Successful Vaginal Birth for Placenta Previa? - Page 2 - Mothering Forums

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#31 of 58 Old 01-19-2008, 12:09 AM
 
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I can not imagine that you wouldn't have had bleeding at the beginning of labor- telling you that you needed further care. You then would have had time to go to a hospital in all likely hood.

-Angela
probably. But we don't know.

But with the knowledge of the previa the mom can anticipate and plan the birth she desires. She can wrap her head around surgery and all that means when her plans were for a homebirth.

That's quite a leap to have to make on the fly (hands off homebirth to high tech surgical birth).

Can you imagine suddenly bleeding, scared and with all your birth dreams out the window when you get checked out and it's a no-option situation?

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#32 of 58 Old 01-19-2008, 12:11 AM
 
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I can not imagine that you wouldn't have had bleeding at the beginning of labor- telling you that you needed further care. You then would have had time to go to a hospital in all likely hood.

-Angela
(bolding mine.) that's just not a risk that some of us are willing to take. And yes, bleeding at the beginning of labor might be the first sign of a previa for someone. But given how quickly that can go downhill for both mom and baby, that's a situation that I don't want to fool around with at all!

We each have to go with what feels right to us in any situation, but I would personally never feel good about playing the odds with a previa.
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#33 of 58 Old 01-19-2008, 12:14 AM
 
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probably. But we don't know.

But with the knowledge of the previa the mom can anticipate and plan the birth she desires. She can wrap her head around surgery and all that means when her plans were for a homebirth.

That's quite a leap to have to make on the fly (hands off homebirth to high tech surgical birth).

Can you imagine suddenly bleeding, scared and with all your birth dreams out the window when you get checked out and it's a no-option situation?
Each mom has to make her own decisions.

Routine u/s has not ever been shown to improve outcomes.

-Angela
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#34 of 58 Old 01-19-2008, 12:15 AM
 
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(bolding mine.) that's just not a risk that some of us are willing to take. And yes, bleeding at the beginning of labor might be the first sign of a previa for someone. But given how quickly that can go downhill for both mom and baby, that's a situation that I don't want to fool around with at all!

We each have to go with what feels right to us in any situation, but I would personally never feel good about playing the odds with a previa.
Again- each mom has to make their own choices.

However it is important to note that no studies have ever shown an overall improvement in outcomes due to routine u/s.

-Angela
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#35 of 58 Old 01-19-2008, 12:27 AM
 
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although a 20 week ultra sound if it says there is NO previa then it is accurate the problem is that diagnosing a previa at 20 weeks is about 80% false positives if not more so if it seems like there is a previa at 20 weeks you will need to be re-checked later because it is probably wrong-- so if you are looking of information on placenta previa the more accurate screen would be 30+ weeks if there aren't bleeding events before that
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#36 of 58 Old 01-19-2008, 12:28 AM
 
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Each mom has to make her own decisions.

Routine u/s has not ever been shown to improve outcomes.

-Angela
I'm aware of this. However I can see how in this particular case it would improve outcomes. Knowledge creates choice.

I know for me, planning the birth and anticipating welcoming the baby is everything. Loosing my birth plans because of something mainly unpreventable (like sudden bleeding from a previa--while I'm in labor) would have been devastating. But knowing in advance would give me the chance to plan the safest best birth possible.

I could then choose my caregiver, hospital, pack my cloth diapers, get the best care set up for the other kids etc.

an ambulance ride would be tramatizing.

Carrie, The Birthteacher CCE and Doula, real mom to five; and womb-mom to G. born at 23w by emergency C. 12/09
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#37 of 58 Old 01-19-2008, 12:58 AM
 
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Yeah, knowing ahead of time that a c/s is necessary would be much preferred, to me, than the last minute "complication" of bleeding once labor started. My fastest labor was barely over an hour with my longest 6 (an average of 4), that is just not a lot of time for me to prepare mentally to go to the hospital (I have NEVER been a patient in a hospital before other than my own birth, and it would take a bit of mental prep work), and it is also not a lot of time for me to find suitable child care for my other children and prepare the household to run without me for a couple of days or more.

I have also had seven children, with six of them having a 20-23 wk u/s and all of them ruling out previa. It may not be that way for everyone, and may not even be that way for me forever, but I have good experience in that area, and have never had a further u/s for any reason.

And a u/s in the instance of a complete previa has a very huge potential to improve the outcome by knowing what it expected. Again, I don't think it is "necessary" but it can really help in this particular circumstance.

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#38 of 58 Old 01-19-2008, 01:01 AM
 
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It has been done-- I believe I read about it on unassistedliving.com , but it's one of those things that I think even 99% of potential UC'ers would go for a c-section for.
I had a C-sec for PP which was only diagnosed at 40 weeks. The OB discussed one other possibility with me. He said that, if the previa were only partial, and the fetal head was well engaged, the pressure of the fetal head would prevent bleeding until after the birth. He said he would attend a birth under those circumstances only if (1) I had an ultrasound to confirm the exact position of the placenta, and (2) I laboured on an epidural, so he could do a section at a moment's notice. He only made these allowances because I felt strongly about having a vaginal birth if at all possible. I still opted for the C-section, since I agree that placenta previa is a good reason for a section if ever there was one; but I thought I would mention the other possibility. This was twenty years ago; I doubt if an OB today would consider it.
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#39 of 58 Old 01-19-2008, 03:30 PM
 
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Again- each mom has to make their own choices.

However it is important to note that no studies have ever shown an overall improvement in outcomes due to routine u/s.
You know, something just occurred to me... I've heard this mentioned several times. But... what does that *mean*? Has that been shown across all birth situations? I mean, I can totally believe it in a full-service hospital setting, where anything that could have been diagnosed prenatally can be handled as it comes up... but has it also been shown for homebirth, or rural hospitals without all the bells and whistles?

Also, there's the question of what an "outcome" is. It seems like, in most clinical research, "outcome" just takes into account whether everyone's alive, whether any injuries were sustained, and whether there's any permanent physical damage. Plus, we don't count certain things... having a giant wound across your abdomen isn't counted as a negative "outcome" of a c-section. But do we look at the psychological state of the birthing mother? The attachment between mother and child? The impact on the family? As someone mentioned earlier in the thread, a mother might have a significantly different experience if she has to plan a c-section ahead of time for previa, than if she goes about her birthing business and then, suddenly, when labor begins, there's "too much blood" and she's rushed off for an emergency c-section. Do the outcome measures capture that difference?
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#40 of 58 Old 01-19-2008, 07:00 PM
 
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Just wanted to add in response to one of the questions that I believe a prior c/s is a risk factor. Not 100% certain but I think it's more likely if you've had a c/s (probably something to do with the scar and attachment of the placenta?).
Yes, it is. I don't have the numbers in front of me, but the Landon study looked at this. It also showed that each c-section increases the risk of developing previa in subsequent pregnancies (there's a big jump at...fourth section, I think - oh, goodie for me). A history of c-section also increases the odds that a mom with previa will develop accreta, and that risk also goes up with each subsequent section. If I recall correctly, after four sections, a mother with previa in a subsequent pregnancy had a 67% chance of developing placenta accreta. (Of course, the absolute numbers were getting so small by that point that it's hard to say how statistically relevant that is...I think the study included 3 moms with four previous sections who had placenta previa, and 2 of them developed accreta.)

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#41 of 58 Old 01-19-2008, 07:02 PM
 
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As someone mentioned earlier in the thread, a mother might have a significantly different experience if she has to plan a c-section ahead of time for previa, than if she goes about her birthing business and then, suddenly, when labor begins, there's "too much blood" and she's rushed off for an emergency c-section. Do the outcome measures capture that difference?
In my experience - no - they don't even think about them. No matter what the circumstances, we're just supposed to smile brightly, say "oh, what a cute baby" and forget it ever happened.

Of course, I always seem to be the freak, as I found both of my scheduled sections to be light years more traumatic than either of my emergency ones. (Losing Aaron was the worst trauma of all, but that was separate from the trauma of the surgery itself, if that makes sense.)

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#42 of 58 Old 01-19-2008, 07:14 PM
 
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Again- each mom has to make their own choices.

However it is important to note that no studies have ever shown an overall improvement in outcomes due to routine u/s.

-Angela
But when did this become a thread about the merits of routine u/s??

I think that if a woman is comfortable having an u/s to rule out a previa, it's up to her, and with my current experience, I would definitely recommend it. And I agree with Rockies5, knowing in advance for me is far better than planning and hoping for an idyllic home birth and then being transferred last minute in an emergency situation. Is it possible to detect a previa without an u/s? I'm sure that there are ways with a doppler or fetoscope depending on the position of the placenta. Mine is a complete previa and posterior, so since I haven't had any bleeding, I doubt it would have been picked up on any other way besides the u/s.
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#43 of 58 Old 01-19-2008, 07:18 PM
 
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I had a placenta previa that was diagnosed at 14 weeks when I went to the E.R. for cramping and intense pain. I do not think that my son would have survived if he had been born vaginally, and I was not willing to take the risk.

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#44 of 58 Old 01-19-2008, 08:03 PM
 
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Again- each mom has to make their own choices.

However it is important to note that no studies have ever shown an overall improvement in outcomes due to routine u/s.

-Angela
I chose not to have any u/s for my homebirth so you can see where I am coming from BUT I'm 99.9% positive those studies would have been done during a hospital birth and therefore with more immediate emergency care. I've always wondered what those types of studies would show if they did all homebirths?

Rachel, mom to Jake (5/04) and Alexia (7/07) a surprise UC thanks to hypnobabies!
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#45 of 58 Old 01-20-2008, 05:08 PM
 
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I have yet to read of a case of placenta previa that presented with NO bleeding by labor.

-Angela
I had complete placenta previa and I never bled. Any review of the medical literature on previa will quickly reveal that while asymptomatic previa is less common, it still occurs.
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I chose not to have any u/s for my homebirth so you can see where I am coming from BUT I'm 99.9% positive those studies would have been done during a hospital birth and therefore with more immediate emergency care. I've always wondered what those types of studies would show if they did all homebirths?
The study showing no improvements in outcomes from ultrasound is a very large study (10,000+ cases) from Ireland (I think? -- european country, anyway). It's not of people in labor, though I don't know if it includes homebirthers or not. It's looking at those who have a 20-week "anatomy" ultrasound or not, and whether that correlates with improved outcomes in the form of more live babies -- which it does not. The very, very few things that an early ultrasound can find that make a real difference in outcome are so rare that they don't affect outcomes, statistically. Since *most* previas present with bleeding before labor or in early labor, even early detection of them with ultrasound doesn't make a *statistically significant* different in outcomes *when measured over a very large population.* Meanwhile, the early ultrasounds often lead to higher-intervention pregnancies and births, with worse outcomes for the babies without those few rare conditions.

savithny, 42 year old moderate mom to DS Primo (age 12) and DD Secunda (age 9).

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#47 of 58 Old 01-20-2008, 09:33 PM
 
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While I agree that it is highly possible that an u/s will not affect the final outcome of a complete previa (baby is born by c/s and both mom and baby survive), it can affect the birth tremendously. It can make the difference of planing a birth that is calm and exciting and something you have been waiting for to having a frightening and stressful time needing to be rushed to the hospital, maybe via 911 and ambulance, to have an emergency c/s at a moments notice to save both mom and baby.

Sure, in the end, they both may survive. But I think the early moments of life for the baby and mother will be severely impacted in a very negative way.

Yes, it could be don't but that does not mean it is the "best" way to have it done. But again, everyone has to make those decisions on their own.

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#48 of 58 Old 01-21-2008, 01:11 AM
 
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I had complete placenta previa and I never bled. Any review of the medical literature on previa will quickly reveal that while asymptomatic previa is less common, it still occurs.
Did you go into labor?

-Angela
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#49 of 58 Old 01-21-2008, 06:51 PM
 
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I would think that most bleeding for previas occur because dilation occurs before labor, sometimes slowly over the course of days or weeks, thus making the bleeding start.

However, for my labors, let me take one in particular, this is not true. The day before I went into labor I was 0-effaced and 0-dilated. Meaning, that if bleeding occurs because of those factors, I would have had no bleeding at all. And when the first contraction hit, I had barely over an hour before my daughter joined the world. So, if she had been a previa baby, I would have had a lot of trouble, with tons of bleeding, very suddenly, and little time to get to the hospital that was not overly close. Time would have been a big factor in her healthy outcome. And as such, knowing ahead of time could possibly have changed the outcome drastically.

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#50 of 58 Old 01-21-2008, 09:03 PM
 
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I would think that most bleeding for previas occur because dilation occurs before labor, sometimes slowly over the course of days or weeks, thus making the bleeding start.

However, for my labors, let me take one in particular, this is not true. The day before I went into labor I was 0-effaced and 0-dilated. Meaning, that if bleeding occurs because of those factors, I would have had no bleeding at all. And when the first contraction hit, I had barely over an hour before my daughter joined the world. So, if she had been a previa baby, I would have had a lot of trouble, with tons of bleeding, very suddenly, and little time to get to the hospital that was not overly close. Time would have been a big factor in her healthy outcome. And as such, knowing ahead of time could possibly have changed the outcome drastically.
I think that you have got a very good point and how I think about why there is bleeding in some women and not in others-- if there isn't dilation or effacement why would there be bleeding?
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#51 of 58 Old 01-22-2008, 04:14 AM
 
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I think that you have got a very good point and how I think about why there is bleeding in some women and not in others-- if there isn't dilation or effacement why would there be bleeding?
how likely is it not to be dilated even a bit with a third baby?
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#52 of 58 Old 01-22-2008, 05:04 AM
 
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how likely is it not to be dilated even a bit with a third baby?
It happens. One of the first things I learned working with birthing women is that with the third baby, all bets are off.

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#53 of 58 Old 01-22-2008, 08:49 AM
 
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how likely is it not to be dilated even a bit with a third baby?
The baby in example (where I had 0-D & 0-E), was baby number six. And I had excellent prenatal care, so I know exactly how my cervix was. Surprisingly enough, that was my only baby that I saw an OB right up to 40 wks. Most I stopped seeing at early third trimester.

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#54 of 58 Old 02-09-2008, 10:28 PM
 
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I found out something today I thought I'd add to the discussion. Apparently with complete previa, you are less likely to have bleeds. Having a partial previa means only an edge of the placenta is over the cervix, and it's more likely to get tears and bleed. But with the complete previa, the middle of the placenta is over the cervix and is less likely to separate enough to bleed.

So the worst case scenario for delivering vaginally is the most likely to produce no symptoms until labour.
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#55 of 58 Old 02-10-2008, 02:09 AM
 
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I had complete Previa with DS#2 that resulted in a c-section. (DS#1 was a vaginal birth but I did have a subchorionic hemorrhage with him that cleared up by 20 weeks)

At the 20 week ultrasound it was low but I was told there was still plenty of time for it to move. I had bleeding on and off from about 30 weeks on. I had another u/s at 36 weeks and it was complete. My OB said if it hadn't been complete, they would have let me try a vaginal birth but that we would need to schedule a c-section. It was scheduled about a week or so before I was due. At just over 37 weeks I started bleeding heavily, I mean heavily. I went to the hospital and they admitted me. I had been contracting on and off through the night but I didn't even know it. When the OB came in the next morning she said she didn't want to push it anymore, I was bleeding enough and with the contractions she didn't want to wait until I was in labor and have a bigger problem. So I was having the c-section ASAP. It wasn't an emergency, but it was rushed. DH had about a 20 minute ride and he got there just in time. Honestly the c-section went well and both of us did fine. Holden had no problems and I recovered extremely well.

I am happy we knew ahead of time. Though the c-section wasn't when I thought it would be, I was prepared that I might not make it that far. I had knowledge of what Previa was and what the complications were. I had bleeding with my first, but it was nothing compared to the bleeding I had before DS#2 was born, that was scary.

This time around I was planning a VBAC which was fine with my OB and was happy to hear my placenta was up high. Unfortunately at the 20 week u/s we found out the baby has some complications so it will be another c-section for me. This has nothing to do with the placenta. So while there is a chance that once you have complete previa, you may have it again but it's not always the case - don't give up hope for your next birth!

If you have any questions, let me know and I'll be happy to help!

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#56 of 58 Old 02-10-2008, 06:16 PM
 
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Here's my experience, for what it's worth.

I have had two vaginal deliveries - in the hospital but no drugs whatsoever. Gave birth naturally each time to 9lb babies. Wonderful births, as far as hospitals go. I was able to labor on my own with virtually no intervention other than checking my blood pressure and monitoring baby's heartbeat. I called all the shots and everyone listened. Perfect births for me!

With my third baby (born 10 days ago!) I had placenta previa. Diagnosed via 20wk ultrasound and then followed until 39 weeks. Never moved far enough away to have a safe birth (it was 1.7cm away from cervix...too risky for us). I never had spotting at all at any point during my pregnancy. We planned a c-section for 39wks 3days. I was so bummed. But I knew it was the right thing to do.

At 39 weeks I wasn't even effaced, let alone dialated. This was my third baby! Why wasn't my cervix getting ready at ALL? Why was she still riding so incredibly high? Why didn't I feel "labory" in the slightest? My previous births I did and all signs were there that I was going to have a baby. With my third, the only sign was that there was a baby in there but there were no signs she was comin' out any time soon! I am certain, absolutely certain that this was my body's way of keeping her safe as long as possible - my body is smart. It knew that things weren't right and she didn't have a safe way out. If I had been allowed to labor and try to give birth, I really wonder what that labor would have been like. My guess is that it would have been a very start-stop-start-stop kind of labor with little to no progress occuring 1-2wks after my EDD, with more bleeding than normal (I'm not sure the quantity but I know there is a specific # of ounces that is considered going into unsafe territory...we made sure to get the info in case I went into labor early at home since we live on an island and need to ferry into the city), signaling that something was up.

I am really bummed that I had to have a c-section, especially after having two beautiful natural vaginal births. But I shiver to think of the possibilities if I hadn't done it. Things can go bad REALLY fast and it wasn't worth it, even in a hospital setting where there's an OR right there just in case. In the time it would have taken them to prep me for surgery and get my baby out, she could have suffered brain damage or even worse, died. Even if it was just a matter of a few minutes.

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Callahan 3yrs
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#57 of 58 Old 02-10-2008, 06:50 PM
 
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CJ'sMommy, are you saying your placenta was only low-lying at 20 weeks but moved OVER your cervix?

I asked my doctor about that, because mine has been right on the edge of my cervix and it is posterior and I was worried that as I grew 'out' that maybe my uterus would stretch more in the anterior direction and it could pull the placenta MORE over my cervix, and he said that 'never' happens, that they either stay put or they move away from the cervix - never toward/over.

I'm 31 weeks tomorrow and will be having another u/s to check my placenta in a few weeks. I sure don't want to find out it moved over my cervix and I'm in for a C-section for sure

Also, my OB said as long as it's not 'covering' the cervix at all, it's safe to do vaginal birth. Geneva - with yours 1.7 cm away, what did your doctor say the risks were? I just have this horrible picture of the baby 'blocking' the hemmorage while in the cervix/vagina and then coming out and a huge tidal wave of blood coming after her - not sure if that is irrational or not. Any info you can share on the risks would be so helpful! How many cm away would you have felt comfortable with?
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Originally Posted by JavaFinch View Post
CJ'sMommy, are you saying your placenta was only low-lying at 20 weeks but moved OVER your cervix?
It was partial at 20 weeks and then at the 36 week ultrasound they said it was complete. Maybe it was just really close, I don't know. I do know that unless it was too close she would have let me try for a vaginal birth. She told me to no circumstances to let anyone do an internal on me because of the chance that fingers could poke a hole in the placenta.

At 20 weeks they told me it would probably move up and the chance for complete previa was rare. Wouldn't you know....my body is odd though so it doesn't surprise me.

Mommy of 3 super charged kiddos
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