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Boundaries and Communication: Me, MW, DP

post #1 of 88
Thread Starter 
Hi all~

I'm looking for advice on a couple of fronts. This will probably be long-winded, but it boils down to me needing suggestions on how to communicate better with my midwife and partner on care-related issues. Also, if I need to edit this for negativity or being too complain-y, please let me know. I'm trying to be objective in what was done in order to be clear about how I feel now and why I need advice.

Let me open by saying, I cannot deal with doctors and/or medical interventions. I did my homework and decided on homebirth. Partner and I picked a midwife and things were great. I felt the "click" you moms always talk about. My partner was completely on-board with homebirth - we're supported by his family, he saw I was happy, he clicked with the MW.

Sounds good, right?

My MW gave me a getting-to-know-you questionnaire. I detail my issues with depression, anxiety, weight/anorexia, and history of multi-flavored abuse. I explain my triggers. I make clear, in no uncertain terms, I do not like being touched. I told my midwife even my relationship with my gynecologist has been developed over years. I tell her I am uncomfortable with spectators, and I know I will need to work with her on a plan to get me through delivery, because I was not sure how to develop trust to be touched while nude and in pain. My partner is supportive; he tells me he will help her respect my limits and boundaries and will advocate for me.

She's on board. Says she understands and we will go slow and she will respect limits and boundaries. Everything's great, right?

The topic of boundaries hasn't been revisited by my partner or MW since then. My partner now tells me once I'm "giving birth" I won't care who is watching or what is going on. Please let me assure you I will absolutely be aware of what's going on, and also be locked up like a deer in headlights.

Today we see her. My MW mentioned having an assistant/doula, but I hadn't met her til today. I immediately get the "hackles up" feeling with the doula. I tell my partner. He says, "We haven't even said anything to her yet. Relax." My MW opens the interaction with, "Aww, you're showing." I feel sad and fat. The doula tells me statistics about the number of births she's been to, then sits back and watches. My MW starts chatting. I'm constricted and I'm 150% focused on the fact that a complete stranger is in the room listening to my discussion about breast pumps and vaginal discharge. The midwife says I'm edgy, but doesn't do or ask anything else. I get a tight smile, I get the "I need to scream and cry" feeling in my throat.

The MW says an exam to determine fundus height and listen to a heartbeat would be good. I JUST had an ultrasound, so partner and I know everything is fine. I said I didn't need it. She said, "I need to know how things are progressing." Doula is still there. Partner says nothing. I ask my partner, "What do you think?" What I mean is, "Please tell her we don't need it, so we're backing each other up." (Disclaimer: I know that's not what I said and my partner isn't psychic, but I expected him to at least see I was uncomfortable - he knows me!) He says, "Sure, we can." My midwife notes my body language is saying I'm uncomfortable, and suggests a pillow under my knees for the exam. I felt this was sprung on me and can't get words out.

She did the exam, and I felt terrible. Hands were where I didn't want them, I was tense, nobody was picking up on it, and I literally couldn't speak. Partner and doula were both there. She palpates and then gets the doppler and puts goo on it. I squeak out that I didn't want it; she said it's only a little goo and it won't be on my clothing. I got goo on my clothing and sat with cold, wet, slimy stuff all over the inside of my shirt and top of my pants.

We eventually leave, and partner says, "You looked really flustered in there." It's now SIX hours later, and I still need to cry. I can't bring myself to talk to my partner, as he let me down in a HUGE way. He keeps saying he doesn't know what he did or what my "problem" is with him. I thought about writing an email to my midwife, but I don't want to be rude and I know I'm too emotional to be civil right now.

I need ideas for how to set limits so that I don't alienate these people, and ways to stop saying "yes" or saying nothing when what I really mean is "NO." I'm normally assertive, just not when it comes to my body.

If you read that far, thank you - and again, if I need to edit for crankiness or the user agreement, please let me know. I really just want help with how to talk to them, and I never developed this skill in communication.
post #2 of 88
I think you do need to talk to your partner and your midwife. Preferably when calmer, your post seems pretty clear though. I think an email is a good way to discuss it, I know when I am upset about something, it is easier to write it out. Sometimes my husband and I will email each other from the other room to discuss something heated. There is no interruption and you get all your thoughts out.

Talk to your partner, I know you are feeling disappointed in him and I understand why but it sounds like he was just oblivious to why you were acting that way and what you wanted him to do about the situation.

Sorry you had a rough day and a bad appointment with someone you thought was a good fit. Your relationship can be fixed with her and it is better to address things now than in labor.

post #3 of 88
When you first met with the midwife and told her you didn't like being touched, did you make it clear you meant any touch and that routine prenatal exams would be difficult for you? And that when you didn't want spectators, that means you were not comfortable with the assistant/doula which you say she told you about up front? I know you're hurting, but please remember that what you have been through is so far out of most peoples' experiences that you are going to have to be very, very specific about your needs. I don't know exactly what was discussed between you and your midwife when you first met, but as I'm reading about your experience today I'm seeing myself do and say the exact same things your midwife did unless you had specifically told me those things were not okay because those things (being examined and having an assistant present) are a standard part of midwifery care.
post #4 of 88
Thread Starter 
I would normally be willing to give him the benefit of the doubt but... (and I left this out in the interest of brevity in the original post)

This isn't the first time he "swung and missed" on advocating for me. An intern asked if he could observe during my last ultrasound. I was uncomfortable and said I wasn't sure about it - which is a LOT for me; I normally just cave. Partner said he was fine with it, so the intern stayed without getting a confirmation from me even tho I was the "patient."

I talked to DP afterward and DID give him the benefit of the doubt, because it wasn't invasive - just a little more "showing" than I like in front of unknown men. He said he noticed I was uncomfortable, but said "you made it through okay." I told him that wasn't acceptable, since he knows I wimp out when telling people to stop. He knew I wanted him to help and said he'd do more...but today was the same as before.

I've opened a couple emails to my MW (DP doesn't check his mail, so I can't use that suggestion with him), but I get locked up. I feel like I'm being rude and asking her not to do her job. I don't understand what she "needs to do" versus what she "wants to do," so I don't know if I'm asking for things that can't happen?

How do I explain what advocating for/with me actually means? Maybe DP doesn't understand what I want. What does it mean for you all?
post #5 of 88
Thread Starter 

Before posting, I really put thought into what I had told her, and if I had left anything out. I know my MW talked to my GYN, who has had to sedate me just to get me through pelvics (seriously - we joke about "stunning a yak" with my meds), so from a MD-to-MW perspective, I know my issues were made clear. My MD has worked extensively with my MW, and their perspectives are in line with each other...odds are good nothing was mis-communicated there.

When I personally spoke with the MW, we spent two hours (not exaggerating) discussing the form. I was very clear that I can't cope with touch, especially touch in a sexual area (not necessarily a sexual way, just the geography). She knows I chose her practice specifically because she doesn't require routine pelvic exams, as well.

The topic of the assistant/doula goes both ways. I needed to be more proactive in that area and ask more questions, because I think I made a faulty assumption (but now am at a loss for how to correct it).

My MW said she had an assistant/doula she worked with, but mentioned her only once at the first visit. After five meetings, this was the first time I've met her - which the MW said was unusual and due to scheduling problems. After so many visits WITHOUT her/any discussion of her, I started assuming she wasn't involved in my care. I mean literally NO mention of this woman - I just got her name today. She's not even referenced on my MW's website.

I should have asked about the assistant more, for sure. But I've now got the feeling that the MW and her assistant are a package deal, and the vibe I got from the assistant, even before I got squicked out by the exam, was Very Not Good. My initial reaction to her wasn't colored by the MW's later actions.

Do midwives work without assistants? I don't know how to say "I like you but I'm uncomfortable with your helper" - that seems really over the line of requests.
post #6 of 88
Are you sure your feeling is that there's something truly wrong with this assistant, and not that you have negative feelings about her because you were taken off guard?

Midwives work with assistants. That is standard and safe care. What if you were hemorrhaging after the birth and the baby wasn't breathing? Just one of those complications alone is really too much for one midwife to comfortably handle on her own.

It sounds like you need to start over with the midwife regarding what is necessary to care for you and your baby. Did she have a copy of your ultrasound report? What if you had a miscarriage tomorrow and the health department investigated her for negligence and all she had documented in your chart was that you said you didn't need it? I'm sorry that you had this horrible experience, but it sounds to me like there is still a great deal of misunderstanding on both sides. She picked up that you were uncomfortable and made efforts to try to make you comfortable. She misunderstood why you were uncomfortable, but it sounds to me like she is actually very conscientious and caring.
post #7 of 88
Mama!! What a complicated issue. Pregnancy and birth is complicated enough to have to deal with issues like you're facing. I hope you don't mind my being a bit...blunt, I guess. I think you can work with your MW and your DP but that you may need some extra support in addition to what those two can give.

How did your MW react to your first conversation about these issues? Does she have any experience with these types of issues? Do you think (at the time) that she understood the severity of your feelings?

My feeling from reading your post is that, even though you feel like you've been very clear, your DP and MW may not fully understand what you're going through and what you need. And, in their defense, I think that's a TALL order.

Have you considered posting on MDC about some of your anxiety and trying to get some feed back specifically about that? Have you done some reading on pregnancy and birth and how it relates to anxiety, body and abuse issues? I am not all that familiar with these things but I *know* there must be wonderful articles and support networks for pregnant women.

One great thing about MDC is that you can come here and vent and talk and get feedback. Maybe you want to start a whole tread about how to communicate during pregnancy exams. I'm sure lots of mamas feel similarly to you about them.

Anyway, I hope you get the support you need from MW and DP.
post #8 of 88
Thread Starter 
Gave it more thought...I'm sure my feeling was about the assistant and not about being taken off guard. The assistant was milling around the meeting room, and the vibe I got was "wrong" even before I knew who she was and before we started the meeting. Comparatively, I was taken off guard by the U/S intern who stood in, but I didn't get the "ewwww" feeling from him. Her, I did. My MW has other people in her practice who I like MUCH better, but they don't work as her birth assistants. It's just this one woman, so I don't think there's going to be any bending on the issue. If it's S.O.P., then I don't really know what to say about it.

I see Nashville's point - there may be situations in which she needs the help. I guess I thought issues = emergency room.

Nashville - can you explain more about what an assistant is meant to do? My understanding is that they're going to "switch off" during the birth, so I'm working with both of them and not my MW primarily/solely. Is that the norm?

P and I offered the midwife a copy of the ultrasound report, the statistics/measurements, and the slides. She refused it, stating that they were often inaccurate. I don't know how true that is or not (I know weight can be a big issue with them), though I will say that the measurements she came up with manually were the same as the machine. I guess I'm just really average?

I'm sure MW really understood what my issues were. She talked to my MD, who explained my history. She talked with me, and I re-explained my history. I made it clear I did not want to be touched.

In that sense, she tried to be helpful and understand. She committed to being aware of boundaries and going slowly, and so did P. The MW also said she's worked with clients with similar difficulties before, so I didn't feel like I was outside of her scope. Therapy, medication, reading - that's all part of what I've done and am doing, so I'm not trying to throw everything in her lap and say "FIX ME!" I've read everything I can find, from clinical to earthy, about loving your body, what the process of birth is like, overcoming abuse and on and on. I think I just have a low threshold for triggers?

I don't know how else to word things to either person, though. When I explain them in a non-exam situation, I can stay calm and explain, give examples, etc. My brain goes into "drooooool" mode when actually in an exam, and it's like I never said anything in the first place. I'm wondering if me 'freezing up' is being misinterpreted as "She must trust me, she isn't complaining," even though I've explained that's not how it is.

LOL - Who votes I should go off into the woods and have this kid? j/k, j/k
post #9 of 88
I wonder if it would help your partner to not "swing and miss" if you and he come up with a specific code phrase you can use when you're feeling locked up and like you can't say no even when you want to? I haven't been through the same journey as you, but I sometimes freeze and don't say no or ask for time to think in stressful situations, and dh felt very frustrated a few times when I made it clear afterward that he didn't protect me as much as I needed. He WANTED to protect me, but we just didn't connect. So we came up with an innocuous phrase, talked about what I needed him to do if I said the code phrase, and I reminded him of it before doctor appointments and whatnot. Big, huge difference, having a specific phrase set up ahead of time.
post #10 of 88
My MW for my homebirth in NY did not have an assistant. My MW here in NC does. Your MW may be accustomed to working with one, and not feel confident about the care she can provide otherwise.

How about this: why don't you try to get to know the assistant. See if you can have her over for coffee or something and feel her out better to see if you can get used to her.

ETA: just read the newer post. If you are really sure, then you are really sure.
post #11 of 88
You need to ask your midwife exactly what her assistant's role will be.
post #12 of 88


Edited by coraljean - 2/18/14 at 6:42pm
post #13 of 88
I was going to suggest a hand signal, but the code-word above would do the same thing. If you did a "time-out" hand signal, it means everyone out of the room while you tell your dh what you are feeling and needing right now. Let the midwife and hubby know in advance.

My mw always asks about the littlest things, and gives warnings, like "I am going to put my hands on your belly now" ... or "can I pull the waistline down a little further?". It is a little over the top for me, but I would prefer to err on the side of respect. Maybe you could ask your mw to make sure she clearly lets you know exactly what is going to happen, and make sure she asks for each little invasive thing.

I also think that if you really have an issue with the assistant, then you can ask the midwife if there is anyone else you can meet and use instead. By itself, that is not an unreasonable thing to ask. You should tell the mw exactly what happened, and that somebody needs to be introduced before witnessing your very private moments. Since this person was added at the same time as other triggers, maybe giving her another chance is appropriate.

Sounds like a midwife and homebirth are the right choice for you. And it sounds like you need another frank discussion with your midwife. I would suggest writing it all out, and sending it to her in email, letting her know that you want to discuss it at your next appt. That way everything you are feeling is out there, and it may be easier to discuss without clamming up.

Good luck mama. You can do this!!
post #14 of 88
Originally Posted by earthmama369 View Post
I wonder if it would help your partner to not "swing and miss" if you and he come up with a specific code phrase you can use when you're feeling locked up and like you can't say no even when you want to? I haven't been through the same journey as you, but I sometimes freeze and don't say no or ask for time to think in stressful situations, and dh felt very frustrated a few times when I made it clear afterward that he didn't protect me as much as I needed. He WANTED to protect me, but we just didn't connect. So we came up with an innocuous phrase, talked about what I needed him to do if I said the code phrase, and I reminded him of it before doctor appointments and whatnot. Big, huge difference, having a specific phrase set up ahead of time.
I think this is a very good idea. According to your previous posts you are saying to him, "what do you think" and he is answering with what he thinks. That's not actually what you are looking for when you say it, so you should come with a phrase that means "I don't want to do this, and I need you to say no for me" to the both of you. If that phrase needs to be something like, "I'm not sure" to make you comfortable than fine, but it needs to be specific, the same everytime, and he needs to know what it is. Can you get your own doula (can certainly be a friend) to help advocate for you if you think that for whatever reason your husband can't step up?

Originally Posted by coraljean View Post
Would it help if you had a specific plan with your midwife in place as far as what happens at each prenatal visit, so you know what to expect? At each of my prenatal appointments my midwife usually:

- Takes my pulse and blood pressure
- Measures the fundal height/palpates the abdomen to feel baby's position
- Listens to the baby's heart with either doppler or fetoscope

Perhaps if you know to expect each of these things, or not if you decide to forgo some of these things ahead of time, it won't catch you off guard. I wonder if it would also be a good idea to have an understanding with your midwife in advance that she waits for you to say you are ready to do each of these things? Like "Ok, I am ready for you to listen to the baby's heart now."

It sounds like you were also caught off guard by the goo they put on your stomach to use the doppler. If your midwife has a fetoscope, they don't need to use the goo with that. With the fetoscope you don't get to hear the baby's heartbeat out loud, just the person doing the listening.

Perhaps you could also request to have a consultation with the assistant (seperate from a prenatal visit), to get to know her better, find out if you can be comfortable with her? I think this is a reasonable request, especially considering your situation. I can understand how it would be upsetting to have someone you haven't met before at a prenatal visit, which is so intimate. If it turns out that you really are not comfortable with the assistant, you can inquire about hiring a different birth assistant to attend your birth, if there are many working in your area.
This again is all good suggestion, and I think totally reasonable. Perhaps too, maybe she can teach you how to do some of this stuff yourself, at your appointments in her presence? If you can find your fundus and palpate and say, "I think it's here, maybe she can then do a very quick check to comfirm? If you place the doppler and find the hb, she can just listen. Once she starts measuring fundal height, maybe your dh can do it. I don't know if your mw would be agreeable to all this, but you could ask. Also if you just can't get comfortable with the assistant and she has to be there. Maybe it would be okay if she were to expressly stay out of the room you were in until the baby is born, or until there is an emergency. If she is in the same house then the MW should be able to call for her if she needs to. If you were to go into it with the understanding that the assistant wouldn't be touching you unless there was an emergent situation, would that be something you can handle?

my last 2 cents here-

I am also in SE Michigan. There are several hb mw's here. She might be an awesome mw, but perhaps she's not the one for you? You have so many options here, maybe you can find someone who has actual training in working with abuse survivors? I realize your MW has put some time in already and that she has spoken to your MD, but that doesn't mean you have to stay with her. Some people are better than others at applying concepts to their actions. Your midwife knows about your situation, thoroughly, correct? She knows you don't like being touched, at all? She knows that you have a hard time expressing these issues in the moment? Some of her comments are just not terribly sensitive to your situation. It's like when meet a person for the first time, you don't start joking with them before you know if they are the kind of person who likes banter, even you are a joker by nature. If she knows you have anxiety about your body image, it seems in poor form for to say "awww, your showing" I would think it might be better to just ask you how you are feeling about the changes going on in your body, and then actively listen, rather than say something (while obviously well intentioned and probably said to try to make you comfortable), that is in essence, small talk. You have a situation that is not the norm, and you have basically said, "treat me with kid gloves." I would think that it wouldn't be that hard for a mw to say to you, " I would like to do X for this reason, during X I will do this, this, and this. You can stop me at anytime if you get uncomfortable, is it okay if I do it?" and then again, I don't see why it would be difficult for her to be asking you if you were okay during the exam too. It doesn't seem like she's doing that for you right? I mean, am I way off the mark here?

I do think if you stay on with her, you need to be clear and specific with her when she makes you uncomfortable. If it has to be in a letter after every appointment, so be it, just tell that's what you have to do so she expects it. Perhaps you can have a "stop" code word with her too? Is that something that might help you?

Finally, have you actually looked in UC? You might be happier. Anyone who is interested in learning more about UC is welcome on the board here, you don't have to be dedicated to it. Just something to consider!

That was really long. I hope it was at least a little helpful!
post #15 of 88
Oh honey! I think that talking or emailing your midwife about this issue is NOT rude AT ALL! It is important for her to know so she can proceed with your care. Maybe if you even let her know when you seem tense and can't speak, that everything needs to be halted for a bit, that may help quite a bit. If I had a client who was panicking when I touched her, I would hope she would let me know so that we could work something out where I could collect the info I need while she could feel respected and safe.

Have you been working with a therapist as well? If so, maybe she could help you work on these sorts of communications to help you feel stronger when you need to be able to say NO.
post #16 of 88
I feel for you, and in your place, I would be a lot angrier. Even so, your MW is not a mind reader. If something is common practice for her, and you do not specifically and clearly refuse it, she will go ahead with it. I sympathize with your difficulty saying no, but if you find something unacceptable, you need to communicate that to her somehow. Maybe you need a simple signal for "I am not being heard," to prevent yourself being pushed along into something you object to.

You have got the problem across very clearly in this thread. How about sending the MW an email, saying "I have some serious concerns about my last visit, and expressed them on this discussion board," followed by a link to this thread? (Is that allowed by the UA, in a private email?) That should at least clarify things for her and get the ball rolling.
post #17 of 88
I read this as your DH not really getting it either. He says he does and thinks he does but thinks you are going to say "I'm uncomfortable." In the moment, he's focusing on the visit, and not getting the code of "what do you think?" His radar is picking up on your discomfort but he's taking in a lot of things and not zeroing in on this like he needs to, because he's listening to the midwife and so on.

I think "what do you think?" COULD be an effective code phrase, but only if drilled into him before hand. That means a bit talk about it, and I think you'll need to reinforce that right before any visit. "Hon, remember, if I say "what do you think?" that means HELP! It means I need you to take over and say no."

Discuss with him ahead of time how to handle it if there is some debate about what to do. For example, the midwife pressured you to have an exam. You didn't want an exam. You give him the code phrase. He "gets" it but he's also thinking "the midwife thinks it's necessary, so we should do it." Because if you guys don't figure it out ahead of time, he's not going to know what to do.

I am thinking the best approach would be for him to agree that he is your guard dog, your husband-bear, above anything else. You NEED to trust him. If there is a situation when you are giving him the signal to say no, and he's not comfortable with that, then HE needs to call a time-out of sorts, whatever it takes for you to be able to HONESTLY assess whether you agree or not.

Could he ask them to excuse the two of you so you could discuss? What I mean is, if he says "can you give us a few minutes?" and ushers everyone out of the room, and now it's just the two of you, do you feel you could discuss the issue at hand honestly? Or will you still cave under the pressure? If you can discuss it if you're alone, then he needs to agree that if you give him the code phrase he will EITHER 1) just say No, absolutely, on your behalf or 2) ask (demand, if necessary) time alone to discuss with you. And either way, you have the final answer.

When it comes closer to the birth, I think you'll need to bring it up again, in a whole new way. Probably don't bring this up the first time, but discuss and implement the basic plan. Now comes the hardest part. What if he REALLY disagrees with you, like he feels it's a life and death thing? You guys need to sort this out so you absolutely trust each other.

You need to trust him that he will stand up for you no matter what.

But he needs to trust you that you will make a good decision when the stakes are high.

Imagine, for example, that you experience shoulder dystocia and your midwife needs to reach in. I assume this would be extremely hard for you. In the moment, when you don't have time to research and discuss and so on, can you make the decision to allow such a thing? This is an honest question, not a leading one: can you choose to set aside your trauma for the safety of yourself and your baby? Think about it deeply.

Your husband will NOT know as well as you do what the stakes are. He is more likely, just by virtue of being the husband of a birthing woman, to freak out and think you have to obey anything the midwife says. So that's why he needs to be able to trust you that when you say No (or, more accurately, don't say Yes, which means No), that you are making a level choice, not just instinctive recoil from trauma. So should the midwife say "we need to do this" and you know or feel that it's not actually that necessary (just like the exam wasn't all that necessary), he can trust you. But when the stakes are really high, will you say yes?

If he can trust you on that - and to do that, you'll have to spell it out for him, that you will do it - then he should be able to commit to protecting you. If you say/imply No, and there's no time to discuss it, he needs to be your bear. Can you do it? Can he do it?

And make sure that if he commits to it, he really does. You would rather know (and say this) if he's unsure. I don't know what you should do if he's unsure, but better to figure it out ahead of time than when you have no options. Better to work on saying No yourself, or get someone else who can be your bear, or consider UC or whatever else you might do.
post #18 of 88

I think an email is fine.
Let her know that when you don't say "yes" it means "no" or at least "not right now." Let her know that having an unknown woman present was uncomfortable for you, even though you understand it is her assistant. It's okay to tell her that you need to be comfortable with everyone in the room before an exam begins.

Remind her that you are not able to articulate your needs when in a situation where you feel uncomfortable, and maybe ask her again if she feels she is able to work with someone who has your needs.
I agree with the suggestion that your husband may need a specific code phrase.

I hope that you feel better about this after talking to your midwife again
post #19 of 88
I'm going to go to the other end of the spectrum and suggest you look into planning an unattended birth. Communication is great, working through issues is great, but I don't necessarily think that it has to be done when giving birth to your first child. There are some great books about it and some email lists and forums I could direct you to. I'm happy to talk to you about it privately if you want to IM me.

If you decide to keep the midwife I suggest being very clear with her. You cannot abide having the doula attend the birth or any prenatals. I can't understand why the midwife would try to strong-arm you into a situation in which it would be very difficult to give birth (having a person there that you simply cannot relax with). She doesn't need an assistant, plenty of midwives attend births without one. I think you should read Dr. Sarah Buckley's book Gentle Birth, Gentle Mothering. I think it would help you to understand how all these emotions will affect your labor.

I also second the suggestion to have a code-word with your DH. Prenatally this word could mean that he says you guys need private time to discuss whatever it is. In labor it could mean he clears the room.

post #20 of 88
UC might be a great option for you...and I'm not a UC advocate.
If it's not, then I would recommend finding someone to be with you who is a fellow survivor. I am a rape survivor, and I chose a doula who is, too, for my third birth (after one practically unattended hospital birth, and one hospital birth that still makes me feel icky to think about). She was able to recognize from personal experience when I was uncomfortable but unable to defend myself, and she spoke up for me. She will be at my birth again in January, along with a MW who is also a survivor.
Best wishes for an amazing and empowering birth!
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