Breña’s Birth

On Tuesday the 9th I woke up and noticed my uterus and cervix were achy.  I had been exhausted for a few days but I was having no contractions, no bloody show, and none of the other things you hear about that indicate labor, so I thought nothing of it.  By the time I went in for my standard 38 week check up that afternoon it had slipped to the back of my mind.  I was shocked to find I had gained 6lbs in just a few days – how was that possible?!  I put it in my mind to ask my doctor about.  I settled in for my second NST of the week thinking about nothing more than whether or not the paper would run out this time.  When my doctor came in she said, “You aren’t going to like me.”  She had said that before when I was put on bed rest and when it was time for my GBS test, so I thought it was no big deal.  I never expected what she told me next.  Despite a pregnancy with perfect blood pressure, no swelling, no headaches, clean catches, well controlled gestational diabetes, and fabulous BPP’s and NST’s, her supervising doctor was insisting I be induced the following Monday!

Up until that point never had induction been brought up beyond a simple, “Do you want to be induced?” to which I replied no.  “OK.” she said, friendly as usual.  She didn’t try to intimidate me, bully me, or throw scary words at me to make me acquiesce.  She simply wanted to know what I desired for my birth, and she respected my decision and my right to make it.  That was the end of it, or so I thought.  One week later I lay on that exam table listening to my baby’s heart thump away on the machine, thinking about that ugly word: induction.  Why?  My pregnancy was finally past the crisis of the short cervix.  Everything was going perfectly.  Why this, why now?  I looked at my doctor and asked, “Does doctor Bell think I should be treated like every other woman?  Because not every woman is the same, and I am not them.”It was explained to me that because gestational diabetes makes big babies, they wouldn’t let me go past 39 weeks.  The growth ultrasound from the day before had estimated my baby at 6lbs 15oz, so what did that have to do with anything?  Even given a margin of error of one pound she wouldn’t be a big baby.  If their plan was to induce at 39 weeks anyway, why did they even bother managing my diabetes so well?!  She took a moment to think about her reply.  “Well, there’s this thing in the medical community called, you have to do what everyone else is doing.”  I was floored.  She told me about the natural options she wanted to try – the foley catheter balloons, followed by misoprostol if the balloons failed to yield results.  The final resort would be pitocin.  None of the dangers of any of these were ever mentioned, which still blows me away.  Where is the informed consent in telling someone what something is supposed to do and not what might go wrong?

As my doctor was going to find someone to unhook me from the machine, I happened to mention the soreness I woke up with.  She hesitated and said she’d check me before I left.  “I’m not going to let you walk out of here if you’re like 5cm or something.” she joked.  It was just that to me, a joke.  As I was undressing I felt wet and, feeling rather embarrassed, I grabbed a paper towel to wipe off with.  Much to my surprise it was covered in a lot of yellowish slime!  I knew it must be some of my plug but still thought nothing of it.  Moments later I lay back for my doctor to check me; I didn’t note at that time that it was much less painful than the previous check.  I was still floored when she said, “It looks like you are.. going to labor and delivery.”  All I could think to say was, “Liar!”  I was 4.5cm!  Thankfully she changed her mind and let me go home.  I knew women could be 4cm for some time.  Lacking contractions, I wasn’t sure what to think.  I told a few close friends and left it at that.

That night at home was very uneventful.  I went for my evening walk and had a few very mild contractions after wards.  Of course I was amped up and stalking my toilet paper, but there was nothing to be seen.  Just before bed I was scrolling through my news feed and saw a post from Improving  On a whim I decided to send them a message.  I wanted to know my rights as far as the induction that was being thrown on me.  I crashed and slept a full 12 hours.  The following day I spent a lot of time thinking.  Cristin from Improving Birth had given me some links to great information which really bolstered my decision to refuse an induction.  I simply did not feel it was necessary to risk my baby for one doctors ‘standard of care.’  Meanwhile I noticed my body was a little off.  My bowels were emptying a great deal, I was still exhausted after napping off and on all day, and my nipples had very significantly increased in size.  I had this nagging feeling I was in pre-labor.  I decided I was going call my doctor the next day to talk to her about it.

That evening I had enough contractions that I started writing down the times.  They were nearly all at least a minute long but were coming anywhere from 9 to 45 minutes apart.  I took my walk again and noticed no significant change, so I went to bed.  The following morning I called my doctor and was surprised to find that my induction options had changed.  Because I was so dilated, the balloons and the gel would no longer be viable routes.  Breaking my waters would be the only step they would take before pitocin.  This gave me so much more to think about and research that I ended up not talking to her about refusing induction.  I did tell her why I thought I was in pre-labor and she said she didn’t think I’d make it to Monday which gave me a sense of relief.  I was hopeful that I wouldn’t have to have the pitocin fight after all.  The rest of the day I had almost no contractions which kind of worried me, but that evening they started up again.  They were coming about 9-15 minutes apart.  Some were about a minute long, some less, which was discouraging, but I went for my walk and went to bed.

The next two days I had no contractions at all which was so disheartening.  Monday was only a few days away and I was sure pre-labor had just stopped.  I had woken up with very swollen feet, which was a first, and worried me more.  Fortunately when I went for my second weekly NST my blood pressure was fine.  I was checked and still at 4.5cm; when they brought up the pending induction I very directly said I was going to refuse.  That led to the L&D resident on call coming in to talk to me about it.  He asked why I was against it, and I explained my reasons – it was pretty clear everything I said went right out of his head as soon as he heard it.  He did not care what my reasons were.  He gave me a generic spiel about why they want to induce gestational diabetics at 39 weeks and how hospital policy dictated if they broke my waters I would have 24 hours to labor before anything was done.  I made it clear I was not comfortable with them breaking my waters.  He he said I needed to talk to my doctor about it and he called doctor Bell to talk to her about who knows what (I was not told).  I left feeling even more frustrated.

Saturday brought almost no contractions and nothing at all of note.  I started to feel a little bit of dread coming on with the weekend nearly over.  We had a trip out of town planned for Sunday so I decided to try to enjoy myself and forget about the rest for a day.  We were going to be leaving around 10am so I went to bed somewhat early but was having trouble sleeping due to some pain in my left side.  When I woke up the next morning I picked up my phone and saw it was 7:29.  I sat up and had a small leak, got up to go to the bathroom, and noted a few contractions about 3 minutes apart.  When I went back to bed and lay down a big gush of fluid came out.  I nearly didn’t get up but I thought I should see if it was really as much as it felt like.  Sure enough, the pillow was soaked on one side.  I went back to the bathroom and nothing happened, but when I wiped there was a small string of blood.  I didn’t want to get my hopes up so I stood and timed more contractions.  They were all coming 3-7 minutes apart.  They weren’t so strong I couldn’t talk through them, but my doctor had said that might not be what my labor was like, so I called L&D and asked them if I was supposed to come in.  They said yes, that I needed to be tested for amniotic fluid.  I woke John to tell him I was pretty sure my waters had broken.  “How can you be pretty sure?” he asked.  I said I just was and I was going to take a shower before we left.  In the shower the contractions slowed down somewhat, though I couldn’t say how much.  I got out, packed the few daily essentials that had to wait until the last minute, and we left for L&D.  Had I had any idea what that decision would lead to, I would have never gone.

We got to L&D around 9am and the amniotic fluid test came back positive.  They hooked me up to the monitor and called my doctor.  I really wanted to get out of bed but they “needed” 20 minutes of strip.  Meanwhile they tried (and failed) multiple times to get a cannula in my hand.  My doctor got there around 9:30 and a cervical check put me at 5cm.  She informed me that despite the fact that I was already in labor, doctor Bell wanted me to be on pitocin.  I could not believe the absurdity of it!  I told her in no uncertain terms that I was not going to consent to it.  She left the room to call doctor Bell and I sat, still laboring, still strapped to the machines.  On top of it the bed was making one of my lower back muscles cramp up.  When my doctor came back she said that they did not believe my labor was strong enough because I wasn’t “freaking out” through the contractions and that doctor Bell would give me until noon to progress before she was coming in to talk about induction.  I was furious.  By this time it was 10am, I had still not been allowed out of the bed to labor, my contractions were no more than 5 minutes apart, and here she was giving me a deadline of two hours?!  What exactly was going to satisfy the woman that I did not need induced?!  I said that she could come but it wouldn’t change my mind, and my doctor said since I wasn’t wanting induction that it was time for them to let me walk around.

Finally out of bed, I asked John to go home and grab my grandma’s necklace and aunt Lisa’s ring for me.  He left and I walked the hallways breathing through back to back contractions and talking on the phone to Dawn and Cristin from Improving Birth.  They were so supportive, they let me know what my rights and options were and what they were willing to do to help me.  It moved me that they would be standing by in case I needed to talk to someone.  Just after I got off the phone with them one of the nurses, Holly, came and asked if she could get another 20 minutes of strip.  Fortunately she was willing to let me stand up while she did so.  Once the strip was done I turned on some music and another of the nurses, Jeanine, brought me a birthing ball.  The relief was incredible.  I sat and rocked on it while I lay my arms on the end of the bed.  I don’t remember how long I was doing that before a number I didn’t recognize called.  It was John calling to let me know he had been arrested on a traffic ticket and was waiting to be bailed out.  I was so overwhelmed in that moment I almost started crying.  All I could imagine was having to give birth without him there, and him missing the amazing first moments of our baby’s life.  He said that he would be back soon.  I didn’t want to be alone so I called my parents and asked them to come.  To my surprise they were already in the waiting room.  They came and sat with me while I waited for John and labored on the ball.

John finally came back a little before noon; my parents left and my doctor came in to check me which was truly awful.  The contractions were three times as painful laying back in the bed and I nearly couldn’t stand it.  She told me that I had maybe dilated half a centimeter and that she was going to have to call doctor Bell.  I said I hoped doctor Bell was ready for an argument because I was not ok with taking pitocin.  They asked me to stay in the bed long enough for them to try to get a cannula in my arm instead, which fortunately was successful the first try.  After that I got back up and continued laboring on the ball.  Suddenly I was burning up so I took one of my shirts off.  I was starting to feel light headed and shaky.  I had only had a turkey sandwich to eat that morning so I was given some apple juice to boost my blood sugar.

When doctor Bell showed up she gave me a condescending speech about how pitocin was standard procedure at this point, that she would give it to any woman with broken waters and any woman “not showing progress” like me.  She had no interest in why I didn’t want it.  She told me that she did things “safely” and that if I didn’t want pitocin, I could get a second opinion, find another doctor there to deliver my baby (one a male which she knew I was not comfortable with, and the other a doctor I had been dissatisfied with in the beginning of my pregnancy), or leave and go to a different hospital.  The implication was very clear to all of us in the room – agree or leave.  I asked her out right if she was saying I could not stay if I didn’t accept pitocin and she said that was up to me.  I pointed out that multiple hospital employees, as well as a resident under HER, had told me in the case of ruptured waters there was a 24 hour period before intervention and she said, “I won’t get in to a conversation about credentials.”  I must have said something about the research I had done because she said, “When I take my car to the mechanic I don’t question him.”  I laughed out loud at that – since when was a laboring woman like a car?!

By the time she left I was even more furious than before.  My doctor said she would give me fifteen minutes and come check on me.  That was when I really began to feel like I was being backed in to a corner.  I spoke to Cristin and Dawn again and they contacted someone to call the hospital and speak to them on my behalf.  I was feeling very overwhelmed and frustrated and asked for their honest opinions, if they thought I was making the wrong decision.  Hearing from them that I wasn’t was a boost I really needed at that point.  After I got off the phone with them my doctor came in to ask if I had decided anything.  She mentioned that someone had said if I left the hospital against medical advice, my insurance most likely would not pay for the time I had been there.  That felt very manipulative to me – both she and doctor Bell knew I could not afford to pay medical bills myself, and I felt like it was thrown in my face as a tool of coercion.  I was also told that if I went to the nearest hospital there were no guarantees I would get a doctor who would be ok with letting me deliver naturally because it was a Sunday.  It was beyond me why anyone would treat a woman in labor this way.  Of all the things I needed to be thinking about right then, all of this was the last.  Undue stress was the very reason I had not wanted to labor in the hospital in the first place.

I sat laboring for a while longer.  Thankfully Holly was still there with me off and on.  She hardly left the room aside from taking her lunch break.  She was a calm, quiet source of support and, as she kept stressing, no pressure was coming from her for me to make any decision.  She just wanted to help me however she could.  That meant a lot to me.  My doctor came back in off and on to check in.  One of those times she told me doctor Bell had spoken to one of the other doctors in the hospital and he said he would not be willing to take over my care.  It was just more pressure I didn’t need.  I knew I wanted the right thing for my baby and couldn’t understand why nobody could grasp that!  I talked to my doctor while I labored, asking her any and all questions that came to mind.  I asked how many babies she or doctor Bell had delivered without pitocin – I was shocked when she said she had never delivered even one without it.  I said as much, and that it was horrible.  I asked if she had ever lost a baby.  I asked how many inductions she had been involved with had led to c-sections.  I pointed out that nobody had bothered to tell me the dangers of pitocin and that if I hadn’t done the research myself, I wouldn’t know there were any, to which she had no reply.  While I was in the bathroom I heard John ask about the risks, and the answer he received was something along the lines of, “Everything increases the risk of a c-section.”

At 1pm my doctor came in with an ultimatum – I had to stop “stalling” and make a decision (I don’t know when asking questions and seriously contemplating a medical decision became stalling).  I was truly at the end of my rope.  She pointed out the fact that I had said not every woman should be treated the same, and that they had given me four more “extra hours” than they would have any other woman.  As if it were a gift on their part!  My phone was dead so I couldn’t call anyone for support or advice.  John was telling me to “just do it.” so we could get it over with.  I felt so isolated, sad, frustrated, and helpless.  I don’t even remember what questions I asked her at that point, just that I had quite a few more.  I do remember asking how the baby was doing through contractions and they said she was doing great.  I asked my doctor if she would check me again to see if I had progressed.  She did and said I was at 6cm.  “That is not the kind of progress we want to see at this point.” she said.

I got on my knees in the bed, leaned forward on the birthing ball, and kept thinking.  I felt like I had absolutely no options whatsoever, and that no matter what I did I was not going to be allowed to do what was in my baby’s best interest.  The contractions were strong enough that I couldn’t talk through them and I was emotionally alone.  My resolve was waffling.  I thought about the dangers of pitocin and for the first and only time in my entire labor, I cried.  It was all too much.  I told my doctor I knew I had no choices and this was absolutely ridiculous.  In the end I said that I wanted an intrauterine pressure catheter so that they would know exactly what the pitocin was doing and they could back off if it started to be too much for the baby.  She said that she would get everything ready and be back soon.  I leaned on the ball and kept breathing through contractions while trying not to start crying again.  John had been on his phone off and on for hours and I told him to please put it down and just come be with me.  I felt so alone.  I also threw in a comment about how doctor Bell had better stay on the other side of the room if she came back because I’d be tempted to punch her.

I had to sit back again so they could get the fetal heart rate and I was in a lot of pain.  When my doctor and doctor Bell walked in the room I was pissed off, sad, and hurting, and I greeted her with, “My least favorite person of the day.”  She said that wasn’t a very nice thing to say to the person who would be delivering my baby.  I couldn’t help thinking that Holly, Jeanine, and I were the ones doing all the work, not her!  She had only ever come in the room to bully me to doing what she wanted.  My doctor handed me the consent form and I listened to doctor Bell complain about my ‘foul’ language and repeat nearly everything she had said the first time.  She was twice as rude this time and really pissing me off.  She kept saying “This is not a battle of wills.” which was very telling in my opinion.  My concern was not my will, it was my baby, and clearly she could not say the same.  As she was talking a contraction hit and I closed my eyes to breathe through it.  While I was doing that she said, “Why don’t we just get her the discharge papers and get her out of here.”  I nearly started screaming at her, then.  She was going on and on and never considered that maybe I had other things on my mind right that moment.  I finally snapped at her, “I was having a contraction, is that fucking alright with you?”  I told her if she was worried I’d sue her for not telling me I had other ‘options’ that she could rest assured I’d be more likely to sue her if she caused my baby harm with her unnecessary intervention.  I signed the consent form and told them I wanted out of that bed right then.

Jeanine asked if I wanted to try laboring on my side but I didn’t think I could do it, I just wanted to get up.  I got on my knees on the floor with a pillow under them and leaned on the end of the bed.  Every time a contraction hit I went vertical and gripped the bed frame.  It was around then my legs started to feel wobbly so between contractions I was sitting back on my heels.  Obviously that made my lower legs go numb.  With each contraction I felt the urge to bear down again.  Jeanine said to do small, short pushes to ease the pressure.  It was amazing how much that helped.  They sat on the floor with me giving quiet encouragement while I labored.  My doctor came in to insert the IUPC which meant I had to get back in the bed.  I really didn’t think I could do it.  As soon as I got in a contraction hit and it was horrible.  I suddenly went from sweat pouring down my face to a full body tremble.  She asked if I wanted her to wait but I said no, just get it over with as fast as possible.  Just as she was inserting it another contraction hit.  I don’t know if it was the IUPC or the contraction that caused all the pain but it was the worst I’d felt.  I wanted up ASAP and got on my knees with my arms hanging over the back of the bed.  For some reason the IUPC was not registering the contractions as strong as they were – Jeanine said she felt a moderate one and it was only showing up as a mild one.  I had to lay back down so they could try to fix it and very carefully got back on my knees after.

They needed to watch it while Jeanine held her hand on my uterus to see if it was working properly.  It became clear that it still wasn’t so they paged someone to help.  While we were waiting I continued laboring.  The contractions were hitting me back to back and making me groan a little bit on the exhales.  I began feeling incredibly nauseous and I was going from full body trembling to sweat pouring down my face.  I took off my second shirt, Holly brought me a cold wash cloth and John put it on my face and my neck.  It was about that time I was thinking no way could I handle pitocin contractions if they were going to be worse than the ones I was having.  I remembered what my cousin Suzanne said about transition being the hardest part and on a whim I asked Jeanine if she could check me.  She asked if I could get on my back but I told her I didn’t think I could do it.  She said she could try to do it right where I was first.  I was so grateful to her for that.  She knew being on my back hurt and tried her best to help me be as comfortable as possible.  When she checked me she told Holly she needed to get my doctor to check also because she thought I was about an 8 and fully effaced.  “You may not need that pitocin after all!” she said.  I had not felt such relief since the whole ordeal began.

My doctor came in and she told her she couldn’t feel both sides at the same time, so my doctor checked me herself.  She confirmed that I was a little over 8cm and -3.  She told them to cancel the pitocin and get the room ready for delivery.  After she left I asked Holly if the IUPC could come out since it wasn’t working – she gladly took it out and let me get out of bed.  I was going back to the birthing ball on the floor because it had been so much more comfortable, but as I got up a big contraction hit and suddenly I peed a huge puddle on the floor.  I felt so bad but they told me not to worry about it.  I felt like I still had to go and was nearly to the toilet when another contraction hit.  I squatted against the waist height cabinet that was next to the bath tub and had the strongest urge to bear down.  Again I peed (I think) and didn’t bother getting on the toilet.  I was nearly back to the bed when John asked if I wanted the ball but I knew I didn’t have time to wait.  Another contraction came and I had to get on my knees again.  Holly and Jeanine were so nice, they both got on the floor with me so one of them could hold the heart rate monitor on.  It was a struggle and they both had to try it a few times but they didn’t ask me to move or change positions at all, they just went with what I was doing.  When they finally got it strapped around me they left me to labor in peace, encouraging me to keep breathing like I was.  Someone was text messaging John’s phone over and over and I got really angry.  I told him to turn it off because I needed him right then and this was more important than them.

At one point Jeanine asked me if I felt like I needed to push and I said I couldn’t stop myself.  She asked me if I would get on my knees in the bed so I would be there when I needed to turn over.  I agreed and resumed laboring over the back of the bed.  I could hear the woman in the next room screaming at the top of her lungs the whole time I was positioned on my knees.  John joked that she sounded like a tea kettle which gave us all a laugh.  Someone came in with a cart of supplies to prepare the room for delivery.  Soon after my doctor came in the room and sat, and the three of them quietly gave me encouragement.  I remember my doctor checking me during a contraction so that she could see how I was doing and she said I was at 9cm, -1 station with one cervical lip left.  I was relieved and at the same time overwhelmed – all of that work and my baby wasn’t close to being out yet!  I looked to John and half asked, half told him I could do it and they all said of course I could.  I wasn’t sure what I was supposed to be doing until Holly told me to curl myself around the baby when the contractions came and continue short, gentle pushes.  I was having a lot of trouble doing that the way I was leaning.  Someone asked if I wanted to try it on my back and I figured why not, I could give it a try and see if it was any better.  Much to my surprise it was.  I looked at the clock about then and saw that it was 4pm.

I’m not sure how much longer transition lasted, but I remember noting when the contractions changed.  They became easier and more spaced apart.  Jeanine was telling me to do what my body told me to, and my body was telling me to push.  Holly told me to try pulling my legs toward my body while I pushed; I tried but I kept pushing my legs away instead, so Holly held one for me while John held the other.  It was really a struggle remembering not to push with my legs, I kept starting out pushing and then remembering not to part way through the contraction.  My doctor checked me during a contraction and said that I was 10cm still with one lip in the way.  She pressed on the back of my cervix and told me to concentrate my pushing there.  I can’t remember how many tries it took me but I finally started pushing in the right area.  The first time I did they all got so excited I thought something must be happening.  I was kind of let down to find out they were just encouraging me over that.  I think around this time I remember feeling incredibly annoyed at the heart rate monitor as it was just irritating me.

I never looked at the clock so I have no idea how long I was doing the real pushes.  I just kept pushing, thankful for the breaks between contractions then.  Holly kept gently reminding me to take three deep breaths and push as I let the third one out, then push twice more.  A few times I just couldn’t bring myself to the third push but I surprised myself being able to manage some of them at all.  At one point my doctor said she would check me during the next contraction.  I despaired over that.  “What if it is more bad news?” I asked.  “At this point it is not going to be bad news.” she reassured me.  Sure enough, she said she could feel a head.  That was a huge relief for me.  There was finally a marker of progress.  Doctor Bell came in and stood toward the back of the room while another nurse, Amanda, waited to help if anyone needed her.

I was trembling off and on, so much worse than before, and starting to feel dizzy and very worn down.  I told them I didn’t think I could do it but they kept telling me I could, that they hadn’t seen any woman do as well as me in weeks.  At long last they really started getting excited – they said her head was right there and they could see a lot of dark hair when I pushed.  I told John to get the camera ready.  I don’t think he was expecting that!  “You want pictures of her all nasty?” he asked.  For some reason right then everyone except Holly had turned away to do something and a contraction was coming.  I kept saying, “I really need someone right now!” and Jeanine came back.  That was when I started to feel the most incredible pressure.  The more I pushed the worse it was, and I was trying to push harder and longer to make it go away.  Jeanine reminded me to take it easy, that the pressure wasn’t going away and I needed to push three times and take a break to let the skin stretch around her.

I think it was about 10 pushes total to get her head out.  Breña was born at 5:48pm.  I heard my doctor say the cord was wrapped one time and I had to stop so that they could unwrap it.  After that it was just one push to get the rest of her out and she was given right to me.  She actually had a lot of vernix and was only making very small sounds but she had a good pinkish color.  They toweled her off on me and she finally let out some cries.  Everything after that is kind of a blur.  I was entirely wrapped up in holding her, looking at her, and talking to her.  Jeanine took the very first picture of the three of us together.  I know that my doctor milked some cord blood into her and clamped it so John could cut it, and took the rest for donation, just like I had hoped she’d be able to.  I remember feeling a big gush which was my placenta delivering on its own within minutes.  After that they numbed me and gave me a few stitches – I recall someone saying I had a grade 2 tear that looked mostly superficial.

The IV system ended up malfunctioning so the medicine to stop my bleeding didn’t get administered until about 20 minutes later.  We got one brief latch in before that, and one after her statistics were taken.  I got to hold her for an hour before they weighed and measured her.  She came in at 6lbs 13oz – just two ounces shy of what they estimated her the week before!  She was 18.5 inches long and her head circumference was 13.5 inches.  Her APGAR scores were 8 and 9.

There were also some things I didn’t know until later.  One was that Cristin had reached out to find a doula to support me, and a wonderful woman came from over an hour away.  Unfortunately my phone had been dead and we had accidentally been opted out of the registry, so they wouldn’t let her come back to my room.  Still she stayed in the waiting room for some time I believe.  I am so touched by both of their amazing kindness.  There were supporters of Improving Birth rooting us on from all over the world.  Also, I didn’t know that Holly’s shift had ended hours before Breña was born.  Before she finally left she told us that she was really hoping we would have a good outcome because she was determined not to leave us until it was all over.  She moved me so much.  I count myself so luck to have encountered so many amazing people during that very long week!

Photos © Ashlee Cadwell Photography


~ by Ashlee on July 14, 2013.

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