waterbirth safety? Our scary experience - Mothering Forums

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#1 of 35 Old 09-18-2010, 10:50 PM - Thread Starter
 
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What is your personal opinion on waterbirth safety? I know that there is very differing opinions out there. I know that advocates say that babies do not swallow or inhale water because they aren't breathing until they are removed from the water. On the other hand, I know that some disagree.

My 3rd baby was born slightly in the water. I say slightly because the water level was very low and I think my midwife actually kept her out of the water! LOL

My 4th was born on the 4th of this month into the water at home. My water broke only a minute or two before his head was born and then his body was born during the next contraction, just a minute or less later. He came immediately out of the water. Hours later he went into severe respiratory distress. He spent a week in the NICU after a very scary trip to the ER. The doctors say that they believe he aspirated pool water and got pneumonia.

My midwife definitely respects her clients needs and wants as far as where they want to birth. However, she personally has worries about water birth since the 3 babies that she's had to transfer (that weren't due to birth anomolies) were all babies born in the water who experienced respiratory distress. However, she's also had hundreds of healthy water birth babies.

While I am unsure of what happened with my sweet son, I don't think I'd ever feel comfortable giving birth in water again. I am interested in any personal stories or in any research anyone has to share.
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#2 of 35 Old 09-18-2010, 11:00 PM
 
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Babies have to have air hit their face before they take a big breath. I have been to many many waterbirths and breathing issues have never been an issue. How is she bringing babies out of the water?

This is from a midwife here in the twin cities:

In addition, the baby has an autonomic reflex, called the dive reflex, which prevents it from inhaling any substance that is in the throat and causes it instead to swallow. (This reflex disappears after about six months.) There is a complex chain reaction of hormones and chemicals that cause the breathing process to begin; just know that it is impossible for a newborn to breathe until up in the air. However, the baby should not be left under the water for an extended period of time (longer than half a minute). There are several waterbirth videos that show babies under water longer than this who do just fine, since the placenta is still supplying the baby with oxygen; but it can’t be predicted when the placenta will begin to separate and stop the flow of oxygen. The safest approach is to remove the baby unhurriedly, face down so water drains from the nose and mouth. ~Vanessa Stephens Coldwater

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#3 of 35 Old 09-18-2010, 11:20 PM - Thread Starter
 
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Hmmm... She let me bring the baby up. It was very quick, like I described in my first post, but I birthed the baby and then reached down and put him on my chest. There was a few brief seconds in between when the midwife made sure the cord wasn't going to be in the way but the baby definitely wasn't under water and out of my body for more than 10 seconds. Probably more like under 5 seconds.

I know that is the argument that water birth supporters have stated. But at the same time, I can't help but wonder. Especially after my own personal experience as well as the experiences of my midwife.
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#4 of 35 Old 09-18-2010, 11:29 PM
 
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Never had a water birth but wanted one. My thinking is any time water is involved like that then there is going to be a risk of the baby aspirating the pool water. I know that there is a certain way the baby should be brought up to the surface to prevent it but I have seen it done every which way watching water birth video's.

 
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#5 of 35 Old 09-18-2010, 11:38 PM
 
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Sounds danged plausible to me. I mean, we watch babies on ultrasound doing breathing exercises, and they're definitely in "body temperature fluid" then. Do I think that in most births being in the water is going to be an issue? Nope. But if the baby panics (not unheard of) they can gasp, and I'd imagine they can aspirate any liquid they're in whether it's amniotic fluid, meconium filled amniotic fluid, or bath water.


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#6 of 35 Old 09-18-2010, 11:44 PM
 
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I haven't been able to find any valid evidence of any risks associated with waterbirth. I think it's safe. My sister's baby went through a very similar experience in her dry land hospital birth. Later in the day of her birth, she developed respiratory distress and they found fluid aspirated in her lungs. I'm sure if it had been a waterbirth, they would have blamed that but it wasn't a waterbirth so they didn't...they said it was amniotic fluid. It happens.
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#7 of 35 Old 09-18-2010, 11:45 PM - Thread Starter
 
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Loveneverfails, I actually just PM'ed you!
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#8 of 35 Old 09-18-2010, 11:47 PM - Thread Starter
 
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Yeah, they never found fluid in his lungs though, interestingly enough. They found inflammation. They blamed fecal matter in the water (mine, supposedly, since he didn't have meconium) but his blood cultures came back negative.

It really is a mystery, I guess. We'll never know. I am extremely glad he is ok. At the same time, I wish I knew what had happened.
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#9 of 35 Old 09-18-2010, 11:49 PM - Thread Starter
 
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Also, Erin, that's what's frustrating me.

Since this was my first homebirth, I'm getting the feeling that the naysayers amongst my family and friends are having an "I told you so" moment. When in reality, respiratory distress is very common amongst c-section babies because they don't express the fluid from their lungs like they would during natural birth. And if I had given birth in the hospital, I *still* would have had a water birth.
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#10 of 35 Old 09-18-2010, 11:52 PM
 
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I'm glad that he is ok too!! My sister's baby spent 5 days in the NICU. It was so strange because I came to visit after the birth but before she developed pneumonia. Everything seemed fine with her sweet little baby when I was there so I was shocked that things had turned. It's hard to go through that mama, I'm very sorry that two of you had that experience. I think it's important to process and question why things happened. Barbara Harper is an excellent resource for waterbirth research.
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#11 of 35 Old 09-19-2010, 05:55 AM
 
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I don't know--it's just hard to believe that your baby's resp distress was caused by inhaling the pool water. From what you say, it just doesn't seem there was enough time for that to have happened before baby was out of the water. I have seen a couple waterbirths where it was apparent that the baby was ready to breathe while head was still underwater--dive reflex or not, if there is cord compression or a separating placenta while we're waiting for the baby's body to deliver, baby will do the next thing if oxygen level is compromised enough: try to breathe.

In the cases I saw, baby's head was born and then there was a good 2-3 min before next contraction. At first, babies were still and calm, maybe opening eyes a bit--but as time went on, they got 'more awake'--and opened their mouths, grimaced, while heads were getting that purple look (blood congesting in the head due to body-compression). On land, I would not have been alarmed --but in these couple of cases, I did believe the babies were about to breathe, so I had the moms stand up immediately. Once their heads cleared the water, these babies did start respiratory activity, one was fully crying before entirely born (shoulders came fine, but delivery of body was slow).

Maybe I don't know enough--such as how much time there was, between delivery of your baby's head and body. And I suppose anything is possible, really. But I do know that docs tend to make declarations of certitude that often are not at all correct. Knowing you had a waterbirth, it would be so easy to call that the culprit! But it really doesn't sound like the evidence bore that out. As for finding inflammation...when did that occur in the chain of events? Had deep suctioning already been done by staff, before signs of inflammation were noted? Or any other invasive procedures...lung tissue is so delicate, it is not hard to cause inflammation to them, with deep suctioning or other invasive things.
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#12 of 35 Old 09-19-2010, 10:56 AM - Thread Starter
 
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Msblack, that's exactly what my midwife said. My son's CRP level was only at a 2 in the ER and his lung XRay was clear. The next morning, after many, many hours of CPAP and lots of suctioning, his level was at 17. Anything over 10 is considered cause to be concerned. My midwife believes that the damage they saw on the second XRay (not alot but one lung had some "white spots") and the high inflammation level was very possibly caused by the forced air and suction.

I wish I could say exactly how long he was under water but in the moment I was pretty busy I do know my water broke and with the next contraction his head was out. It was most definitely less than a minute before his body was born. So his head was under water for less than a minute. Except for the midwife making sure the cord wasn't in the way, he came up out of the water very quickly.

But I can't figure out what the green/brown fluid was that he spit up...? That's why they're claiming he swallowed/aspirated pool water. He had no meconium but I did have a bowel movement in the water.

BTW, he was a BIG guy. He weighed 11 lbs 15 oz. I do wonder if that could have anything to do with it although I have no reason to think so. I had no GD and his blood sugars were always fine when tested in the hospital.
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#13 of 35 Old 09-19-2010, 11:07 AM
 
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Originally Posted by Momtotwo2004 View Post
Hmmm... She let me bring the baby up. It was very quick, like I described in my first post, but I birthed the baby and then reached down and put him on my chest. There was a few brief seconds in between when the midwife made sure the cord wasn't going to be in the way but the baby definitely wasn't under water and out of my body for more than 10 seconds. Probably more like under 5 seconds.

I know that is the argument that water birth supporters have stated. But at the same time, I can't help but wonder. Especially after my own personal experience as well as the experiences of my midwife.
The first waterbirth I ever apprenticed at, we had to resuscitate the baby. My midwife is a big supporter of waterbirths for the moms, but she says it poses problems because it's extremely difficult to resuscitate in the pool. She had to clamp and cut the cord before it stopped pulsating in order to get the baby on a flat service so we could administer oxygen.

I think a waterbirth allows for a slower, calmer transition - but I don't want one for myself. Biologically speaking, I can't think of another land mammal that gives birth in water. I also want my baby to smell like me. I've heard a few waterbirth moms say that their babies smelled different.

That being said, that's a personal decision of mine. If waterbirths were unsafe, midwives wouldn't do them IMO. And, even if it were "iffy" - then hospitals DEFINITELY wouldn't do them - and some hospitals do. I've never minded attending waterbirths - and most of them go off without a hitch.

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#14 of 35 Old 09-19-2010, 12:18 PM
 
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Those CRP levels are definitely low enough that I do not buy the sepsis diagnosis. CRP is a non specific marker for inflammation, and it should not ever be the sole reason for a diagnosis of sepsis, especially if the clinical picture doesn't jive with infant who has sepsis. And even if he DID started getting infected, given the clear initial x-ray, I would really be wondering if all the suctioning caused the problem by forcing stuff down towards his lungs.

Ugh, I'm so sorry!

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#15 of 35 Old 09-19-2010, 12:54 PM
 
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That being said, that's a personal decision of mine. If waterbirths were unsafe, midwives wouldn't do them IMO. And, even if it were "iffy" - then hospitals DEFINITELY wouldn't do them - and some hospitals do. I've never minded attending waterbirths - and most of them go off without a hitch.
Water birth is safe but hospitals do things that are unsafe, unscientific and bad for babies all the time.

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#16 of 35 Old 09-19-2010, 01:02 PM
 
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I really doubt that your baby aspirated pool water. The dive reflex is not easy for babies to overcome. Gasping is a last ditch reflex response to a lack of oxygen which would mean the baby somehow was deprived of oxygen from his cord. If your baby was fine during labor, was born that quickly and was vigorous at birth it seems very unlikely that your baby gasped during the 5 seconds he was in the bath.

as for the 'breathing movements' in utero, that is true that you see those movements, but the baby isn't actually breathing amniotic fluid into his lungs.

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#17 of 35 Old 09-19-2010, 01:15 PM
 
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I've heard of at least a couple of cases where HB babies have had respiratory distress and they weren't water births... I think there are many many reasons and I wouldn't pin it on water birth alone.

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#18 of 35 Old 09-19-2010, 01:33 PM
 
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But I can't figure out what the green/brown fluid was that he spit up...? That's why they're claiming he swallowed/aspirated pool water. He had no meconium but I did have a bowel movement in the water.
I am not any kind of birth expert. But all my brand newborns (all born on land) have spit up green/brown/red! stuff in their first couple days. It was enough to make me panic a good bit each time. But the nurses and doctors always just said it was "normal". Just thought I'd throw that out there.

Sorry you had such a scary experience.

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#19 of 35 Old 09-19-2010, 01:45 PM
 
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I'll say that in my personal case, waterbirth makes me nervous. I've had two babies born where the cord was not pulsing and the placenta followed baby out immediately with my last birth. I tend to have short cords and I think that might contribute to it, but it seems dangerous in a case like that. Not that I think this applies to you at all! Just wanted to share my experiences. I know women choose waterbirth all the time with no issues at all, and I do respect it as a choice. It's just not for me.

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#20 of 35 Old 09-19-2010, 01:48 PM
 
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I'm no expert, but I'm voting "witch hunt". Given the information here...it sound a lot like the hospital thought, "She gave birth at home? And in the water? Well OF COURSE that caused the problem!"
I'm sorry you and your baby had to be put through the NICU experience, for any reason.
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#21 of 35 Old 09-19-2010, 01:58 PM
 
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I think it is possible for a baby to inhale pool water, I too have seen things similar to what msblack mentions, and the other thing is if a baby is already in primary apnea no matter where he she is there will be gasping . Hard to say what all happened , it is typical for the docs to attribute pool water for everything, so much so that they can miss a dx- which happened here locally, if it were not for an older long practicing neonatal nurse an over looked heart problem would have gone undetected because the docs just rubber stamped the problem as water. In your case it seems easy enough to trace the cause
the green/brown fluid the baby spit up, is most likely meconium I could think of several ways that the fluid was not stained yet it got inhaled, i personally would attribute this to exposure to mec - if it were your bm the color would be brown/light brown- the shades of green degrading to brown are mec
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#22 of 35 Old 09-20-2010, 12:13 PM
 
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Water birth is safe but hospitals do things that are unsafe, unscientific and bad for babies all the time.
Agreed.
But those things are usually things that make life convenient for them:
  • CS for failure to progress (or 'big baby' or opposing or outright banning VBAC)
  • cEFM
  • pushing in lithotomy
  • unnecessary induction (Can be a big cost saver - easier to predict staffing levels)
  • pushing epidurals so mama stays still & quiet (& less likely to fight against stuff like pit to speed it up)

or they do things to hurry it all along: (Again, to save time = save money)
  • AROM
  • pit

or they do things they think limit their liability
because, as we all know, "you get sued for the CS you don't do [or other intervention you don't do], NOT for the one you do."
  • so, 'nothing by mouth'
  • not 'allowing' a mama to go beyond 41W or 42W
  • not 'allowing' a mama to labor or push longer than XX hours

Water birth doesn't fit into any of these categories. It has no advantages for the docs, the hospital administrators, etc. As a matter of fact, it makes life MORE difficult because you can't have cEFM that the nurses watch from the nursing station & the OBs watch from their mobile phones. I would imagine it makes vaginal exams more difficult or time-consuming to wait for mama to get out of the water. & it MUST make it more difficult for an OB to "monitor" all during the pushing phase.

Finally, there are plenty of HCPs who would say, "XYZ thing went wrong because it was a water birth.' But NO ONE would say, "XYZ thing went wrong because it was a land birth - it would have all been fine if you'd just had her birth in the water." That's never going to happen.

So, all that being said, while I agree that we can't point to hospitals and say, "They do ABC thing, so it must be safe." I TOTALLY AGREE with mrsdewees that if hospitals do water births, they must be safe, because, as analyzed above, hospitals don't do things that aren't either liability-reducing, convenient & cost saving/ revenue increasing (i.e. & speeding things up saves costs) & water birth is none of that.
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#23 of 35 Old 09-21-2010, 10:17 AM
 
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I think in situations like this the problem is that it is simply unknown what happened and was like a couple factors together. Sounds very unlikely that it was the water birth but also can't 100% rule it out I guess, simply cause it is really impossible to know exactly what went on and what factors played a role. It also sounds like that whatever did happen ended up worse with all the suctioning etc.

I agree with many other PP that the doctor/s took the easy way out to simply blame the water birth without considering other options as to them it probably seemed very "obvious" as a cause, when in reality it most likely was not.

I totally understand why you would not be comfortable with water birth again- you would likely be stressed out - not a good way to have a baby!

Time in the NICU is not fun - my daughter was there for awhile for other reasons. I greatly respect our NICU staff/nurses after that, but I also hope to never have to see them again!

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#24 of 35 Old 09-21-2010, 11:51 AM
 
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The first waterbirth I ever apprenticed at, we had to resuscitate the baby. My midwife is a big supporter of waterbirths for the moms, but she says it poses problems because it's extremely difficult to resuscitate in the pool. She had to clamp and cut the cord before it stopped pulsating in order to get the baby on a flat service so we could administer oxygen.
I'm curious...is it really that difficult to get mom out of water with baby still attached if rescucitation is necessary? I had no trouble getting out of the pool with baby unassisted 5-10 minutes after waterbirthing my son, so at least for me it seems like it shouldn't be that big of a deal, but I know some moms are more ungainly when pregnant so maybe it'd be more of an issue for them? The CNM around here who attends homebirths doesn't allow water births at all because she says it's too difficult to resucitate baby if they need it.
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#25 of 35 Old 09-21-2010, 11:55 AM
 
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I agree that we could get a mom out who is holding a baby in very little time.

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#26 of 35 Old 09-21-2010, 06:12 PM
 
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Not only is it possible to get mom out but it is also possibly to start resus on a board (cookie sheet, cutting board, special board made for that purpose) poolside. There is very little excuse to cut the cord, it's just a bad idea, especially in a compromised baby.

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#27 of 35 Old 09-21-2010, 10:56 PM
 
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I don't have anything new to add, but I did have a similar situation with my now 4 month old. He was not born in the water. He was a big boy (10lbs 7oz). He was born quite quickly. My midwives were worried about a shoulder dystocia and had me pushing even without a contraction to get the rest of him out once his head was born. He was fine after the birth, but 24 hours later he had respiratory distress. We went to the ER. He had a septic workup and Xray. Everything was 100% fine. His breathing normalized after 24 hours in the NICU. We spent 3 days in the hospital. Doctors said it was TTN.

In my case I think we had 3 risk factors for TTN....big baby, male baby, and precipitous delivery.
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#28 of 35 Old 09-22-2010, 12:25 AM
 
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FWIW, my sister's baby who went through this was also on the bigger side at 10lbs 4oz.
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#29 of 35 Old 09-22-2010, 01:27 AM - Thread Starter
 
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Well, now I'm feeling a bit peeved.

My baby was most definitely macrosomic at almost 12 lbs. He was male. He had an extremely precipitous birth. His breathing issues cleared up well under 72 hours. These are all signs of TTN.

When I mentioned TTN in the ER they said it wasn't because his breathing difficulties didn't show up until many hours after birth. They did ask me when it all started and I said that we really got worried in the evening, hours later. The reality was that I (and my family) thought his breathing was off all day long. My midwife said his breathing was fine after birth and during all of his exams. And while I love her and the care she gave us, I disagree. I wish I had spoken up when the doctors asked me.

I am now nearly 100% positive that's what he had. And that the 6 day NICU stay was unnecessary and that I missed out on quite a bit of time with my sweet baby because of it. But I'm trying to tell myself that all that matters is that he's ok and that it's all over and done with.

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#30 of 35 Old 09-22-2010, 01:31 AM - Thread Starter
 
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Me again. I think what's bugging me about this is what everyone else is saying. That the AUTOMATIC assumption was that it was the water birth/homebirth. Both by the doctors and by some family and friends.

And I'm a bit mad at myself that I didn't speak up. I guess I didn't feel comfortable disagreeing with my midwife as though it would make her look bad in front of the doctors. But I *told* her I thought his breathing looked funny. And I even remember her assistant questioning it at some point too.

I certainly don't blame her. I think she honestly thought he was breathing fine. And it wasn't *that bad* at the time. But something was definitely off and it got progressively worse.

I'm just mad at myself for not saying so. You'll have to pardon me. This is the only place I have to talk this through and work through the feelings I'm having. My husband is done talking about it. He wants to move on.
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