Let’s Talk about Transfer

You’ve done your research.  You decided you want a homebirth.  You interviewed midwives and feel like you found a good fit. Now you’ve been taking good care of yourself and your baby for these last few months. Your plan is in place.  But what it things don’t go as planned?  What if you have to transport?

A lot of us don’t want to think about transport or the need for more medical intervention and assistance when we are planning our natural and physiologic birth, but it’s an important topic and every midwife and every family should discuss the possibility of transport to a hospital during labor.

But….

 

The chances are really good that you will have the homebirth of your dreams. Sarah and Erin started going to births together in May of 2013 and today is the last day May of 2018. Our transport rate during labor over this time period is 8%.  That’s right, the overwhelming majority of families planning a homebirth WILL have a homebirth.

We Talk about Transfer During the Prenatal Period

We usually first talk about transport during the interview or consultation visit.  Even before you have decided to work with us, we think it’s important that transport and emergencies that may be managed at home are topics that are out in the open.  Birth is unpredictable. Sometimes it’s smooth.  One of my midwife friend calls those butter births.  Sometimes it’s a little rocky, but it’s still safe, possible and desirable to stay home to complete the birthing process. Sometimes it slowly or abruptly becomes clear that the hospital is the right place to be.

We welcome questions about transport at any time during the course of prenatal care. We usually have an extended discussion about transport at one of the 3rd trimester visits. Late in pregnancy is the usual time that the birth begins to occupy more space in a women’s mind and spirit. It’s time to reckon with the big task of giving birth.

Which hospital?

One of the things we talk about is which hospital would we transfer to if needed.  We usually determine which is the closest hospital and what is the preferred hospital.  In the case of a true emergency, we would go to the closest hospital under almost all circumstances. In the case of a non-emergent transport, where travel time is not the most important factor, we can take lots of things into consideration including if a hospital is in or out of network with your insurance, what the facilities are like, your experiences with a certain hospital or what have you heard from your friends.  We can also share our experiences as midwives at a given hospital, what kind of treatment do clients and midwives get at a certain hospital.  If you live in the cities of Minneapolis and St. Paul, there are many excellent choices.  When transferring to a metro hospital, it’s pretty likely that your receiving providers have had experience with a homebirth transport.  They know that neither the family nor the homebirth midwives are a bunch of crazy people! Sometimes in tiny rural or exurban hospitals, staff may not have met a homebirth midwife before or had a homebirth transport in recent memory.  We do everything we can to make those experiences smooth and collegial. Sometimes, however, rural and exurban clients may choose to drive further for a non-emergent transport to a hospital that is more familiar and receptive to homebirth transfers.

Midwife to Midwife Transfer

Back when we were training taking a mom into the hospital during labor meant you got provider potluck.  Now, however, thanks to the hard work of some of our Minnesota midwives, there are formal processes in place for transferring care from a homebirth midwifery practice to a some CNM midwifery practices that deliver in hospitals.  This is a wonderful development for the birthing community!  Hospital based CNM care can utilize more technological tools at birth, while maintaining the  midwifery model of care, which respects women’s choices and autonomy and values physiologic birth.  Whenever possible Geneabirth midwives try to help our clients transfer to a midwifery practice when a hospital transfer is necessary or desirable

What does transport usually look like?

long labor transport

Hands down the most common scenario for a  homebirth to hospital transfer in labor is first time mom experiencing a long, long labor with little to no progress and exhaustion and discouragement.  In fact, looking over our stats from the last 5 years, I would place about 70% of our transports into that category.  Homebirth mamas are some tough women and homebirth midwives are known for their patience with the birthing process!  By the time we get to transfer we have done ALL THE THINGS.  This mama may be 24, 36, 48, 72(!!!) hours into this process.  She’s been in the birthtub, she’s lunged, and walked the stairs, she’s rested and tried to sleep between contractions, she drank the labor aide and ate the eggs, she’s had lots of loving support from her partner, midwives, doula and mom. The chiropractor or the cranial sacral therapist has come to do a home consult. All the spinning babies tricks have been used.  Maybe herbs have been used or homeopathic remedies or essential oils. These women are so brave!  At some point though maybe contractions have started to space out, they aren’t long enough, strong enough or close enough to effect change and make this birth happen. Or maybe the mom just can’t keep any food or drink down, which contributes to a vicious cycle where the body is not nourished and hydrated enough to keep a good, strong active labor pattern going. Or maybe a woman just feels done.before transfer

 

This is not a unilateral decision made by Sarah and Erin. We don’t decide that a woman has run out of time.  As long as baby has good heart tones and mama has healthy vitals and there are no other concerning symptoms we can stay home and keep trying. Slow can be normal. But sometimes over a period of hours and usually with lots of conversation and trying or re-trying a few more things, a woman and her partner decide it’s time to go in.  It’s not a rush. It’s not an emergency. The mom gets into the clothes she wants to wear and with help packs a bag.  A midwife calls the hospital and let’s them know that we want to come in, make sure there’s room for the birthing woman, appraise them of the details of the labor so far.  We fax over the records.  We listen to the baby one last time.  We get in our own cars and drivel to the hospital.  Typically, one of the midwives stays behind to clean up your home and even take down the birth tub.  She will join us later.

When we arrive at the hospital, a midwife will talk to your nurse and receiving midwife or doctor. We’ll help explain the situation and share any relevant information about your health, pregnancy or labor thus far.  After which, our primary role is as support person. The hospital staff will be providing your care, but a midwife stays by your side, with hands-on physical support and suggestions, emotional support and encouragement helping you formulate questions or advocate for your self and your baby.

Interventions as help

People planning homebirths are trying to avoid interventions.  Physiologic birth means letting your body do what it’s meant to do and letting the process unfold.  In the case of transfer to the hospital during labor, we are going in for interventions. All the low-tech things like hydration, calories, position changes, fetal positioning techniques and natural therapies have already been tried and they just haven’t been enough. Medical interventions, whether it’s an IV, Pitocin augmentation, pain relief in the form of nitric oxide, other medications or an epidural can be viewed not as things to necessarily be avoided but as tools and as a way to help the baby be born. The majority of transports for a long labor result in a vaginal birth, it’s just that sometimes a mom needs some rest or some stronger contractions to make it possible for her to birth her baby.

C-sections and other operative deliveries

Over the past five years we have only had two transports in labor that have resulted in a cesarean section.  Going to the hospital does not mean a surgical birth is inevitable! As mentioned above those interventions that can be helpful in the case of a long labor, can actually help you have a vaginal birth.  We have also had one client have a forceps delivery and one client have a birth assisted by vacuum.

What about Urgent or Emergency Transports?

Not all transports are for long labors and maternal exhaustion. Sometimes the midwives have real concerns about the health of mom or baby or rarely, it’s a legit emergency.  The most common urgent reasons we have transported are related to fetal heart tones. We transported 1x for tachycardia (rapid heartbeat) which, along with other symptoms was a result of a maternal uterine infection. We transported 1x for a highly unusual fetal heart rate patterns with incredible highs and lows. In that scenario it turned out there was an occult cord prolapse, meaning the cord was coming down with the head of the baby and getting pinched.  It is times like that every midwife, no matter how naturally minded, is grateful for life saving technologically sophisticated medical care. In another case, we transported for decelerations of the fetal heart tones occurring regularly fairly early in the birthing process. In one case, we transported by ambulance for suspected abruption.  In other words, the placenta was shearing away from the wall during labor, rather than after the birth of the baby.  Excessive amounts of bleeding was present well before birth was imminent. That third time mom birthed her baby vaginally in the hospital! We are just one small practice. For a comprehensive list of reasons that a family might transfer from home to hospital during labor, consult the Minnesota Midwives Guild Standards of Care, appendix E.  In more urgent transport scenarios,  we try to keep things calm and smooth, but there is less time for talking and planning.  Your midwives are moving swiftly and may need the birthing family and their support team to move swiftly as well.

Postpartum care

In the event of transports we continue doing midwifery style postpartum care. We’ll see you five times (or more if needed) during your six week postpartum period and we are available by phone or text to help with nursing, making sure your baby is gaining well, assessing jaundice, cord and belly button care, looking after your emotional and psychological well-being, diet, bleeding, healing, anything you are concerned about.  We are always available to process the birth with you.  Women’s reactions and feelings about homebirth to hospital transfer are really varied.  Many people have a mix of emotions which may be positive like relief and overall satisfaction, but sometimes people feel disappointment or grief.  The door is always open to discuss your birth at any point during the postpartum or beyond.

How much should you plan for a transfer prenatally?

packing a hospital bag

Considering how unlikely that you will have transfer, you don’t have to give a ton of mental and emotional space and energy to the possibility transfer.  But DO have the conversation about hospitals, transfer scenarios and reasons with us or your midwives during your prenatal period.  It’s important!  For first-time families at least some reading or education about hospital birth is helpful.  You can get this from the internet or a good book. If you are taking comprehensive childbirth ed like Bradley Method or Hypnobabies, they will cover this in class. The Childbirth Collective has a free parent topic night called Medications and Interventions that is part of their regular rotation of meeting topics. (Also a great place to meet a doula!)

Should you write a hospital birth plan?  Most homebirth families don’t write a birth plan.  There’s so much time at appointments and you get to know your midwives so well that by the time the birth comes around we know all about your dreams, wishes, fears, who will be at your birth, what you are doing with your placenta and all the other big and small details.  Some families, especially families birthing for the first time or for the first time at home will write a hospital birth plan.  Remember if we are going to the hospital in labor it’s because we need help.  It is counter productive to write a birth plan for the hospital that says no IV, no Pitocin, etc.  We need what they have to offer.   It may really helpful in making your wishes about you newborn know to the staff.  Do you plan to decline eye ointment or vitamin K or the hepatitis B vaccine?  Are you planning to breastfeed or room-in or bathe the baby yourself for the first time? Your hospital plan should communicate those things.

 

 

 

7 Things You Can Do with Your Placenta…Instead of tossing it.

plplacenta

Our appprentice, Hayley, is also a placenta specialist. She encapsulates, makes tinctures and cord keepsakes for many of our families and her private clients.  She has written this great article about all the things you can do with your placenta. When Sarah and I were having babies, most homebirth families buried the placenta and planted a tree or some other plant on the site. This is a lovely and meaningful choice. In the last few years we’ve seen an explosion of interest in placenta medicine.  So many choice! What do you want to do with this amazing organ that nourished your baby months?

by Hayley Duke; Placenta Specialist, Doula, Apprentice Midwife

Most people see the placenta as that thing that comes out after the baby is born, the afterbirth. In the hospital they take it away, but what do they do with it? Usually, the placenta is sent to pathology for analysis per policies. After they analyze it, it is thrown into a bucket with formaldehyde and tossed into the biohazard waste. After your baby is born, the placenta likely won’t be on the forefront of your mind but try not to forget about this beautiful organ that transferred oxygenated blood and nutrition to your baby throughout the course of your pregnancy. Here is a list of 7 things you can do with your placenta instead of tossing.

1. Encapsulate It.

The most popular form of encapsulating is based on Traditional Chinese Medicine (TCM). The first recording of using placenta in the form of medicine was by a pharmacist in China in 1578. It was started to be used in 1980 in America by a midwife who studied TCM. Encapsulation works by dehydrating the placenta and then grinding it up into a powder. The powder is then placed into vegetarian capsules. Your placenta is filled with wonderful things like: iron, vitamins B6 (aids in the making of antibodies), vitamin E (heals damaged skin cells), corticotropin-releasing hormone (reduces stress levels), oxytocin (known as the feel good hormone-essential for successful breastfeeding), and more!

2. Turn it Into a Tincture.

Turning your placenta into a tincture is just another great way to ingest the nutritional benefits. A tincture only takes a small piece of placenta so if you’d like to, you are still able to encapsulate it as well- in fact, a lot of Placenta Specialists will even offer you a discount for doing both. To make a tincture, the small piece of placenta steeps in 100 proof alcohol inside a dark colored glass bottle for at least 6 weeks. After 6 weeks you are able to take the tincture on as ‘as needed’ basis. The average recommended dosage is 7-10 drops held under the tongue for 60 seconds or more drops if going to be diluted in juice. This dose can be taken a few times per day but as always, listen to your body. The tincture has been useful for many women from PMS to menopause and can even be used for the teething infant. A tincture is a great choice if encapsulation isn’t an option for you, it is simple to do at home and the shelf life is indefinite.

3. Placenta Art.

Placenta art can be something as simple as a placenta print to something very complex like placenta jewelry. A placenta print takes very little time and supplies, here’s what you do: Get a large piece of paper or canvas, paint or food coloring if you want to encapsulate afterwards, and some cotton swabs. Lay your placenta out on a clean surface, vein side up (this is the fetal side) and pat dry with a paper towel. If you want to be really creative, you can turn the umbilical  cord into a fun shape or letter. Then take your paintbrush or cotton swabs and paint the entire placenta and umbilical cord. You can do a mix of colors or just one – whatever suits you. After everything is painted, take your paper or canvas and place it right on top of the placenta. The color from the placenta will transfer onto the paper. You can do this as many times as you’d like, just make sure to wipe the placenta down with a paper towel between prints. This is a fun project the whole family can get involved with. Have fun! Placenta jewelry is very time consuming and takes a lot of practice, with a quick Etsy search you can find instructions to do it yourself or someone to do it for you.

4. Smoothie.

Yum! Placenta smoothies are a delicious way to enjoy the benefits of your placenta immediately after birth. There are many benefits for consuming raw placenta, including: it promotes faster healing, aids in easing into the hormonal transition, helps to prevent baby blues, decreases postpartum blood loss, replaces iron, vitamin B6, protein, and minerals. This is a quick and easy way to consume your placenta and like the tincture, it only takes a small chunk so you’re still able to use your placenta for something else that interests you. You can use any smoothie recipe but this one is my favorite:

Tropical Raw Placenta Smoothie Recipe

  • 3 inch chunk of placenta
  • ½ Cup frozen or fresh mango
  • ½ Cup frozen or fresh strawberries
  • ¼-¾ Orange juice (depending on consistency preference)
  • 1-2 Tbsp Flax seed (optional)
  • 2-3 Ice cubes

Blend ingredients together until you reach the desired consistency. Serve immediately. Contact a placenta specialist for proper placenta storage instructions to ensure a healthy placenta.

Some people like to have one placenta smoothie right away after the birth and then encapsulate the rest, while others like to have several smoothie. If you would like to save your placenta to make more smoothies, have someone cut the placenta into small 3 inch or so pieces. Place those pieces spaced out on a baking sheet so they’re not touching. Throw the baking sheet into the freezer for a few hours until completely frozen. Once frozen, store pieces in a double bagged freezer zip loc. It is very important to use proper handling- clean utensils, supplies, work space, and wash hands thoroughly.

If this sounds like to much work after you’ve just had a baby, no worries! Placenta specialists are happy to come to your home, hospital, or birth center to prepare a smoothie for you!  

5. Lotus Birth.

The act of lotus birthing is leaving baby, umbilical and placenta attached for days while the umbilical and placenta dry out, naturally and gently detaching from baby. Lotus birth is the biological way to sever the bond. This is encouraged by rubbing salts and herbs into the raw placenta to preserve the tissue. It is a common misconception that you cannot choose both lotus birth and placenta encapsulation. As long as the placenta is taken care of properly and diligently during the lotus birth, the salting preserves the tissue, similar to salting fish or meat, and the placenta can be rinsed, steamed, dehydrated and put into capsules. Another benefit of lotus birth is it truly encourages the mother to take a babymoon. The babymoon is the period after birth in which the mother is lying with her newborn, bonding, nursing and cuddling skin to skin.

6. Bury It.

Burying your placenta in the garden or under your favorite tree is a wonderful way to honor the life sustaining organ. Not only will you always know where it is, the placenta also makes a great fertilizer. Remember to bury it at least 1 foot deep so you won’t have to worry about it being dug up by any curious animals.

7. Donate It.

There are plenty of people and organizations that would love to have your placenta. Call around to your local midwives, doulas and placenta specialists. Sometimes these birth workers are studying the placenta or training their students to know what is normal and what isn’t, therefore they need to see a lot of placentas. Your placenta can also be donated to be used for medical purposes to help other people (yes, placentas are just that awesome!) www.placentadonation.com is a good place to start if you’re interested in learning more about that.

 

Hayley is a doula, placenta encapsulator and apprentice midwife serving the Twin Cities and surrounding areas.. She believes in families and loves discussing anything related to pregnancy, birth, and babies. If you have any  questions or just want to chat, she is available by phone or email.

hayley duke geneabirth apprenticehttp://www.naturesintentbirthservices.com

239-357-6616

hayleyduke@naturesintentbirthservices.com

Introducing Hayley: Geneabirth’s Student Midwife

hayley duke geneabirth apprentice

We first met Hayley when she pregnant and chose us as her midwives. We enjoyed getting to know her and her lovely family. Hayley shared with us her midwifery aspirations very early in our relationship. We were impressed with her initiative and felt that she shared a similar philosophy towards birth, breastfeeding and family life.  We invited Hayley to attend prenatals with us during her pregnancy.  

After the birth of her second baby, she took some time off but has returned to her midwifery apprenticeship and went to her first births with us in January.  We think she’s a wonderful addition to our birth team.  She is caring, sincere, down to earth, intelligent and hard working.  Hayley will be involved in the prenatal and postpartum care and births of some of our geneabirth mamas.  Sarah and I both trained in this community through the traditional apprenticeship model and we find it so satisfying to share the practice of midwifery in this way.  Families who work with Hayley are participating in this unbroken chain of the passage of midwifery skills from woman to woman.  

I asked Hayley if she would answer some questions about herself as a way to introduce her to our community.We hope you enjoy getting to know Hayley as much a we have!

 

hayley duke geneabirth apprentice

 

What draws you to homebirth midwifery?

There are so many things: I have always been interested in neonatal and maternal health, reproduction, feminism, babies and shock value. Homebirth midwifery offers me a chance to enjoy all of that.

Share a little bit about your own births.

Atom was born at home, in Florida at the end of February 2014. We had great support during a long labor that included two doulas. Atom was born in the posterior position (the back of his skull rested on my back) with a nuchal hand (his hand was born at the same time as his head.) I remember being very tired the entire time. I even fell asleep in between contractions and during pushing. I didn’t want to move,eat, or drink. At this point in my life, I wasn’t educated on comfort measures and birth physics, and I definitely wasn’t expecting that kind of intensity. After a relatively short pushing phase, he was born and it was the first most beautiful, magical and transforming experience of my life. He had a very short cord, so he rested on my stomach while our minds traveled back to earth. I wasn’t able to see his face, but I knew he was perfect. I delivered him on our bed, and his father’s hands were the first to greet him. Atom’s birth wasn’t only special for us, his parents, it was also special for my Great Granny too. At 83, his was the first birth she ever witnessed, and she still talks about it often.

Kelvin’s birth was very different from Atom’s. I woke up at 7 am having very strong contractions that were 10 minutes apart. I called Erin, my doula Emily, and my birth photographer to let them know labor was starting. Little did I know just how short it would be. It started out with two contractions 10 minutes apart, then I had two contractions 8 minutes apart, and then two contractions 6 minutes apart. I woke up Granny who was staying with us at the time, and was extra quiet, so I didn’t wake up Atom. While I was pregnant, I did a lot of reading on how to get a posterior baby to turn before in labor. I knew if I kept walking through the house everything would be easier than last time, so that’s what I did. Atom eventually woke up and was a little frightened by the noises I was making, so I started smiling to let him know I was ok. I was standing up in our hallway when Kelvin was born, smiling and roaring my birthsong into my doula’s ear. Granny was holding Atom while my husband caught our second baby boy.

 

Tell us about your birth related work and training so far.

My first introduction to birth work was a 6 week doula training course that taught me how to give give educational, emotional and physical support to women during pregnancy, birth and postpartum. This was a fantastic experience that really focused on the spirituality of birth. I learned so much from that class, and I am so happy to have taken it. However, I knew going into doula work that I eventually wanted to become a midwife. After I completed my doula training, I decided to become a certified placenta specialist. From the time I found out what a placenta was, I have found them very beautiful and fascinating. I enjoy being able to offer placenta encapsulation and other placenta services to the families I work with. In addition to my doula and placenta specialist training, I took a really fun neonatal resuscitation class taught by Karen Strange in 2015.

What are your favorite resources for birthing families?

I think Ina May’s Guide To Childbirth, or any other book by Ina May Gaskin is a great place to start. She also has a website with great articles her favorite resources: http://inamay.com/ Another great website is http://sarahbuckley.com/category/blog. Sarah Buckley is a family physician who studied obstetrics and family planning. Her blog consists of evidence based posts about these topics often. Penny Simkin’s video Comfort Measures During Labor is a nice, slow paced video for couples to watch together. She is a physical therapist that has been specializing in childbirth education and supporting women in labor since the 1960s. In this video, she reviews many comfort measures that are known to be helpful in labor. The video Birth As We Know It is another resource I find myself recommending often. You can find this on the internet or on the bookshelf at Geneabirth.

What is your philosophy of birth?

“Birth is designed to work in case no one but the mother is there.” I remember Karen Strange saying this several times throughout her class last year. My philosophy of birth is that the mother should be able to labor with as little medical intervention as possible. I believe that every family and labor will be different and should not be treated the same. I believe through education, understanding and support mothers will be able to, without shame, use their primal instincts to birth their babies. I believe that families are capable of making decisions for themselves and their babies, and families should be encouraged to be active participants during and after birth.

What parenting issues are you most passionate about?

Evidenced based education. I think it is so important to be educated and prepared. It is so easy to forget that things can be done differently than the way we’ve been taught. Breastfeeding, nutrition, routine infant circumcision, home birth, vaccines, doulas, cry it out, car seat safety, epidurals, surgical birth, placenta encapsulation, ultrasounds, rice cereal, belly binding, hormonal birth control, chiropractic care…I think it is important to educate parents on these topics and when they are educated, they will make the decisions that are right for their families.

If you could give a little bit of advice to all women before giving birth what would it be?

Oh man, the first bit of advice I would give is to take more time for yourself. The moment your baby arrives, your entire life will change. Finish your sewing project now, watch the new Star Wars, take a weekend getaway. It is very easy to forget about making time for yourself when you are so wrapped up caring for the most perfect baby in the world. The next bit of advice is spend more time researching about real, raw birth. The media has done a great job making birth out to be a horrible, painful, traumatizing event. Take the time to detox yourself and your partner from these beliefs. Ina May Gaskin’s Guide to Childbirth is a collection of real birth stories. It is a fun, short read that will boost your confidence and educate you at the same time. Finally,  labor will progress faster if you stand up or walk around (yay gravity!), and smile.

hayley baby feet

Hayley offers placenta encapsulation services.  This is a great resource for our families.  She is available to answer your questions about placenta encapsulation, different methods, benefits, placenta tinctures or smoothies.  If you are looking to hire a placenta specialist to encapsulate or prepare your placenta, consider Hayley.

What to do if Baby Arrives Before the Midwives: Childbirth 101

 

mom and baby immediate postpartum

We spend a lot of time during the last weeks of pregnancy talking about how to recognize the signs of labor and when to call the midwives.  Our goal is to make it to your birth in plenty of time. We want  to set up the equipment and supplies, listen to your baby, check in our your well-being and offer support to you and your family.  Most often labor begins gently, with noticeable early signs.  However, sometimes labor begins with a roar and unfolds remarkably quickly.  Some women birth very quickly with a labor that last just 3 hours from first signs to birth. Sometimes a first birth was difficult and long and a second time mom may experience early and active labor as not very uncomfortable, she thinks she has a long time to go and doesn’t want to bother us and then we get an urgent call from a woman’s partner that the baby is coming quickly! We are speeding towards the family and we will almost certainly get there in time. It’s good for partners and other family members to have a little education about what to do if your baby is coming quickly and your midwives are on the way. Sarah has written  some tips and important points to remember because what will happen at each birth cannot be predicted and it helps to be prepared for all possibilities.

  • Put your midwife on speaker phone so you can talk to each other.
  • Don’t panic!  Everything is going smoothly and that’s why baby is on the way.
  • Grab the towels from your birth supplies and a package of the blue chux pads.  If the birthing woman is out of the tub, place some blue pads under her to protect your floor if you have time.
  • When the baby is emerging, don’t pull on the baby’s head.  JUST RECEIVE.
  • The baby can be brought right to mama’s chest, skin too skin to help the baby stay warm.There are two important things to keep in mind with a newly born baby:  BREATH AND WARMTH
  • Sometimes a baby born quickly is stunned.  Rub your baby, flick the soles of the feet, press firmly on the back, rubbing up and down while talking to your baby.
  • Dry baby off while on mama’s chest. Then replace the wet towel with a dry towel.
  • You do not need to cut the cord, tie the cord or deliver the placenta.
  • Keep the baby warm and close to mom.
  • The midwives are on the way!
  • If at any point during the labor, birth or immediate postpartum you can call 911 for extra assistance if you are concerned about mom and baby’s well-being.