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How can Newborn Babies See At Birth?

I was at the birth of my nephew some years ago and the moment he came into the world is one that I will never forget.  There was hardly a whimper.  His mother gave birth with him on her hands and knees and he came out the back.  As soon as his head emerged, I saw his eyes scanning the room, turning his head to see.  It was as if he was saying, “So this is what it looks like out here!”  My initial thought was, “He is a wise soul.”

I’ve always taken it for granted that a baby at the moment of birth will be able to open his eyes and just automatically see anything there.  It never occurred to me to wonder how this actually happens. I believed that the optic nerve is developed in utero and then at birth it just starts working.  Though this is true, it is not the whole story. How is it that a baby’s eyes are able to see at the moment of birth? Is it with the sudden stimulation of light? Or is there some preparation while in the womb?

Since then, I have learned more about the science of how a baby sees.  The optic nerve doesn’t just automatically adjust to light on the outside – it has to have had preparation and practice while still in the womb.  But how can this happen when it is dark inside the womb?

After about four months of gestation, the human fetus has grown 200 billion never cells in the brain, twice as many as it needs. 1 We do know that when nervous systems are not properly stimulated during specific critical sensitive periods in development, they never function properly, even if they are stimulated later.2  We also know that a fetus in the womb is exposed to sounds, pressure on the skin, smells and even flavors in the amniotic fluid.  The fetal brain is actually shaped by these nerve signals that travel down nerve pathways.  Those that are used most often become stronger.  Those not used as often become weaker and may even be eliminated.  So it makes sense that the optic nerve for sight would have a stronger pathway to prepare the infant to see at birth.  But how?

The fetal brain uses artificial
stimulation to help its
visual system develop.

It was fascinating to read the answer to this question in “The Promise of Sleep” book by Dr. William Dement, MD.  It turns out that neurological research provides evidence about another wonder of the human body. It has been discovered that the fetal brain uses artificial stimulation to help its visual system develop.  He states, “Since the womb is dark, the eyes can’t send messages back to the visual area of the brain and give them the workout they need to develop. And yet, immediately after birth, the eyes and the visual areas of the brain work fine. This is possible because the eyes of fetuses create their own nerve signals, just as they would if activated by light. These signals then pass from the retina to the visual areas of the brain and give them the stimulation they need to form images later.  This allows the visual system to organize itself so it can make meaningful images from the first patterns of light that hit the eyes after birth.”

“REM (Rapid Eye Movement) sleep continues to be an important part of visual development after birth, hitting brain cells in ways that complement the stimulation from light.”3  It is interesting to note that REM sleep is dream sleep so perhaps visual images in utero provide self-stimulation laying the foundation for its own organization by creating proto-sensations that train the brain and prepare it for the real-world sensations to follow.4 When the nerve cells for the visual system are not stimulated by either light or REM sleep signals, the visual nerve cells atrophied (wasted away) even faster.  This suggests that REM sleep continues to be an important part of visual development after birth, exciting brain cells in a way that complements the stimulation from light.

At birth, babies cannot see very far, 8-15 inches but that is the perfect distance to see their mother’s faces.  In fact, they prefer faces rather than other shapes, and also shapes that have light and dark borders – just like their mother’s eyes.  A mother and her baby are primed to bond and connect with each other in fascinating ways such as this. They are several months old before they can see their first color – red.

What is important to know and believe, is that a baby at or near full gestation at the moment of birth is very competent.  His nervous system is very well developed from the neck, up.  The sucking reflex is primed for survival and is calming.  No wonder then that the body since ancient times has determined a creative way for us to see at the moment of birth.

(See our blog on the size of baby’s eyes)

  1. Dement, William MD, PhD. The Promise of Sleep, Random House Inc, NY. 1999, pages 254.
  2. Ibid p. 254
  3. Ibid p. 254
  4. Ibid p. 254
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Breastfeeding and Your Telomeres: Helping you and your baby to live longer

Do you want to increase the chances of you and your baby living longer?  Here is another wonderful benefit of breastfeeding and it has a lot to do with your Telomeres (tee-lo-meres)?  Telomeres are located on the tips of our chromosomes and correlate significantly with health and longevity. 

In fact, they may be considered the fountain of youth people historically have been searching for and yearned for.  But much of this is dependent on our lifestyles.

The research on telomeres is relatively new in science and presents a new way of thinking about human aging.  The question that is raised in the book “The Telomere Effect” by Elizabeth Blackburn, PhD and Elissa Epel, PhD, is “Why do people appear to age differently?”  

The DNA of every chromosome has DNA strands at their tips, which are coated by a protective sheath of proteins.  Even though they are very small, less than one-ten-thousandth of the total DNA of our cells, they are vitally important to our lives.  They are known to shorten with each cell division.  They help to determine how fast your cells age and when they die, depending on how quickly they wear down.  We didn’t use to believe that they could grow longer again, but now we do know that the ends of our chromosomes, our telomeres, can actually lengthen.  Though we will all become older, new evidence shows this is a dynamic process that can be accelerated or slowed, and even reversed.

Our telomeres actually listen to us by responding to the instructions we give them.  This happens through the foods we eat, how we respond to emotional challenges, how much exercise and sleep we get, and trust and faith in those surrounding us.  In this way, we have a degree of control about our cellular health.

We now know that a new mother can actually “feed” her baby’s telomeres by making sure she is exclusively breastfeeding in the first weeks of life. A study out of UCSF found that children who were only breastfed in the first six weeks of life (no formula or solid foods) had longer telomeres.1 Therefore, introducing solid food before six weeks of age is linked to shorter telomeres. And just as interesting is the fact that a mother who has shortened telomeres, actually passes on these shortened telomeres to her baby in the womb, not giving her baby a good start in life.  “If the mother’s telomeres are short throughout her body (including those in the egg) when she contributes the egg, the baby’s telomeres will be short, too.  They’ll be short from the moment the baby starts developing.” 2 Therefore, if the mother has been exposed to life factors that have shortened her telomeres, she can pass those shortened telomeres through direct transmission directly to her baby. Furthermore, It is now known that telomeres are transgenerational, affecting future generations.3   It appears this is true for the father of the baby as well, but to a lesser extent than the mother. 4  

Shortened telomeres increase risk to children as they grow. Young children with shorter telomeres, were found a few years later to be more likely to have a thickening of their arteries, placing them at a higher risk for cardiovascular disease. 5 

Nutrition and oxidative stress are two aspects of lifestyle that significantly affect the length of our telomeres.  It was found that three year old children who drank four or more sodas a week had a greater rate of telomere shortening.6 Processed meats also appear to shorten our telomeres.  In fact the SAD American diet high in salt, sugar, and fat is associated with shorter telomeres whereas diets high in fiber, vegetables, nuts and legumes fruits and omega 3s are associated with longer telomeres.7  Mothers with inadequate folate in pregnancy have shorter telomeres.8 But one study showed that too much folate may decrease her baby’s telomere length. Therefore moderation and balance are essential.9

In terms of severe stress (as opposed to lower stresses of daily life), a mother’s psychological stress may affect the telomere length of her baby in the womb.  In other words, a baby’s telomeres can suffer from his mother’s prenatal stress.  It is the stress hormone cortisol that crosses into the placenta and affects the fetus.10

The conclusion of telomere research on pregnant women is that we must find ways to protect pregnant women from severe stress in life.  We must reach pregnant women with early childbirth preparation, have a birth doula, a kangaroula, and a postpartum doula with her so she can feel safe and produce hormones of joy. And most importantly, we need to encourage pregnant women to breastfeed their babies at least in the first six weeks of life, so they can lengthen their telomeres and give themselves, their babies, and future generations the best chances for a happy and long life.

  1. Wojcicki, J., et al. “Early Exclusive Breastfeeding I Associated with Longer Telomere in Latin Preschool Children,” American Journal of Clinical Nutrition (July 20, 2016, doi: 10:10.3945/ajcn.115.115428
  2. Blackburn, Elizabeth PhD, Epel, Elissa, PhD, The Telomere Effect, Grand Central Publishing, NY. 2017. P. 283
  3. Blackburn et al, The Telomere Effect, p. 282 (see #2 above)
  4. Blackburn et al, The Telomere Effect, p. 283-84 (see #2 above)
  5. Skilton, M.R., et all, “Telomere Length in Early Childhood: Early Life Risk Factors and Association with Carotid Intima-Media Thickness in Later Childhood,” European Journal of Preventive Cardiology 23, no. 10 (July 2016, 1086-92, doi: 10.1177/2047487315607075.
  6. Factor-Litvak, P., et al., “Leukocyte Telomere Length in Newborns: Implications for the Role of Telomeres in Human Disease,” Pediatrics 137, no.4 (April 2016): e20153927, doi:10.1542/peds.2015-3927.
  7. Blackburn, et al “The Telomere Effect” p. 238. (see #2 above)
  8. Paul, L., et al., “High Plasma Folate Is Negatively Associated with Leukocyte Telomere Length in Framingham Offspring Cohort,” European Journal of Nutrition 54, no. 2 (march 2015): 235-41, doi:10.1007/s00394-014-0704-1.
  9. Entringer,S., et al., “Influence of Prenatal Psychosocial Stress on Cytokine Production in Adult Women,” Proceedings of the National Academy of Sciences of the United States of America 108, no. 33 (August 16, 2011: E513-18, doi:10.1073/pnas.1107759108.
  10. Skilton et al. “The Telomere Effect” p. 296 (see #2 above)
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Keeping Doulas at Births in Hospitals During Covid-19

Stages of Grief: Our community was thrown off-kilter mid-March 2020 with the official arrival and acknowledgement of COVID-19 as a global threat in the United States. It was upon us and as with any stressful event, many birthworkers, myself included, walked through the stages of grief in regards to the pandemic.

First Stage Denial: Surely this wasn’t really a thing, was it?

Second Stage Anger: I felt anger acutely as a doula. The restrictions on birth support hit me in the gut and I’m not ashamed to admit that initially I took it as a personal attack on doulas. Of course, I have since come to my senses and understand that at the heart of the decision by hospital administration was to keep everyone safe, including doulas, which brings me to the third stage.

Third Stage Bargaining: Birthworkers explored how to continue to offer birth support, even if virtual, and they pivoted to accommodate the needs of their clients through FaceTime, Zoom, text, and phone.

Fourth Stage Depression: Depression was in there too, and lingers today for many of us. As doulas, we yearn to be with our clients, sharing their birth space and offering physical support in their presence. It pains many of us when we are separated from our clients during birth. It’s truly a struggle that hits a doula right in the heart. And finally, we
encountered acceptance.

Fifth Stage Acceptance: COVID-19 will remain in our midst for awhile and have far-reaching implications on how births will look for the foreseeable future. It is our new, indefinite normal, restrictions, masks, hand sanitizer, and all.

Acceptance is unacceptable.

Doulas and birthing families have had six months of processing the restriction of doulas from physically attending births in the hospital setting. It’s time to push more aggressively to reintegrate doulas in-person at birth. If you are a birthing parent, I implore you to advocate for your doula, and for all doulas, to return to the hospital. Doulas should be
permitted to attend in person because it is the right of every laboring woman to have support, but also because the research is extensive proving that the continuous labor support doulas provide improves birth outcomes. Doulas help everyone, including the staff and care providers! In fact, reputable birthing organizations such as The Association of
Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) have made statements early on defending doulas as essential members of the birth team, and encouraging them to be permitted to continue to serve in person DURING the pandemic. (https://awhonn.org/covid-19-archived-updates/)

Advocacy: So what are we to do to affect change in hospital policies? There needs to be a push from the birthing parents to hospital leadership. Contact the manager of the labor and delivery unit, and the administrator of the hospital. Make a phone call. It’s harder to ignore a voice on the line. Follow up your phone call with an email and a letter. Paper trails are also hard to dismiss. If there are other hospitals who have allowed doulas to return, be sure
to mention them as well. In Hampton Roads at the time of this writing the only hospitals permitting doulas to attend births alongside the primary birth partner are: Sentara Leigh, Sentara Obici, and Sentara Williamsburg. And don’t forget to express your wishes with your provider. Not just one, but to each doctor and/or midwife at every appointment.

This needs to come from the birthing families, not the doulas. The amount of research in favor of the presence of a doula is dizzying. And the number of statements by various obstetric, nursing, and birth organizations is compelling. The evidence is there and the need is higher than ever. What’s lacking is the advocacy for the presence of doulas during the pandemic. I have compiled some links in an effort to cut down on your need to research data. You will find them at the end of this post. Feel free to use any or all that you see fit. And write those letters, send those emails, and make those phone calls. The change must begin with the birthing women. Not the doulas. We believe in you and we support you. Be an advocate not just for yourself, but for all birthing families.

Below are some links to incorporate into your letters/emails/calls campaigning for the reintegration of doulas to attend births in-person. They are particularly timely and relevant since the statements were made in March 2020, right as the pandemic was taking hold in the US.

Cochrane Database Evidence that continuous labor support may improve outcomes for mom and baby:  https://www.cochrane.org/CD003766/PREG_continuous-support-women-during-childbirth

AWHONN Position Statement for Continuous Labor Support for Every Woman: https://www.jognn.org/article/S0884-2175(17)30482-3/pdf

ACOG (American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine’s joint document on the Safe Prevention of the Primary Cesarean Delivery: https://www.acog.org/en/Clinical/Clinical%20Guidance/Obstetric%20Care%20Con sensus/Articles/2014/03/Safe%20Prevention%20of%20the%20Primary%20Cesarean%20Delivery

ACOG Approaches to Limit Intervention During Labor and Birth: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/02/approaches-to-limit-intervention-during-labor-and-birth

March of Dimes Position Statement on Doulas and Birth Outcomes, January 30, 2019: https://www.marchofdimes.org/materials/Doulas%20and%20birth%20outcomes%20 position%20statement%20final%20January%2030%20PM.pdf

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Risks and Benefits of Fetal Monitoring During Births

In a recent article in the August 1, 2020 edition of American Family Physician which is a peer reviewed and editorially independent journal of the American Academy of Family Physicians, there is an interesting study discussing “Intrapartum Fetal Monitoring.” It explains that continuous electronic fetal monitoring (CEFM) was developed to screen for evidence of fetal distress including hypoxic ischemic encephalopathy or fetal acidosis (compromised brain function due to inadequate circulation and oxygen delivery to the brain), cerebral palsy (which
is most likely caused by factors prior to birth), and impending fetal death during labor. Because of the low frequency of occurrence of these events during labor, CEFM has a false positive rate of 99%. In other words, lkg99% of the time when the monitoring shows a pathologic pattern, it is not indicative of an immediate danger for the fetus.

CEFM leads to increased rates of cesarean delivery

The widespread use of CEFM has led to increased rates of cesarean and other operative deliveries without any significant improvements in outcomes for the newborns. CEFM is a very blunt tool for detecting fetal distress. CEFM is falsely positive for fetal acidosis 67% of the time and when actually present, has a low sensitivity of 57% of correctly detecting fetal acidosis. When fetal acidosis is not present, there is a low specificity of CEFM with only 69% of the time showing a negative or normal result. Further complicating this is difficulty interpreting the CEFM tracing with agreement between experts on interpretations of the CEFM tracings only half of the time.

Structured Intermittent Auscultation (SIA)

Structured intermittent auscultation is preferred for women without risk factors as detailed below. ‘The main antepartum factors indicating high risk labor and the need for CEFM include any condition in which placental insufficiency is suspected such as intrauterine fetal growth restriction, known fetal anomalies, maternal preeclampsia/gestational hypertension or maternal type 1 diabetes mellitus. Intrapartum factors indicating high-risk labor and requiring CEFM include presence of meconium, presence of tachysystole (overactive uterine
contractions), signs or symptoms of intrauterine infection, unexplained vaginal bleeding, or use
of oxytocin or other uterine stimulants for labor induction or augmentation.

If one of the following is detected during SIA for a low-risk patient switching to CEFM is recommended to assess the National Institute of Health and Human Development category and to determine necessary clinical management: irregular fetal heart rate, fetal tachycardia (<160bpm for >10 minutes), fetal bradycardia (<110bpm for >100 minutes) or recurrent decelerations following contractions (<50% of contractions) or prolonged decelerations (>2 minutes but <10 minutes).

Risks of CEFM

The main risks of CEFM are increases in cesarean and operative vaginal delivery rates without improvements in fetal outcomes. Along with the increases on operative deliveries also come costs of longer hospital stays and higher risks of complications such as infections, bleeding, and bladder injury, etc. Another important consideration is that the ability of the laboring woman to move around and walk or assume a position that facilitates her delivery and labor is very restricted, making a normal natural labor and delivery almost impossible to achieve.

Barriers to Implementing SIA

Not all birthing facilities offer the option of SIA because of barriers in nursing staffing and education and physician oversight. Most organizations, including the American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse Midwives (ACNM) recommend instituting SIA with the onset of the active phase of labor. However, there are differing ways of defining active labor. The two most commonly used are 4 cm of cervical
dilatation and 6 cm of cervical dilatation but regular uterine contractions which are strong and frequent (<5 contractions in a 10 minute period averaged over 30 minutes) without uterine stimulants is also important for active natural labor. Be sure to ask your birthing facility if the option of SIA is available.

Choosing Wisely Campaign: Advice for birthing women

A recommendation from the Choosing Wisely Campaign is to not automatically initiate CEFM during labor for women without risk factors, and consider SIA first. Another very important recommendation from the Choosing Wisely Campaign is: Don’t separate mothers and their newborns at birth unless medically absolutely necessary. Instead, help the mother to place her newborn in skin-to-skin contact immediately after birth and encourage ongoing skin-to-skin contact and always keeping the newborn in her room during the hospitalization after the birth.

Breastfeeding within a half an hour after birth is optimal both for the mother and infant’s health along with exclusive breast feeding for the first 6 months of life after which appropriate complementary foods should be introduced, and the infant should continue to breastfeed for one to 2 years or longer as desired. Worldwide, the lives of an estimated 1.5 million children less than the age of five would be saved annually if all children were fed according to this standard.

References:
1. “Intrapartum Fetal Monitoring,” American Family Physician American Family Physician,
2020;102(3):158-167
2. For more information on the Choosing Wisely Campaign, see
http://www.choosingwisely.org. For Primary care see
https://www.aafp.org/afp/recommendations/search.htm

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What is Birthpedia and How is it Changing the World of Birth?

A qualified resource where the worlds of hospital, birth center, and homebirth co-exist? A place
where parents’ choices are respected, where information isn’t condemning, but enlightening? A
resource like that simply didn’t exist… until now.

In this post, you will learn how Birthpedia is changing the way information about birth is being
presented and why future parents and birth professionals should know about it.
What a wonderful world it would be if every mother felt empowered during her pregnancy and
believed in her ability to give birth. But information for pregnancy and birth are now found in a
world of excessive data, obsession with social media, and self-diagnosis thanks to Google. The
upcoming generations of parents are found here, and they are lost. Between horror stories of their
mothers and the latest forum board on BabyCenter, parents are feeling anything but educated,
empowered, and prepared for the journey of parenthood. Confusion, debate, opinion, and fear
dominate their circles of influence. There has to be a better way. A midwife/OB can only stretch
themselves so thin. A doula can only have so many clients. And childbirth educators can only
reach those who take their classes.

Birthpedia is a subscription-based app and website that provides quick, current, and
qualified information to expectant families, delivered in short videos by birth professionals.
Birthpedia’s mission is to provide this information in a judgment-free space, helping expectant
families and parents of newborns make educated and informed decisions.
We believe that providing information in a collaborative way helps families feel supported and
equips them with essential knowledge—which empowers them to make informed decisions
within their experiences.
The app and website are organized into three main sections: ASK, SHARE, and DO.

The ASK Area:
Consists of five color-coded categories: Conception, Pregnancy, Labor &amp; Delivery, Postpartum,
and Newborn Care. A search bar allows for search on any topic or question, or by category. Each
question will be answered in a 1–3 minute video by a birth professional. The database of
questions will hold over 1000 videos from over 100 birth professionals called “contributors.”
Contributors include midwives, obstetricians, doulas, childbirth educators, massage therapists,
chiropractors, fertility specialists, anesthesiologists, aroma therapists, herbalists, and more.
Answers to questions are based on the most current information in each category and speak to
the pregnant family—regardless of where they choose to give birth.

The SHARE Area:

Users will find a variety of shared stories. These stories are inspirational: stories of birth,
fertility, and adoption. The videos share positive and redemptive real-life experiences. Sharing
these stories will inspire new parents to believe in themselves and their natural, instinctual, and
God-given abilities. They will encourage couples struggling with infertility, going through a
grueling adoption process, or preparing for a VBAC.

The DO Area:
Users will find a wide variety of instructional videos, such as prenatal and postpartum exercises,
prenatal yoga, labor positions, breastfeeding, babywearing, changing a diaper, nutritional food
prep, and more! These videos will encourage users to be more active and provide up-to-date
visuals to help guide them.

WHO is Birthpedia for?
First and foremost, future and expecting parents. Birthpedia offers three different subscriptions;
24 hours, monthly, or six months.
Birthpedia also serves to be an excellent reference resource for current birth professionals. Birth
Professionals can sign up for a Lifetime Membership and grow with this incredible resource for
the lifetime of their career!
Birthpedia aims to be a socially responsible company that strives to invest in improving the
global birth landscape for better birth outcomes.
At Birthpedia, we believe…
● every newborn baby deserves the right to their best birth.
● informed parents create better birth experiences for all involved.
● birth is a primal human function and should not be treated like a disease
● every woman giving birth has a right to respectful maternal care
● every woman has the freedom to choose how she wants to give birth without
condemnation.

You are invited to join the journey toward better birth with Birthpedia! Birthpedia can be found
online at www.birthpedia.net, Instagram @Birthpedia, and Facebook/Birthpedia. For a limited
time up until January 2020, all of the content is FREE as the Birthpedia database continues to
grow!

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Adina’s Testimonial

Attending the BirthWorks childbirth education workshop in Mt Dora, Florida this May was way more than I bargained for! The place was absolutely stunning. A Victorian style historical hotel with sprawling grounds against a backdrop of the magnificent lake and quaint town. But even more than that was the content of this 3 day workshop given by Cathy Daub. The workshop was so comprehensive and included topics such as grieving, mother daughter relationships, optimal pelvic positioning as well as many others that are not usually included in typical childbirth preparation classes. They were all taught through hands on experimental learning and not through didactic teaching. It was the BirthWorks experience I came out with!

One of the really vital things was teaching and facilitating using open ended questions and letting the other party find their inner guide to direct them. That evening I had a chance to really practice this skill. Being a doula, I had a client in labor and sent a backup.  Right before pushing, my backup called me asking if I could speak to the client as she was panicking about pushing. Instead of going into my long speech about why she shouldn’t be scared to push and how she’s done this in the past, I asked her what her fear was. She said she’s afraid she can’t do it. I asked her what she felt she needed to be able to move forward and she said she thought she needed help from the doctor. I said what kind of help. She said she remembered from her last birth that the doctor did supra pubic pressure because the baby’s shoulders got stuck. I gently reminded her that the only reason the doctor did that was to help the shoulders but the head was out already. So she said, “oh ok, but I’m still scared.”  So I asked her, “What do u want?”  She said she wanted her baby to come out without pushing. I said great. Imagine it. She said she can’t because she  has no energy. So at that point I told her to visualize G-ds energy as she inhales coming into her uterus and as she exhales pushing out her baby. She said,”Ok you visualize it for me!”   I said sure and she hung up empowered and pushed her 9 and half pound baby out with one push!!!

It was such a great lesson for me and I can’t thank Cathy and BirthWorks enough!

Earlier that day this same client was laboring pretty slow so I instructed my backup to do the rocking technique we had just learned that morning and she progressed very quickly to 10 cm!

Recently I had a prenatal meeting for a client who had 2 previous c sections and I used the grieving process we learned, asking her if she wanted to share anything that was hurting her  and she ended up telling me about a few childhood moves her family made when she was in school and how she was afraid to get too close to anyone and then have to move again and she came up with the idea that she was scared to carry something through to the end, the finish line. Explaining to her how we birth the way we live, both her previous births she stalled at 3 cm and wasn’t able to progress further. That awareness was amazing for her and it’s all due to the skills I learned in the grieving session.

Thanks a lot!

Adina Hoffman