though she wasn’t moving, she was okay.

Then all the questions in my mind began.

“She’s probably fine.”
“It’s probably just a growth spurt.”
“It’s going to cost me a fortune to go to L&D”
“I am going to get there and she will move like crazy and then they will think “I” am crazy.”
“It will end up being a waste of time and money to go in.”
“I heard her on the doppler and her heart rate was fine, so she is fine.”
“I don’t want to go and be admitted.”

I am sure there were many more things going through my head. I called my mother-in-law to tell her what was going on. She had texted a few times and called me but I couldn’t respond. She rationalized with me and said everything was probably just fine. We talked for what seemed like, FOREVER. I just wanted her to say I should be seen but I never heard that. I just kept rationalizing and since I was going back and forth, I decided to drive home.

I called my husband on the way home to update him. He didn’t have an answer for me either. He just kept saying that it was probably a growth spurt and she was “tired” because I had been in so much pain the night before.

“What if the cord is wrapped around her and she isn’t getting enough oxygen?” You would hear that on the doppler as her heart rate would be struggling.”
“What if my placenta isn’t working right and she isn’t getting enough oxygen?” Same answer as above.
“What if there is something wrong and I don’t go in and she dies?” There is probably nothing wrong.
“What if…”

All my concerns were shot down, either by my husband or by my mother-in-law. In all honesty, I was shooting some of my concerns down as well. But the back of my mind kept saying, “What is your advice to women who aren’t feeling their baby move regularly?”

If your baby’s movements stop, change, or are concerning to you, be seen!

I couldn’t even follow my own advice. I stress this in my classes. I stress this to women in pregnancy after a loss and here I am…the professional…struggling to follow my own advice. How are women going to follow this advice if I can’t?

I got home and laid down on the floor on my back. Surely this would get her to move? Nothing.

I poked her. Nothing.

I listened to her on the doppler. THUMP, THUMP, THUMP, THUMP, THUMP. Her heart rate was in the 140’s.  She still didn’t kick the doppler.

I grabbed some apple juice and a snack and went outside with my son who wanted to play again. I drank the apple juice and sat on the bed of the pickup truck. I had been talking with my mother-in-law who decided that we would have dinner together and decide then.

It had now been at least 18 hours since I felt any real movement from her and in the next few moments, I felt her move. It wasn’t much, but it was more than she had given me all day. This only began to complicate things more for me.

I had dinner with my mother-in-law and had two slices of pizza and a Shirley Temple. This would also HAVE to get her moving, I thought. Nothing. Nothing for an hour!

It was now after 7pm and I really needed to make a decision. I posted on one of my Facebook groups and every person who responded said to go in. I knew I probably wouldn’t sleep much if I didn’t and I knew that I would question every second of her silence. So, I opted to go in. It was such a tough decision and I didn’t want to waste the money but there was that “what if.”

So here is when things really got crazy for me. In the car on the way there, she started to move. I began to actually feel kicks. I hadn’t felt a single kick all day. We almost turned around but decided to go in anyway. Five minutes on the monitor had her moving like crazy. It was like she was dancing inside me and I was so frustrated that this happened to me and I was now here. She even got the hiccups and we decided she was fine. 12 minutes on the monitor and they said all was good with her. 

It took longer for them to “check me in” and “update my chart.”

They were about to discharge me when they took my blood pressure. It was high. While baby was fine, there seemed to be something else going on with me. It took two more hours, a urine test for protein/creatinine, and blood pressure checks every 10 minutes, before I was able to go home. Diagnosis, I have borderline high blood pressure which needs to be followed up on.

I learned quite a bit though. I learned that even though I know when I am supposed to go in, it’s not as easy as it sounds. I learned that I should have gone in earlier when the decision was technically easier. I learned that it’s not as simple as “go in if your baby isn’t moving regularly.” Now I just need to take all this information and work on a new way to present it.

Was it worth going in? Absolutely!

The D&E for Miscarriage

When a baby dies in the second trimester of pregnancy, their death is either a miscarriage or a stillbirth. Stillbirth in the U.S. is defined as when a baby dies after 20 weeks gestation. A death before 20 weeks gestation is called a miscarriage. A second trimester miscarriage is a miscarriage between 12 completed weeks and 20 weeks. How a second trimester miscarriage is managed differs greatly between care providers. This post is the information I give my clients when they are told the unfortunate news that they are experiencing a second trimester miscarriage.

There are multiple factors when it comes to options for delivering a baby who has died or will die before 20 weeks gestation. Many care providers immediately state that the patient needs a surgical procedure called a D&C; although beyond 12 weeks gestation (in the second trimester), the surgical procedure is a D&E; which is different and I will explain those differences.

First; however, let me state that if the woman is experiencing a missed miscarriage, a D&C may be performed instead of a D&E. For example, if the woman goes to her 16 week appointment only to discover her baby died at 11 weeks gestation, the doctor will likely recommend a D&C. But, if the woman goes to her 16 week appointment and the baby has recently died, then a D&E would be recommended (even if the doctor calls the procedure a D&C).

When a doctor recommends surgery for the miscarriage, a woman usually schedules the procedure either for that day or within a week but rarely is the woman given any other options.

There are other options for second trimester miscarriage.

Just like with first trimester miscarriage, a woman has three options for miscarriage.

  1. Expectant Management (wait and see approach).
  2. Medical Management (using a medication to induce the miscarriage/delivery)
  3. Surgical Management (D&C or D&E)

When it comes to second trimester miscarriage, the number one cited reason for surgical management of miscarriage is risk of infection from leaving the baby or “pregnancy tissue” in the uterus. Yet, in the several hours of research on this particular topic, I could not find any substantial data to prove that a woman was at a higher risk of infection with expectant management of miscarriage versus surgical management of miscarriage.

This Cochrane Review explained that the risk for infection with expectant management of miscarriage was similar to surgical management; although I did find information here that suggests there is a 1% risk of infection with expectant management and this site suggests 0% to 10% chance of infection with expectant management. This leads me to believe it’s not well studied, especially in the second trimester since second trimester miscarriage and pregnancy loss is less common.

Nearly ALL the websites I explored stated that the woman’s preference should be utilized. But here lies the conundrum because care providers are only presenting one option for second trimester miscarriage; the D&E.

The D&E (dilatation and evacuation) is generally performed for miscarriages over 12 weeks gestation. The difference between a D&C and D&E procedure is that during a D&E, the surgeon dilates the cervix and then uses a grasping instrument (forceps) to remove the baby (sometimes in parts) and then uses a vacuum or curettage to suction and scrape the remaining tissue in the uterus.

In essence, because the uterus is not dilated big enough to remove the entire baby all at once, the baby must be removed in pieces and once removed, a curettage procedure is performed. While this is a very effective and viable option, some women and their partners would like to see and hold their baby, possibly take pictures of and with their baby, receive handprints/footprints from their baby, wash their baby, dress their baby, provide dignified services such as baptisms or blessings, and bury or cremate their baby. Some of these options might be available with a D&E but not all of them.

If I were your bereavement doula, I would personally walk you through these options and discuss them at length so you can make the best decision for your family. Hiring a bereavement doula is highly recommended for miscarriage and stillbirth. It is nearly impossible to explain in such detail here all a bereavement doula would present and help you with in this scenario. Please reach out if you would like to know more, I can help from afar as well.

There is no definitive amount of time on when labor will begin with expectant management. I use the term labor, because it is labor. It is NOT a heavy period, especially in the second trimester. Your cervix still has to soften (efface) and dilate (open) in order for the uterus to contract and push out the baby (“contents”).

Expectant management of second trimester miscarriage could take days, weeks, or even months to complete. Waiting is not always an option for women both physically and emotionally. Preparing to deliver a baby at home would also need to be considered as many women are sent home to give birth to their deceased baby. I do not recommend having such a large baby at home on your own and always recommend to my clients that they are admitted to the hospital for induction. Too many women have gone home to either wait for the baby or utilize medical management (taking medication to induce a miscarriage) and ended up in the emergency room bleeding severely and requiring a blood transfusion.

In my blog post, How to Prepare for Your Miscarriage, I explain in depth the materials needed in order to have a miscarriage at home. If you are considering this option, please read the information and prepare accordingly. If you are uncomfortable with the risks or seeing such an early baby, a hospital induction is an option. Care providers may give some push-back on this option and of course, there may be higher medical costs associated with this option but if you want to deliver your baby in a hospital with all the medical equipment needed for the risks, you can and should have this option.

I want to end this post with the risks of D&E. I have not linked to any specific website on this procedure as it may be too traumatic because the websites that list the risks are for abortion, not second trimester miscarriage. However, should you want to confirm the risks I list, you may conduct an internet search “Risks of D&E” which will provide the information.

The risks of the D&E are very similar to the risks of a D&C.

  • Injury to the cervix and/or uterine lining.
  • Uterine perforation (the provider punctures a hole in the uterus)
  • Infection
  • Bleeding/hemorrhaging
  • Retained products of conception, fetal tissue, or other tissue (requiring a second surgery)
  • Uterine rupture (from medications frequently used before the procedure to prepare the cervix)
  • Blood clots

It is also important to note that with a second trimester miscarriage, you may go through baby blues and/or depression just like a woman who has a full term, live birth and you may lactate and/or have engorged breasts. These are more likely to occur after 16 weeks gestation although I have had a few clients with 14 week losses who lactated (breastmilk).

I highly recommend you purchase the book, It’s Not ‘Just’ a Heavy Period; The Miscarriage Handbook to help you through this process. It explains miscarriage more in depth.

Pregnancy After Loss – Bargaining

Day 1 - miscarriageWhen you pee on that stick and see the positive, you are elated…usually. Even in pregnancy after loss, there are moments of excitement which appear immediately upon seeing the positive test but it isn’t usually long until the worry and anxiety sets in. It’s almost as if entering pregnancy after loss means restarting the stages of grief.

Bargaining!

We will do whatever we can to ensure this baby will come home. That includes delivering early either by c-section or induction. I’ve been there, begging my OB to induce just so I could bring my baby home alive.

Hiring a doula – Some women will hire a doula immediately after peeing on the stick…as if to say, “there, now the baby HAS to come home alive with me because I hired a doula.” We know this isn’t true, but absolutely feels like this can be a sure way to ensure a living baby at the end.

Testing – Some women have as much testing as possible and others refuse all testing.

Ultrasounds – Extra ultrasounds, one each week or more is another way to “bargain.” If I see the baby more often, I might be able to pick up on something that is wrong earlier and hopefully correct it.

Creams – Progesterone creams or other hormonal treatments can be another way women bargain with the universe to keep their baby.

Herbs – Special herbal remedies were definitely something I explored. I remember trying False Unicorn Root during my pregnancy with Ruby. I just KNEW I would get to keep her because I was taking it. She died only a few weeks after starting it.

Prayer – If I pray more, go to adoration more, attend church more, etc…God will give me this baby.

Heck, I would have hired a drummer to come into my home and drum on a daily basis if that would have guaranteed I would bring my baby home. But we know, nothing can guarantee that.

Sometimes it’s about rituals; appointments at the same time and on the same day of the week.  Or still others have avoidance rituals:

Never returning to the same doctor/hospital/clinic.

Not purchasing anything for the baby until they are here.

Not announcing the pregnancy until very late in pregnancy or not at all.

These are all forms of bargaining. It’s a way for us to feel a sense of control. We desperately need to feel in control. We need to feel that we can do something, anything to bring home a living baby because the opposite of that is so extremely painful we feel we won’t survive again. Another loss feels as if we would surely die.

I think deep down we know that it’s still out of our control but we really need to feel a sense of control so we do things. Things that can confuse others and sometimes even ourselves. It’s not wrong to do these things. Some of them may help but at the very least, they help us feel better and as long as we are not putting ourselves or our babies at risk, then why not?

How Far Along Are You?

early pregnancy testWhen a woman discovers she is pregnant, the inevitable question is immediately asked.

How far along are you?

I will say that we had known for weeks before we shared with a few select people and waited even longer to share with the rest of our close friends and family. Some, were kept in the dark longer. I really enjoyed keeping the secret and once it was out, it was a bit disappointing. The pressure also began. The pressure to be farther along than I was so that this baby would matter if this baby died.

The constant question “how are you feeling?” by the people who knew brought on the anxiety but the question, “how far along are you?,” would stop me in my tracks. I had to think about it for too long. Sometimes adding days or weeks to the gestation, just so the baby would mean something to the person asking.

It’s an innocent seeming question but for someone experiencing pregnancy after a loss, this is a loaded question. In all honesty, it feels judgmental.

How far along are you means, I want to know if you are “really” pregnant.

I assure you, there was a second line on the test, I am pregnant.

How far along are you means, I want to know if you are far enough to in the safe zone.

There is no safe zone.

How far along are you means, is the pregnancy far enough to be a considered a baby yet?

It was a baby from the moment of conception (for me anyway).

How far along are you means, you are trying to legitimize my feelings of grief should this baby die too.

My grief is legitimate no matter how far along I am.

How far along are you mean,s that the farther along I am, the bigger the baby, the more worth the baby has.

My baby has worth no matter how small or early he/she is.

As I get bigger, how far along are you, takes on a different meaning.

I am closer to delivery yet still not quite there. Will I make it with the baby alive?

I know the question, how far along are you, seems innocent. It seems like an inquiry and a supportive question but it’s not. It’s loaded, it’s dangerous.

Because if I lost the baby, I will have lost everything I have already dreamed of with her. Yes, her, because I imagined the baby to be a girl. So I have already seen pink and purple, flowers and butterflies, protective big brothers, dancing and singing, a love of reading, nurturing of a girl, bringing out my girly side, dresses for her baptism, communion and wedding. And, I have even imagined her children. Oh and yes…her name.

Call me naïve, stupid, crazy for even beginning those thoughts but it’s impossible not to. It’s impossible to pretend the baby, her future, doesn’t exist or will never exist. I am already in love. Her father and brothers already love her. And if she turns out to be a boy, we will love him too, just the same. So if this is only an “inside baby,” this is what is lost. It will hurt. It won’t hurt because of how short or long I was pregnant. It will hurt because I have loved and lost.

So when you ask “how far along are you? The answer is, it doesn’t matter. Because I am pregnant and I love this baby.

This is pregnancy after a loss.

On Birth and Death – A Doula’s Journey

I enter the small hospital room, adorned with white walls and white boards where his name is scribbled in black writing. Beneath his name is his care plan, followed by contact information for his family. Above the board is an old box TV, hanging from the wall. Fox News is on TV, one of the only shows I remember him watching. He is laying in a hospital bed with his upper body partially raised. He is still, but breathing. I exchange pleasantries with his son-in-law who offered to sit with him until I returned.

I was so glad he was able to stay and provide company to him. It was important to me that he not be alone right now. We hug and tell each other we love each other. Then he departs for the night. His shift has ended and we will see each other tomorrow morning when we will make the decision to move grandpa to home hospice. As much as I wanted to get him transferred earlier, it wasn’t possible to get hospice to the hospital any quicker.

I tell grandpa that I am moving the chairs around and setting things up. He doesn’t respond, he just continues to breath. His mouth is partially open. As he breathes, only his lower jaw moves as he takes in more air. It seems forced in that it doesn’t seem like he is purposely breathing.

The lights in the room are bright. Earlier that day, I made a comment about how bright the hospital lights are and that this place should consider soft lighting. To help fix this issue, I brought an orange lamp from home. I set it up on the stool across the room, plugged it in and turned it on. Then I turned off the brightest light in the room.

I find the larger, more comfortable chair and settle it near his bedside as close as I can. I take a seat on his left side. The side I was given at the dinner table when I became a member of this family. Grandpa is laying on his back and his eyes are partially open as if he was watching TV and dozing off. I don’t think he was really watching. He is partially covered in a soft, blue blanket.

As I sit, I hear alarms sounding in the hallway. They are not his alarms. Just a buzz of activity on the unit. In the hallway, nurses and doctors are going back and forth between the rooms, an employee is buffing the floor, and carts are being pushed back and forth. It’s noisy and I don’t like it. I imagined Grandpa wouldn’t either.

I get up and shut the door. As I do this, I explain to grandpa what I am doing. I return and sit by his side again. We watch TV together. I laugh at the news talking about Hilary Clinton and Obamacare imagining he would have alot to say about these two.

I hold his hand.

A nurse knocks on the door and opens it. As she enters, she asks, “Do you prefer to keep the door shut?” I explained that I did. It was too noisy. She smiles and explains she needs to turn Grandpa. I asked if everything was okay and she explained to me that they turn Grandpa often to help him be more comfortable. Another nurse came in to help and also changed his linens. Once the task was complete, they departed, closing the door quietly behind them.

I was given the Wi-Fi code while the nurses were there so I began to check emails while I sat next to Grandpa. I was also checking in with some friends who have done this before and was asking for their advice but soon, I didn’t feel comfortable checking emails. It felt wrong. I wasn’t present to him and I needed to be.

I decided to turn on some music and sit with him, in quiet. I turned off the TV and turned on Glenn Miller and Frank Sinatra. I used Pandora and had set up a bluetooth speaker in the room. It took some time to work it out but after a while, the music was softly playing in the background. I had the thought to turn it up a bit louder than I felt necessary. After all, Grandpa has hearing aids. I wanted to be sure he could hear the music. I imagined he would get up and dance if he could. That’s what he did when the music of his time would come one.

I sat in the chair and rubbed his arms softly as I talked about the music selection. I told him that if he didn’t like the music, he would have to let me know. I felt his arm move as if in agreement of the music. Every once-in-a-while, the music would stop playing and I would share my frustration with Grandpa. I looked at him and noticed his breathing seemed different since the nurses turned him on his side. I smiled, thinking they must have made it easier for him to breathe.

I put my feet up on the end of his bed and closed my eyes. I took in a deep breath and smelled the hospital. It’s not what I want him to remember and I didn’t either so I got up and took out my essential oils. I diffused peppermint with a hint of lavender. I chose peppermint specifically because Grandpa turned to peppermint mints to replace his cigarettes when he stopped smoking many years before. I thought it might be comforting.

I then turned out the other light by the door. It was getting late, after 9pm and I wanted him to settle into a sleep. As we listened to the music of the 20’s and 30’s, I would rub his arms or hold his hand often. Sometimes, I would lift the blankets and sheets and physically hold his hand that way, instead of through the blankets. I didn’t talk much, we just sat there…together.

I would turn to look at his breathing from time to time. With the orange glow of the room it was difficult to see much movement but I could always see the bottom of his mouth opening with each breath. During these back and forth exchanges of stillness listening to music and breathing checks, I began to doubt my presence. What if he didn’t want someone here? What if he wanted to pass alone? I texted my brother-in-law and mother-in-law these thoughts. They both felt he would want someone here. I suppose but I wasn’t sure.

I pondered this for a while, listening to the music and watching his breathing.

I was going to leave around midnight. Hubby would take the next shift and stay until morning but that meant the kids would be at home alone, in bed for almost two hours. I didn’t like the thought of that. My brother-in-law offered to come and wait until I got home and hubby returned. But he was going to come earlier than I wanted to leave. I just didn’t want to go before midnight. As we exchanged text messages, I watched Grandpa breathe.

I noticed his breathing seemed to be spaced out more than it was before and I told my brother-in-law. He told me he was probably falling asleep and I also just believed he was breathing better because of his new position. But there was a part of me that felt this was him dying, so I stopped texting and just watched his breath. For thirty minutes I sat with him and rubbed his arms. I told him all would be okay. We were all going to be okay.

As time progressed, I noticed his bottom jaw wasn’t moving that much anymore. I feared he was going but continued to sit with him. There was no monitor in the room for me to check, I would have to trust my instincts.

No life-saving measures were to be taken anyway. While his heart was being monitored in the hallway, I had no idea if anyone was going to share with me if his heart had stopped. I went out into the hallway but no one was there. I walked to the nurses station but no one was there. So I peeked over the desk at the heart rate monitors and found Grandpa’s. The rate displayed, 53. “Hmmm…maybe he IS sleeping,” I thought to myself. I looked for his respirations but I didn’t see any. Realizing that these things can be wrong, I just chalked it up to being an error.

I returned to the room and checked my messages. I saw one from my brother-in-law. It was approaching the time where he would be leaving but I wasn’t ready. I told him to just stay home. I couldn’t leave. My entire body was telling me to stay.

I returned to his bedside and sat in the chair. I could still see his lower jaw moving but it was much slower than before. Only a breath every 15 seconds or so. I reached my upper body over the side of his bed and laid there. My arms across his chest and I prayed. “Lord, please take him into your kingdom. Please take him quietly, softly,  and pain free.” I laid there, with more prayers and listened.

Smile,” by Nat King Cole was playing through the speaker. My eyes closed and my body draped across the bed, reaching out to a man I knew was likely leaving this earth. As much as I wanted him to stay, to have one more conversation with him, I knew he was going. When the song was over, I looked up and noticed his whole body was still. Even though he had been still before, this seemed different. I felt like he was gone.

I returned to the nurses station. A male nurse sat at the monitor and I said, “What’s his heart rate?” He didn’t answer.  I asked him again. He looked at me with sad eyes. I told him he seems very still now and I wanted to know if his heart was still beating. He said his heart rate was 24. I said, “So it’s time?”

He replied, “We can’t say for sure because there can be a rebound.” I didn’t care to hear him anymore. I turned towards the room. Another nurse said, “Are you going to call your mother?” I stopped, “Should I?” I asked. She said,  “Only you can know if it’s best to call her now or after.” I returned to the room.

A nurse came in behind me. I moved to his right side and sat in a small chair. I leaned over and rubbed his head and stroked his hair. I began to cry. The nurse was comforting as she listened for his heartbeat. She looked at me. I asked if it was still beating and she said yes, but every 3 seconds or so. She showed me where to watch for his heartbeat and I stared. I told him everything was going to be okay and that I loved him. His pulse, slipped away.

I heard a flatline sound in the hallway. The nurse who didn’t want to tell me his heart rate just a few moments ago, said it was now gone. He was gone. It was 10:20pm.

It seemed fast to me. Just an hour before, he was breathing and now, he was lifeless.

“I have to call the family,” I told the nurse. I took a deep breath and called mom first. I didn’t know how she would answer the phone. I had hoped that she would answer it thinking I was just asking more about if I should be here or not. “Hello?” she said. “Whew,” I thought. “She isn’t crying.”

“He passed,” I said. “Oh he did?” she replied. I could tell she was starting to cry. We talked for a few moments and then I hung up. I called hubby next.Grandpa

A few minutes later, a doctor came in. He assessed Grandpa and stood there, staring at me. I said, “So he has passed?” “Yes,” he said.

I tried calling the other siblings after but no one answered. I sat there, in the stillness of the room. Frank Sinatra playing in the background and I thought, “I hope I did this right.”

“I hope I did this right,” is something I would think often after leaving births. I hoped I provided a high level of service to my clients when they gave birth to their babies. And when I read this, there were so many similarities in the companioning of someone through birth and through death. We use all our senses in these situations. Oils to help relax, provide a memory imprint, to mask a smell; lighting to create a calming environment, releasing tension, submitting to the task at hand; and music to bring up memories or create them.

Birth is very similar to death. It’s a transition from one environment to another; a transition worthy of support and companionship. At birth, the transitioner (baby) is never alone. At death, many of us are alone. I couldn’t imagine leaving Grandpa alone to make this transition. He had a companion with him when he opened his eyes to his new life, he would have a companion when he closed his eyes for the last time.

It rained when we left the hospital. Something that doesn’t happen this time of year. It was a tiny sprinkle but noticeable. I found it significant that it drizzled, mid-winter. It was only for a moment, but it was happening.

I have never companioned someone through death in this way before. I have helped families companion their dying babies and children but I have never been the companion in this capacity. It was truly an honor to be there as Grandpa made this transition and I will never forget these moments we shared together.

In loving memory:
Dorsie J. Meads

What Does it Mean to Bring a Baby “Earthside” and Why it’s Offensive

EarthsideIt’s a term I am hearing more and more. I have used the term in the past but now, I can no longer use the term. It’s offensive! It makes my stomach turn each time I hear it and it’s now considered a trigger. Earthside…or as most often used: “Bringing Baby Earthside.”

A trite term used to describe birthing a baby, the term earthside is offensive to mothers. There are birthing coloring books called Bringing Baby Earthside, a fantastic tool for pregnant women to help relieve stress and focus on the positive aspects of birth but needs a new name; blogs written about the earthside baby such as this one from Birth Without FearPinterest pages dedicated to bringing babies earthside and even Etsy shops with onesies stating “Finally Earthside”. Babies are being welcomed “Earthside” in birth story after birth story.

No definition exists yet on what bringing a baby earthside means. Thank God and I sincerely hope this never becomes a definable term. This phrase needs to disappear as quickly as it came in the typical fad fashion. From Oxford Dictionary, earthside is defined as “on or from the planet earth.”

Unless a religion or belief states otherwise, while a woman is pregnant, her baby is actually on earth. I suppose if the pregnant woman is in space, the baby wouldn’t be on planet earth but where the baby is, so is the mother. The womb is not some intergalactic, off-the-planet place where babies form through stars into human beings and use hyperdrive to perfectly time their birth on this earth [insert sarcasm].

While human creation is a miracle and some might consider it supernatural, it’s not intergalactic. There is plenty of science that supports perfect timing for sperm meeting the egg, creating a pregnancy or forming life, which develops into a human being, and is born via a human being; all of which allegedly takes place on planet Earth. So if we are welcoming baby earthside, where has this baby been the last nine months or so?

Welcoming a baby earthside discounts the pregnancy experience as something it’s not. If the baby is not on this earth, as bringing baby earthside suggests, then how does the mother bond with her baby? If the baby in her womb is not earthside, does she have to help the baby in any way? What obligation does the mother have to the baby who is not earthside? Does the baby even exist? Is there a ball of stars within the mothers womb, bouncing around in there?

In my childbirth education classes, my students are told they are parents from the moment they became pregnant. One could possibly state that they became parents even before pregnancy because they have made decisions for the baby before that baby was even conceived. Oftentimes, my students are a bit confused to be called parents so early in their pregnancy.

But what are they if they are not parents? We call them mother and father in classes and that’s the definition of a parent. So as a mother and father of an unborn child they are responsible for caring for that child. If that child dies, they are still a mother and father.

So they are parents, of little humans, on earth, who have not yet been born. On earth is a key phrase here. They are already earthside. Let’s side-step for a moment.

For mothers enduring pregnancy loss, the term earthside takes on a different meaning. This pregnancy loss blog shares a story where the mother writes to the baby she will never meet earthside. While her baby was already “earthside” within her womb, she is using the term earthside to describe the physical form she will never hold on earth. I feel the same way. I will never hold Gus or Ruby “earthside.”

Her pregnancy loss happened very early and she describes how her loss “flowed from her.” No baby to hold, touch, or see, just blood washing her tiny baby out of her. She is a Christian and will not meet her baby on this earth. But in her blog, she shares her ambivalence with her grief and her struggles with the right to grieve. She has every right to grieve her loss. She loved this baby from the moment she suspected she was pregnant. She dreamed of this baby and imagined a new life with this baby in it. She is worthy of her grief but society doesn’t think so and she mentions this as one reason she did not share her loss with others.

Isn’t it enough for loss parents to have to prove to society the legitimacy of their loss without now having to prove their baby/child was “earthside?” If the baby isn’t really here on earth during the pregnancy, then why would a woman have the right to grieve if the baby didn’t really “exist?” Could using the term earthside damage a woman’s right to grieve? A baby’s whole existence is defined through birthing them alive. If a baby is not birthed alive, society questions their existence and mothers are confused and shameful in their grief.

Why must we define birth as coming earthside?

If a mother on earth is pregnant, the baby within her womb is on earth. The baby is already earthside. The baby doesn’t magically become earthside at birth; to say otherwise discounts the miraculous and earthly experience of conception, development, and birth. To say otherwise, minimizes the experiences of pregnancy loss because the baby never took a breath “earthside.” To say earthside at birth, turns the pregnancy experience into something galactic or alien.

Women should feel connected to their unborn, they should revel in the divine or mystical creation of new life and birth. When a woman discovers she is pregnant, she should shout from the rooftops: WELCOME EARTHSIDE! And when the baby is born she should rejoice, welcome her baby into her loving arms and into the tenderness of her nourishing bosom.

There is no need to define birthing a baby as bringing a baby earthside because the baby already was earthside. A simple “Welcome Baby” is sufficient.

But maybe, just maybe we are also using earthside as a euphemism. A way to describe birth without saying the word birth because to do so, would present the experience of birth as it is currently represented: fear-based, messy, and exhausting. Bringing a baby earthside certainly sounds more pleasant. Sign me up for bringing a baby earthside but “birthing a baby?” Eeewww.

Bringing a baby earthside is just a substitute for the unpleasant thoughts of “birth.” Instead of empowering women to birth, maybe if we just change the word “birth” to the word “earthside,” women will all of a sudden feel confident and comfortable with the experience and their fear will magically disappear?! [sarcasm] As an educator, I suppose I no longer need to teach about the experience of birth but about how to bring a baby “earthside” where there is no pain and your baby is transformed out of your womb, down a rainbow and onto your chest [more sarcasm].

This is no different than storks bringing babies to hopeful mothers. It’s a myth that is perpetuated as a distraction from what birth really is: a transformation which might be uncomfortable and/or painful but it is a transformation nonetheless.

Let’s stop using the term earthside. It’s distracting, it’s offensive, it’s a myth. Women birth babies. We have since time began. Babies aren’t dropped off by storks, they don’t come earthside (they were already on Earth); babies emerge from our wombs, through our vagina or in some cases, via surgical birth. We can’t change that no matter what term we use.

Dear Self Magazine: Change on Miscarriage Starts With You

Self Magazine published an article on August 5, 2016 entitled When You’re Having a Miscarriage but Have to Work Anyway, by Zahra Barnes. This article helps bring to light many of the pressing issues women who miscarry face such has social stigmas and having to work through a miscarriage. Many women don’t realize that miscarriage can be covered under FMLA as a serious complication from pregnancy or a serious medical condition. Learn more about FMLA for miscarriage here.

There are many good things about the article which focuses on the miscarriage experiences of Ashley Frangipane (Halsey), who suffered a miscarriage while on tour in 2015 and took narcotic pain killers while wearing an adult diaper while at her work venue. No time to have her miscarriage in the comforts of home or safety of a medical facility, if she stopped working it could have been detrimental to her career. This is an issue many women face.

1 in 4 pregnancies end in miscarriage; roughly 10-25% of recognized pregnancies. The statistics are frightening because most women don’t realize how common miscarriage is until they have one. Women are typically silent about their miscarriages due to cultural taboo on talking about miscarriage. The social stigma is that miscarriage isn’t a big deal and when women do feel different than the stigma of the norm, there is shame in those feelings. Women become silent and suffer in that silence.

When famous women come out to share their experiences of miscarriage, the media reports for them. This helps women not feel so alone and that is very needed. It sheds light on the millions of women experiencing pregnancy loss around the world. Articles such as the Self article can be helpful but there is a hidden message in the article Self wrote. I will tell you what that is.

At the end of the article, the author calls for change in the beginning of her final statement when she writes: “Although it will take some time for cultural attitudes about miscarriage to shift…” But instead of helping to change that stigma, the author actually furthered a common misconception about miscarriage, that it’s “like a heavy period.” The author interviewed Dr. Sherry Ross, an OBGYN who stated that miscarriage will evolve into something like “the heaviest period you’ve ever experienced.”

I wonder if this doctor has talked with her patients or better yet, been there while her patients experience miscarriage. A majority of them would likely not describe miscarriage this way, especially if they held their very tiny baby. As a woman who experienced miscarriage twice, I can attest and confirm that miscarriage is nothing like a heavy period. In fact, I suffered through horrible periods associated with PCOS and hormonal imbalances for a majority of my life and I would take that experience over the labor pains I had with my miscarriages.

Another OBGYN, a male I might add, describes miscarriage to women as “hell.” He then explains that miscarriage can be “really heavy bleeding, really heavy cramping, and generally feeling really beaten up.” Before I discovered that Dr. Jacques Moritz was male, I made an assumption that this doctor had a personal experience with miscarriage and maybe his partner had one but he still minimizes the miscarriage experience. The statements by these OBGYN’s further trick women into believing that miscarriage is “no big deal,” “not a serious medical event,” can be experienced at home or work with little complication, and that miscarriage, “is like a heavy period.”

Doctors and Miscarriage

My book “It’s Not ‘Just’ a Heavy Period; The Miscarriage Handbook” shares with you how miscarriage is not a heavy period. It’s rarely experienced that way, yet women are told by their doctors that they will bleed like a heavy period and receive little to nothing more. Nothing to help with the pain that shocks them out of their sleep, nothing to catch their baby or remains in, and no real guidance on warning signs. Women are left to go through this experience alone and uninformed. I often wonder how doctors truly understand the miscarriage experiences of their patients when the majority of women are never seen and their pleas for help and guidance are ignored.

The article wasn’t all bad. I know I focused solely on the statements by these OBGYN’s but when Self Magazine calls for change, they should help create that change by interviewing proper professionals or women who have experienced miscarriage. One statement of particular note was when Penelope Trunk talked about how some women might prefer to go back to work immediately and that “there are basically no wrong choices here.”

This is a very true statement and women need to hear this. While some women couldn’t imagine going to work during a miscarriage, there are others who may prefer to go back to work and neither is wrong. Women who don’t feel they can go to work need to be empowered with information on how to manage that, such as through FMLA. Statements like the ones made by medical professionals, minimize the experiences of miscarriage by the majority of women. Because they are medical professionals, society places more trust in their words than in the words of the women who experience miscarriage.

So Self Magazine, if you want change for women; help make that change happen for women.

BL and AL – Do you use these terms?

BL and AL. What do these letters mean? What are their significance? I was going through my Facebook “Memories” today and noticed I was using these terms. I know I haven’t shared what they mean yet but I know many of you will know what they mean. As I scrolled through the memories for today, I was looking at the dates. Pictures and messages I posted on March 7th since 2009 were displayed and as I studied the pictures, I wanted to know…was this “before loss” or “after loss?” BL or AL?

I have had two miscarriages now so sometimes when calculating it gets a bit more complicated but I couldn’t help wondering, was the picture I was looking at before or after? I studied my face, the faces of the others in the pictures, wondered if I was happy then or could comprehend how my life was going to change or contemplating how far I have come, where was I on the grief journey or had it started yet? I sifted through maybe 15 photos before I realized I was placing them into categories, BL and AL.

Then I wondered, how many others do this? I am sure many of you do. What is the significance for you? What do you wonder when you look back at pictures or memories? Would you stop yourself from becoming pregnant if you knew? If you could warn yourself, would you? If you could change something, what would it be?

Here is a picture I absolutely love of myself. It’s a “before loss” picture.

Elizabeth Petrucelli 1

I had just quit my job and was about to being the police academy. I wanted short hair so I cut most of mine off. It was a happy time before my life was turned upside down. Little did I know that just nine months later, I would be mourning the loss of my second child…a daughter. If I could go back and tell myself something, would I prepare myself for the loss?

Here is a picture of me after two losses.

Elizabeth Petrucelli 2

This is a different angle and lighting but is anything different? I am obviously older. I can tell you that in this picture, I am about four months post loss (of Gus) and I had chopped off all my hair. I hated my hair. I don’t recommend chopping off your hair within the first few days (or even weeks) after a loss.

Let me show you. Here I am with long hair.

Elizabeth Petrucelli 4

Here I am after the hair stylist didn’t listen and cut off too much. I had explicitly told her my bang should be at my chin. They aren’t even close! This was two days after we discovered Gus was dead and he was still within my womb here.

Elizabeth Petrucelli 3

So the moral of the story is, don’t get your hair cut so quickly after loss. But I digress.

Do you find that you say this was before loss or after loss? What feelings does that bring up for you? I know for me, I do feel sad. I wish I could tell myself what is about to happen and how to prepare. I would want to go back and share as much as I could, telling myself that I will survive. I wouldn’t take the experience back. I wouldn’t stop the loss from happening (assuming I had that kind of power).

The loss of Gus and Ruby are a part of me. They don’t define me, but they are a big part of who I am and why I do what I do. I wouldn’t be able to do it as well if I hadn’t experienced their losses. So what is it for you?

The Dark Side

It’s hard to believe that there is actually a dark side to pregnancy loss organizations. At least some of them and to know that a dark side exists, damages trust. At a time when families need love and support the most, some are being turned away and they don’t even know it.

It’s almost similar to comparing losses. Comparing loss serves no one for sure. I was watching the show Scandal, Cyrus had lost his husband and Mellie had lost her teenage son and was still deep in grief months later. Those around her were trying to be compassionate but she was still not dressing and refusing to leave her home months later. The two were having a conversation and Cyrus ends with, “To take a measure is cruelty.”

Mellie: It’s not the same. My child, your husband. It’s not the same.
Cyrus: I keep hearing that. The loss of a child is greater. I resent that, never having lost a child. I resent having to feel like losing the love of my life, the only someone who ever made me feel like I was truly me, is less of a loss, is smaller than your loss. I am now broken. I’m not me. I’m forever changed. I’m undone. A broken heart is a broken heart. To take a measure is cruelty.

Wave Of Light1

Loss hurts. It hurts so deeply but each person’s experience is different and we have no idea of knowing how it is for them. We do know it hurts to compare losses. A family who discovers that an organization will not help them because their loss was not deemed worthy enough, feels rejected.

I had a family in need. They were told they would receive services from a nationally known organization. People constantly refer to this organization and they are a wonderful organization but like others, they have a dark side as well. This family learned it the hard way.

Told one thing by nursing staff yet refused assistance, the family turned to Dragonflies For Ruby for assistance. I hurt for them. I had seen the added devastation to families during their darkest hours, seeking compassion and love, yet being sent away because their child didn’t make the cut. They knew this, because the nurse was tired of families being rejected and she had to share with this family they why.

Most families will never know this. Most families will not be told the reason services were not provided and while that may save them from added devastation, that doesn’t make this scenario right. And this needs to change.

We are screaming for equality in this world right now. There are hundreds, if not thousands of organizations out there trying to ensure that people are treated equally and fairly yet discrimination of our tiniest humans is still taking place. Maybe it’s the culture of death? Maybe it’s another lobby against these tiny humans? Maybe it’s a lack of understanding for the needs of bereaved parents?

I believe it’s all of that plus more but because I believe the best in most people, I will err on the side that it’s a lack of understanding for the needs of bereaved parents. Because this is something that I can wrap my head around and facilitate change. To see that it is a lobby or lumped into the culture of death makes this issue much harder to tackle in my mind.

So what can be done?

We continue to share with others the needs of bereaved parents. Sure, each family might not need or desire the same services and resources and there are certainly differences in the types of pregnancy loss but all bereaved parents need compassion, love, and support. They should not be denied services based solely on disability, appearance, or gestation.

Does this mean that organizations cannot specialize in a particular form of pregnancy loss? ABSOLUTELY NOT! What this means though, is that:

  1. An organization should not pretend to be available for all forms of pregnancy loss.
  2. An organization should provide a resource available to fill the need of the bereaved family when they do not support their form of loss.

Organizations should be transparent. My organization states that Dragonflies For Ruby is a unique service for families experiencing pregnancy loss in any gestation. This implies (in my mind) that no matter how early or how close to term a baby is, the organization will support that pregnancy loss. Could the organization be more clear? I suppose we could list the forms of loss and dig a bit deeper but we are trying to be inclusive and to list all forms of pregnancy loss may accidentally be exclusive.

Bereaved families know very little about what services and resources are available to them. It is important for them to be presented with their options so they can choose what’s best for them. Failing to provide an option based on the assumption they won’t need it or want it, is not acceptable. The option should be presented anyway and let the family choose for themselves.

depressionSo, not only do some pregnancy loss organizations assume that families would not want or “should not want” a particular service, they are actually hurting families and spreading the stigma that certain forms of pregnancy loss are not worthy of grief, that families should feel shame, and are pushing families deeper into grief and pain. This is that dark side. A side that isn’t usually seen and shouldn’t exist. We can’t let it exist. We must create change and not accept these dark sides. Those who know they exist should take action or we are a part of the problem. Yes…that includes me. Because “to take a measure…is cruelty.”

Comparing Loss Serves No One

“Comparing Loss Serves No One” was originally published on December 2, 2015 at Doula Spot.

October 15th Miscarriage VigilRecently in a group, bereaved mothers were comparing the pain they experienced based on the age of their baby. One woman shared she had miscarriages so her pain could not be nearly as painful as a friend who had lost a baby at full term and the friend who lost her baby at full term could not possibly be in as much pain as the person who lost their baby at 2 weeks old. Even with those comparisons, another mother stated that the pain of losing her 24 week gestation child could not be as painful as someone who lost their living child.

The common denominator here is grief, the grief one experiences from a loss; however, there is a societal perception of the pain and grief one might experience based on the longer a person is alive, the more grief that one might experience. Here are some examples of what I have heard or seen regarding grief and pregnancy loss.

Women are told:

They should have nothing to grieve for the baby lost early (before she had a chance to love it).

The baby wasn’t born alive so why is she sad?

It is belittling to mothers who have lost living children for women to grieve a baby who never lived (the perception being that a baby in the womb is not living).

A miscarriage is not the same as losing a child.  

Then there are other comparisons:

A mother who birthed her stillborn baby through her vagina will experience more grief than a mother who had a c-section (as if she was somehow “spared” by not having to deliver vaginally).

These are comments and comparisons I have heard but what purpose do they serve?

Society allows and accepts a family’s grief for a baby or child who passes within the first year of life and beyond because there is a physical body with which they can see, touch, smell, and hear. We also see acceptance and validation for the grief within our own federal guidelines of FMLA (Family and Medical Leave Act); however, there is no time allowed to grieve the loss of a baby not born alive. This gives society the perception that born alive = worthy.

When grief is compared or challenged based on the gestation/age of a baby, it can make women feel they are not worthy to grieve for their baby not born alive; whether they were born in the first trimester or later. It can make women feel ashamed about their very real feelings. Not all women will feel grief from a miscarriage and while that’s okay, it’s not helpful for one woman who was not hurt by her miscarriage to say to another woman “What’s the big deal?” It’s a big deal to her and she deserves support.

Women should be allowed to grieve without shame just as they would grieve for the loss of their parents. Although I have seen people make others feel shameful for grieving the death of their aged parents (because they lived a long life, their death was expected).  Does a woman who just married her boyfriend of six months have the right to grieve? After all, she didn’t know him that long and if the basis for grief is length of time together (as some people have suggested), then she shouldn’t grieve nearly as much as a woman who lost her husband of 15 years. When approached from this angle, it doesn’t make much sense to associate time together with how much grief should be expected or experienced.

MiscarriageValidation that the grief is real and that they are worthy to grieve starts with us (society); sharing our stories of loss, and encouraging society to recognize that the grief from miscarriage exists. For many women, the moment they see the positive test they begin imagining all they will do with their future child. All those hopes and dream disappear in a fleeting moment, a flicker on an ultrasound that diminished too quickly, a kick or punch which faded away, a breath that emptied too soon. All are worthy of grief and mourning.

Shaming the grief experience by comparing grief experienced from pregnancy loss further silences this common experience and forces many women to hide. I remember feeling shame. It manifested in feeling foolish for grieving something I never had (a living baby); feeling silly for grieving a baby I couldn’t hold or see in their full form. I saw my baby on the ultrasound and I saw my baby’s heartbeat so I knew she was real but she was not real to many others. I also felt shame when I was excited to be pregnant and had a new life within me, though a fragile one, and announced it to the world only to have to tell everyone that the baby died.

Many women continue to feel more shame when they choose to hide their pregnancies until much later. Just because a woman doesn’t announce her pregnancy early, does not mean she is living in shame but some do. I have a friend who has already told me that should she become pregnant again, she will not announce until later…much later.

She does not want to have to tell people her baby didn’t make it, like last time. Months after her miscarriage, she is still asked about her pregnancy or what happened which adds to her silent pain; a pain that she carries but doesn’t allow the world to see. Her ‘status’ updates are make believe; pretending nothing ever happened. She buries her pain deep within her but still knowing how far along she would be.

Even I didn’t realize that she had the same thoughts as I do. We would have been pregnant together. We would have been due within one month of each other. I would be 38 weeks with a very ripe belly. My breasts would be preparing to nourish the child within me. I would be making frozen meals and completing the final tasks to bring home a new baby.

I would most likely be sharing with her all the things I have been doing to help her prepare as well; hoping she didn’t make a mistake or forget something I may have. We would be talking about names. And after our babies were home, we would be sharing milestones. Instead, we share death. We share our experiences of miscarriage which were very different yet the same; her entry into the silent club of pregnancy loss and my mentorship of having been through it…twice.

We do not know what is inside of someone else’s mind. We do not know what their experience of pain is. We cannot possibly comprehend someone’s grief based on society’s opinion, our personal opinions, our personal experiences, the experiences of others, etc. The pain and grief a person carries is their own. They may not fully share that pain with you either. Even if we know they had a loss, they may still remain silent which in turn, makes us feel they are “okay.” They might be okay or they might be deeply struggling.

When we know someone has experienced pregnancy loss, the most we can do is offer support. There are many ways to do that. Books and websites are dedicated to supporting families through loss. What we cannot do though, is much for the internal grief they will inevitably experience. We cannot speed up the grief journey; we can only walk with them through it.

Accompany one another with mercy. – Pope Francis

The length of someone’s life, the size of their body, the condition they are in, and the circumstances surrounding their death do not make grief more or less worthy. Grief is grief and is a person’s own journey. Please support them and others through any grief they are experiencing. Most of us have no idea if one experience hurts more than another experience. Can we stop comparing and just support?

Miscarriage

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