EBB 262 – Advocacy Throughout Delivery and Navigating a Hospital Keep for New child Jaundice with Emily Chandler and Taylor Washburn, EBB Childbirth Class Graduates
Rebecca Dekker:
Hello, everybody. On in the present day’s podcast, we’re going to speak with Emily Chandler and Taylor Washburn about their knowledgeable and empowered hospital start story.
Welcome to the Proof Based mostly Delivery® Podcast. My identify is Rebecca Dekker, and I’m a nurse with my PhD. I’m the founding father of Proof Based mostly Delivery®. Be part of me every week as we work collectively to get evidence-based data into the arms of households and professionals around the globe. As a reminder, this data shouldn’t be medical recommendation. See ebbirth.com/disclaimer for extra particulars.
Hello, everybody, and welcome to in the present day’s episode of the Proof Based mostly Delivery® Podcast. Right this moment, we’re so excited to welcome two graduates of our EBB Childbirth Class. Earlier than we get began, I need to let that there’s a content material be aware on dialogue of prolonged hospital keep resulting from new child jaundice. Is there another detailed content material or set off warnings, we’ll submit them within the description or present notes that go together with this episode. And now I’d wish to introduce our honored company, Emily Chandler and Taylor Washburn. Emily, pronouns, she/her, is a marine scientist, and Taylor, pronouns, he/him, is a trainer and rowing coach within the Boston space.
Whereas pregnant in 2021, Emily dove headfirst into studying about being pregnant, start, and the state of maternity care in america. And collectively, Emily and Taylor took the Proof Based mostly Delivery® Childbirth Class with EBB teacher Chanté Perryman. Collectively, they love climbing, biking, rowing, and making the most of the good outside. And so they’re additionally very busy taking good care of their child who’s now virtually 16 months outdated. Emily and Taylor are right here to share their start story about being knowledgeable and empowered, and also will speak somewhat bit about new child jaundice. Emily and Taylor, welcome to the Proof Based mostly Delivery® Podcast.
Emily Chandler:
Thanks a lot. We’re excited to be right here with you.
Taylor Washburn:
Yeah, thanks very a lot.
Rebecca Dekker:
So are you able to inform me somewhat bit… You stated you dove into studying about childbirth care whenever you have been pregnant. How did you discover out about Proof Based mostly Delivery® and the Childbirth Class?
Emily Chandler:
I came upon about it from our doula, so I made a decision fairly early on, and I don’t bear in mind precisely why, that we actually wished to work with a doula. I do know all of the the explanation why, in hindsight, that was factor, however I don’t assume I knew them on the time. And as soon as we settled on a doula, I requested her for data or any assets that might assist us study extra about being pregnant and COVID. In order that was proper as vaccinations have been popping out, and she or he directed me to one among your analysis updates, which was massively useful. After which opened the door into this complete world of data that I used to be desperately craving, and I rapidly grew to become a binged podcast listener, after which determined that it will be nice for us to take the course collectively. In order that’s how we discovered it.
Rebecca Dekker:
That’s superior. And what was your expertise like taking the category with Chanté? Was it a non-public class or a bunch class?
Emily Chandler:
It was a bunch class. I believe there have been three or 4 different households, and it was nice to listen to of their views, and be capable to ask questions but additionally hear their questions.
Rebecca Dekker:
Oh, okay.
Taylor Washburn:
Yeah, I believe each of us listened to a variety of podcasts throughout our being pregnant. So a variety of the knowledge was identified to us, however having a group and having the ability to ask questions, and see that different individuals are going by way of the identical factor that we’re, and having the identical sort of considerations, and questions, and doubts. And I believe creating that group, particularly throughout COVID when the whole lot was distant, was actually useful for each of us.
Rebecca Dekker:
And also you discovered quite a bit from listening to the podcast. What have been some stuff you bear in mind from the category itself, from the movies, or out of your dialogue that actually caught out at you?
Taylor Washburn:
I believe for me, it was simply the extent of preparation and excited about our position in advocating for ourselves through the course of on the hospital. I wouldn’t have been ready for that having not gone by way of that class. And I believe taking that class and considering by way of totally different situations, and having conversations, Emily and I collectively, about what we wished the expertise to be ready us to step in and say what we would have liked or what we wished. However I believe that was actually necessary.
Emily Chandler:
Yeah, I believe popping out of the start class, we made a very detailed start plan, which tends to be the course I air. And that was actually useful, largely as an train for us to verify we talked by way of each attainable state of affairs or a lot of them, and the way we wished to deal with totally different interventions in the event that they got here up, and issues like that.
Taylor Washburn:
And I suppose I’d solely add is, for me as a partner, I believe it made me really feel like I truly performed a very large position in what was going to occur as a substitute of being extra of a bystander. And I believe that was actually empowering for me and made me really feel useful.
Rebecca Dekker:
So it sounds such as you each felt actually knowledgeable, after which Taylor, you additionally felt like an lively participant within the course of, and also you additionally discovered some advocacy strategies, and then you definately had detailed understanding of like, “If this occurs, then we wish this, if this occurs, then we wish this.”
Emily Chandler:
Yeah. And the one different factor that was simply enjoyable that I might add it’s, I’d signed up for his or her course, I discovered one which labored with our schedule. It occurred to be with Chanté, and I believe it was the subsequent day I used to be driving to work, and I used to be listening to the podcast that JaMichael Perryman did with you. And I put it collectively that I knew that identify, I believe since you have been speaking about Chanté, and I set to work and texted it to Taylor, and was like, “You need to hearken to this. You’re going to adore it.” And so getting to talk with him in addition to a part of the course was actually nice for each of us, I believe.
Rebecca Dekker:
Yeah, he got here on in episode 145 speaking about fatherhood and advocacy, and start, and I do know Chanté typically brings him into her childbirth courses to share his perspective and reply questions as a accomplice, and that’s actually enjoyable. I wager you have been like, “Oh my gosh, we’re within the class with this teacher and we’re going to satisfy this man.”
Emily Chandler:
Yeah, just about.
Rebecca Dekker:
So what did you study from JaMichael? What do you bear in mind about his speak with you all?
Taylor Washburn:
I imply I wasn’t considering in any respect about catching our child. He introduced that up and stated, “I’m simply going to let you know my expertise.” And that had me like, “There’s no going again.” I used to be so excited to be concerned in that method. So he framed it in a very highly effective method that made me enthusiastic about what my position was going to be.
Rebecca Dekker:
That’s superior. So that you have been considering you wished to catch the newborn after listening to JaMichael?
Taylor Washburn:
Proper. It wasn’t one thing that ever crossed my thoughts beforehand. However afterwards, I used to be lifeless set-on like, that is one thing that I need to occur.
Rebecca Dekker:
So in direction of the top of your being pregnant, how are issues going? What have been your plans for the start?
Emily Chandler:
I might say, total, we had a fairly uneventful being pregnant. There have been, in fact, little issues that got here up right here and there that we labored by way of, however I used to be feeling fairly good. It was mid-summer, or I suppose it was early August, and I used to be actually heat. I bear in mind being bored with being pregnant and scorching. And at about 38 and a half weeks, I knew, based mostly on ultrasounds but additionally having the ability to contact my stomach, that our child was proper occiput transverse. And I knew sufficient to know that that was not precisely the place I wished her to be. We didn’t know if it was a boy or woman, so I used to be nervous about that doing yoga, spinning infants. After which one evening, we have been preparing for mattress and my water broke, and I didn’t have another indicators of labor that I used to be conscious of, then we referred to as our doula and checked in. And-
Rebecca Dekker:
And the way far alongside have been you, 38 and a half weeks or have been you-
Emily Chandler:
Yeah.
Rebecca Dekker:
Mm-hmm.
Emily Chandler:
Nearly 38 and a half. I had been mentally making ready myself to have a late child, was very stunned when that didn’t occur.
Taylor Washburn:
In reality, the evening that her water broke, she had stated, “Taylor, are you able to please simply go pack your hospital bag? We’re getting shut.” So I used to be packing my bag when hastily her water broke. And-
Rebecca Dekker:
Oh my gosh. Discuss instinct, intuition.
Emily Chandler:
Yeah, the opposite factor earlier than I launched too far right into a start story is I used to be fairly dedicated to the concept of getting a start with as minimal interventions as attainable. Based mostly on the whole lot I had discovered, I believe I used to be wishing I didn’t should go to the hospital and do it, however wasn’t ready to alter plans at that time. However I used to be definitely… I didn’t need any pointless interventions. And I could be a very strong-willed and cussed individual, and I couldn’t really feel myself digging into that, and getting nervous and anxious about it, truthfully, because it bought nearer and nearer. I felt assured in my information however was nervous concerning the issues that I used to be going to have a tough time controlling, and was tremendous grateful to have a accomplice who I knew virtually as a lot as I did, and knew how strongly I felt about it. In order that was actually cool.
Rebecca Dekker:
So, take us to the subsequent step. So your water broke, you referred to as your doula otherwise you reached out to your doula, what subsequent?
Emily Chandler:
In order that was about 10:00 PM and she or he stated, “Okay. Effectively, this might take a short time, however issues are most likely going to select up, so why don’t you attempt to get some relaxation and we’ll simply test in as we have to as issues begin occurring.” I bear in mind waking up a pair occasions through the evening and considering nothing’s actually occurring. And that was fantastic. I used to be okay with that. I believe we bought up fairly early, went for a stroll with our canine. I perhaps felt some actually faint contractions, however having by no means had any, and I hadn’t seen any Braxton Hicks contractions both. I actually didn’t know what I used to be speculated to be feeling, however I actually was not feeling very a lot. So all through that day, I simply took it simple at dwelling. I did some spinning infants workout routines and yoga, and somewhat little bit of curb strolling, simply making an attempt to do something to assist this child transfer somewhat bit, simply understanding that she wasn’t able that was going to essentially kick issues into gear rapidly.
And we have been texting and speaking with the doula all through the day. We have been nicely conscious of the truth that a supplier would need us to come back to the hospital with my water having damaged. We each learn the EBB article on untimely rupture membranes, and that was actually useful and reassuring. I knew that I used to be unfavourable for group B strep. I used to be checking my temperature. Every thing was actually regular. So for probably the most half, we have been very pleased to be at dwelling. And because the day went on, I believe we began to say, “Okay, we’d love to verify the whole lot actually is okay. We predict it’s, however we don’t have the instruments.”
Taylor Washburn:
Yeah, developing on 24 hours since her water broke, it was dinnertime. And I believe at that time, we have been each somewhat bit nervous simply because it had been so lengthy and Emily wasn’t noticing any adjustments. And in order that simply had us doubting somewhat bit, and questioning if there was one thing happening that we clearly weren’t skilled to determine. So at dinner, I referred to as the hospital simply to allow them to know that Emily’s water had damaged. After they came upon her water had broke 24 hours earlier, they stated, “Oh, that is actually uncommon, atypical, you really want to come back into the hospital.” I believe at that time, we felt okay about that. We didn’t rush in. We completed dinner and bought packed, and made positive that we had the whole lot we would have liked. And so we bought into the hospital between 10:00 and 11:00. So, nearly 24 hours after Emily’s water broke.
Rebecca Dekker:
So that they have been making you’re feeling somewhat guilt-trippy like, “Okay,” regardless that you knew the proof 24 hours shouldn’t be a very large deal so long as you have been wholesome.
Emily Chandler:
And it’s exhausting to say in the event that they have been making us really feel responsible or we’re not actual good rule breakers. So, we didn’t think-
Rebecca Dekker:
Yeah, you have been feeling that strain internally, most likely.
Emily Chandler:
Yeah. We knew what the proof was. The article was tremendous useful, and gave me a variety of confidence. And on the identical time, we aren’t medical professionals and knew that another person might test on issues that we couldn’t test on.
Rebecca Dekker:
And I believe it’s exhausting as a result of quite a bit… The randomized trials and the research on which can be in conditions the place they’re extra supportive of ready. And they also’ll typically have you ever are available, get checked out, go dwelling, that sort of factor, whereas you’re similar to, “Effectively, let’s simply wait.” As a result of when you get there, they most likely aren’t going to allow you to go dwelling. So-
Emily Chandler:
Yeah. And so we chatted with our doula earlier than we went in, which was nice. She gave us a pep speak on interventions and inductions, and what we should always anticipate proper after we bought there, which regardless that I knew all of it, that was useful, and I used to be nonetheless actually nervous about it, and beginning to not assume essentially as clearly as I had at different occasions. And so we bought to the hospital and went to triage, and I ought to say on the trip to the hospital, I began to note some extra contractions. Once more, actually not painful, not common. So, yeah. I used to be-
Rebecca Dekker:
Possibly simply the beginning of one thing although?
Emily Chandler:
Yeah. And I believe I’d felt {that a} couple occasions through the day, however by no means sufficient that I might persuade myself that it was selecting up or that there was a sample.
Taylor Washburn:
And I believe any time you stood up, it will go away. There was a-
Emily Chandler:
I believe it was the opposite method round.
Taylor Washburn:
That any time you sat down, it went away.
Emily Chandler:
After I sat down, they’d go away. But when I used to be standing up or strolling later within the night, I used to be like, “Okay, perhaps that’s one thing.” However I knew the very first thing they have been going to do on the hospital was one to twenty minutes of monitoring, and I must sit down they usually wouldn’t see something. So I used to be nervous about all of that, however that’s what occurred. And I used to be stunned after they stated, “Oh, no. We see some contractions occurring.” In order that was nice. I wasn’t psyched about getting cervical checks, however at that time, I additionally wished some data. So I used to be snug with that. And so they stated that I used to be one centimeter and 60% to 70% effaced. The second half was somewhat little bit of a shock, however I didn’t anticipate that I might be very dilated given how issues had been feeling. In order that was what it was. And the on-call physician got here in who Taylor had spoken with on the cellphone, and principally stated, “Okay, we’re going to begin Pitocin.
Taylor Washburn:
The one factor on Emily’s checklist which was a fully like, “I’m not doing Pitocin.”
Emily Chandler:
Yeah. I knew that if we have been going to have an induction, my choice would’ve been for some kind of mechanical like a Foley bulb or one thing like that to assist, they usually wouldn’t do this provided that my water had damaged. I actually didn’t need to be on an IV. I didn’t need steady fetal monitoring. I used to be additionally extra snug standing up. So-
Rebecca Dekker:
Would you say that most likely threw them for a loop somewhat bit?
Emily Chandler:
I suppose so. I completed my 20 minutes in monitoring and I’m standing up within the room, eye-level, with this physician and simply stated, “No, I’m not going to do Pitocin. What are the opposite choices?” And in order that was an uncomfortable interplay, and we by no means truly noticed that physician once more.
Taylor Washburn:
They have been scheduled to go off shift at 11, I believe.
Emily Chandler:
No, she went off shift at 7:00 AM. We had a nurse change immediately. We had a few actually great nurses in triage, after which who went with us into the room. And a type of nurses talked to us about totally different choices. I stated, “What can we do right here? I perceive that we should always most likely do one thing regardless that my contractions have been selecting up.” And she or he recommended we do misoprostol, and I knew what that was. I knew that I needed to do it orally and I couldn’t do it vaginally, as a result of my water had damaged. And she or he stated, “Why don’t we simply do half a dose?” And I used to be like, “Okay, we will do half a dose.”
And that was going to come back with 4 hours of monitoring. I used to be like, “That is going to be an extended course of. I can take care of 4 hours.” By the point we bought checked in in our room, they usually lastly introduced the misoprostol, I believe it was 2:00 AM. It had been a very long time and my contractions have been already selecting up. I used to be getting much less snug. I used to be nonetheless standing, leaning over the mattress. They introduced me a peanut ball or a start ball, however it was so small that for me to take a seat on it was actually uncomfortable, given the place that the newborn was in.
It rapidly grew to become clear that I used to be going to have a variety of again labor, so the whole lot I felt was in my low again. So that they introduced the misoprostol, they hooked me as much as the monitoring straps and issues picked up fairly rapidly from there. I’ll say we requested if we might have a room with a bath or wi-fi monitoring, they usually have been so busy that they didn’t have any of that obtainable, which was… They did have it on the hospital, however that was irritating. However-
Rebecca Dekker:
There’s nothing you could possibly do at that time.
Emily Chandler:
Yeah, nothing we argued about. So I might say, at that time, I bought fairly into the zone, however was additionally nonetheless anticipating this to take a very long time. And so I stated, “All proper, I’ll attempt to get some relaxation.” I stated, “Taylor, you have to lie down and get some relaxation. We’re going to be right here for some time.” After which I began throwing up somewhat bit, and I additionally was getting very shaky. And I knew that that was one thing that was very typical, however I wasn’t actually ready to expertise it. In order that felt simply off-putting, I used to be shivering quite a bit.
After which after I threw up, I began to get nervous about dehydration as a result of I actually didn’t need to be on an IV, and I knew that if I used to be going to throw up, that may be an issue. I did take a dose of Zofran for anti-nausea, and that helped. That was nice. And I believe from then on, for the remainder of the evening, I used to be experiencing these contractions, uncomfortable shifting round somewhat bit, however within the chair or mendacity within the mattress, I used to be not up for standing or strolling. And I used to be falling asleep between the contractions, they went from virtually none to fairly intense and steady. I by no means knew what the spacing was between them. They have been… I might say each couple minutes.
Rebecca Dekker:
So the issues went from nothing to one thing fairly lively fairly rapidly, proper?
Emily Chandler:
Yeah.
Rebecca Dekker:
It sounds such as you have been having the labor shakes, so your hormones have been shifting, and also you have been nauseous, and also you have been uncomfortable, and also you have been undoubtedly… It appears like an lively labor at that time actually rapidly.
Emily Chandler:
However having not carried out it, I used to be like, “I hope that is lively labor.”
Rebecca Dekker:
Yeah, you’re hoping this isn’t the early section.
Emily Chandler:
Yeah. If something was going by way of my thoughts, that’s what I used to be excited about from 2:00 to six:00 AM. I used to be like, “If this isn’t it, I don’t know the way that is going to go.”
Rebecca Dekker:
And Taylor, what about you? What have been you doing all this time, and what have been you considering?
Taylor Washburn:
Who is aware of? I used to be doing the whole lot I might to assist Emily. So issues like counterpressure. And we had a very nice group of nurses that have been serving to us out and giving us some recommendation. So our doula wasn’t there. She got here within the subsequent morning, however we actually felt actually, actually lucky that the workers of nurses we had, that they have been offering assist, however in a method that I could possibly be actually closely concerned, giving me steering quite than doing issues for us. But it surely was actually simply wonderful to be a part of, as a result of as somebody who identifies as an athlete, actually, is like watching Emily undergo this actually unimaginable competitors, this large efficiency the place she was within the zone and dealing so exhausting, and had blocked out the whole lot else within the room. And I don’t assume both of us actually knew how a lot time had handed, how a lot time was passing in between contractions. All I do know is she could be working so exhausting within the second that contraction was over. It was like she went actually inward and was simply probably not conscious of issues round her, and was recuperating for the subsequent effort.
Rebecca Dekker:
Resting intensely.
Taylor Washburn:
Proper.
Emily Chandler:
I used to be falling asleep. It was very unusual.
Rebecca Dekker:
Effectively, what else have been you doing other than counterpressure? What different consolation measures have been serving to? Since you didn’t have an epidural at this level, so what have been you utilizing as a substitute?
Emily Chandler:
I bear in mind I used to be sitting in a chair, rocking backwards and forwards, and that was serving to. And when the contractions picked up, Taylor was urgent down on my shoulders, and that felt actually good. After which I-
Taylor Washburn:
I did a variety of rubbing your again.
Emily Chandler:
Yeah, I used a peanut ball in mattress, a good quantity. And one factor that was happening this complete time is that they have been having a very exhausting time maintaining the monitoring straps able the place they might observe our child’s coronary heart price. And that was so irritating to me, that at one level, a nurse put further straps on, so that they had all these straps wrapped round my stomach. And each time they misplaced the center price, an alarm would go off on the machine within the room, however it wasn’t going off on the nurse’s station. So I needed to name the nurses and say, “May you come flip this off?” In order that, I bear in mind, fairly distinctly not having fun with.
Rebecca Dekker:
The wi-fi monitor most likely would’ve helped quite a bit with the mobility and luxury.
Taylor Washburn:
I imply that’s one thing that Emily, from the second we have been planning and going by way of our start plan, was one thing that she actually felt strongly about.
Emily Chandler:
I actually wished intermittent auscultation, and I used to be going to have to modify suppliers if that was one thing I wished.
Rebecca Dekker:
It’s exhausting as a result of the wi-fi monitor is an efficient in-between choice, however my understanding is that a variety of hospitals don’t have very a lot of them. They don’t need to spend money on it. They get misplaced. They will’t discover them. They’re costly. So it’s an issue, as a result of it is perhaps one thing you’re like, “Oh, I can have this. The hospital says they’ve this, I need this,” and then you definately get there and it’s not there.
Emily Chandler:
Proper. And that was the expertise with the start tub additionally. They wouldn’t have let me get start within the tub. However when it comes to having a bath I might have labored in, I believe that they had two within the hospital, they usually have been actually busy.
Taylor Washburn:
However with the wire arrange, and the truth that it saved disconnecting, I believe that restricted Emily as somebody who likes to be standing and likes to maneuver round quite a bit, and that actually modified, I believe, what she might do.
Emily Chandler:
Yeah, I believe, if nothing else, it was additionally mentally confining, understanding that I couldn’t do a lot about it. I needed to be there tied to those straps, however I additionally wasn’t able to really feel like I might actually push again on that. So I used to be like, “Okay, I’ll trip this out after which at 4 hours we will do away with the straps.”
Rebecca Dekker:
Okay, so that you knew it was a four-hour short-term factor?
Emily Chandler:
Yep, they informed me that with the misoprostol I wanted to do 4 hours of monitoring. And I used to be snug with that, given how lengthy it had been and wanting to verify our child was okay.
Rebecca Dekker:
Yeah. And misoprostol could be a robust medicine, so it’s good to maintain a detailed eye on how your physique is reacting to that and the newborn. So that may clarify, partly, why you have been going so inward. It’s such as you have been making an attempt to deal with all of this and utilizing your psychological coping methods as nicely.
Emily Chandler:
Yeah. And I bear in mind in some unspecified time in the future, most likely 4:00 or 5:00 AM, considering, “Wow, if this isn’t it, if it’s getting an entire lot worse, I don’t know if I can do that.” The large shift change occurred at 7:00 AM after we bought a brand new nurse, and a brand new physician got here on name, and our doula additionally arrived, which was nice. And I don’t actually know what she did immediately, I bear in mind her coming in and she or he began massaging my toes, and that was wonderful. And that isn’t one thing that I might ask for in different circumstances, however it was actually, actually nice. And the nurse, my preliminary impression of her was she was gruff and bustling across the room, and I couldn’t actually inform what she was doing. It was 7:00, so this was now an hour after I had been informed I might get off the monitoring strips, and I used to be nonetheless on them. Taylor had a very totally different first impression of this nurse, which was what we in the end got here to know her as we talked somewhat bit about her.
Taylor Washburn:
No, I imply I used to be simply so impressed. You’re on this hospital room and there’s all these items happening, and she or he got here in, and she or he was simply this beehive of exercise the place I believe taking up for the earlier nurses. The room wasn’t arrange fairly the best way she would have it arrange, so she was each giving plenty of consideration and care to Emily, however on the identical time, getting the room set and prepped for the eventual supply. And she or he was simply in fixed movement, and I used to be simply amazed at how she was juggling all these items. And she or he had a fairly distinctive background.
Emily Chandler:
She’s been a midwife in Africa as a missionary in a earlier chapter of her life. So when EBB talks concerning the golden ticket, I don’t assume we essentially had a full golden ticket, however I’m so grateful that we had this nurse who had plenty of expertise outdoors of hospital settings, and we actually did. She had her arms on me as a lot as Taylor or the doula did. I bear in mind her doing this urgent her fingers into my low again and it appeared to assist, and really feel good on the time. She was actually great, and we have been along with her for the remainder of the morning, which was nice.
Taylor Washburn:
After which she would do one thing that was efficient, after which transfer me into place, and she or he’d go and do one thing else, and it was simply consistently there. She was actually great, and I believe over the course of that morning, bought to know us, and I believe was there to assist the start that we wished to have.
Rebecca Dekker:
That’s wonderful. Did you learn the way far alongside you have been at this level?
Emily Chandler:
So round 9:00… Yeah, 9:00 AM or so. The on-call physician got here in and he wished to do a test to see the place I used to be. He additionally, when he got here into the room, he stated, “Oh, I’ve heard about you,” in reference to how lengthy my water had been damaged. In order that put me on edge. However this physician, I’d by no means met him earlier than, however I knew that he was a supplier that some good buddies of mine noticed. So I felt extra snug understanding that different buddies had expertise with and preferred was there, in order that was useful. However Taylor knew that I didn’t need pointless checks, so principally set the physician out of the room so we might speak about whether or not or not we have been going to provide consent for a test.
Taylor Washburn:
And that was one thing that was emphasised each by our doula and the EBB courses, was that nothing has to occur proper this second until it’s an emergency. You possibly can at all times say, “Hey, can we have now a second to speak about it?” And so I’d, I believe, felt snug. They requested a query saying, “Can we have now a second?” And so when he left the room, Emily was like, “Nope, I’m okay. We want some data. I need to know the place we’re at.”
Emily Chandler:
So he did come and test, after which I used to be at 9 and a half centimeters at that time. I used to be like, “Okay, all proper. I believe I can do it. I bought this far, virtually there.” As endurance athlete, I’m used to pushing myself after which understanding there’s just a bit bit extra that I can push by way of. And I used to be like, “Okay, the majority of the work is completed.” Not that I knew something about what to anticipate with pushing, however I had somewhat bit extra confidence at that time. So, yeah. I believe, most likely had a number of extra common contractions earlier than I used to be able to push. And the pushing section was actually attention-grabbing. I got here out of this zone that I had been in. I used to be tremendous lucid as I knew what might occur, however the pushing was actually unfold out. It was virtually full minutes or a lot of them.
And we have been chatting with this nurse and attending to know her, and we had carried out somewhat bit of labor with a corporation that helps maternal well being in Africa. And in order that’s after we bought speaking along with her about her time over there. And it was so weird to be having this dialog whereas I’m pushing our child out, but additionally actually great. And our doula thought it was the best. It was actually neat. However when it comes to pushing, the nurse was nice, recommending a number of totally different positions. I want that I had stated, “No, I need to stand up and do that standing up,” however I wasn’t having that feeling within the second. It’s one thing I’d hoped to do, however I did somewhat little bit of pushing on my arms and knees, and side-lying. And in the end, we did a good quantity of tug of struggle with a sheet that the nurse set us up with earlier than the pushing.
Truly, that they had stated they wished to watch the newborn’s coronary heart price through the start. And I wasn’t psyched about that, however I believe they stated it was as a result of my water had been damaged for thus lengthy. And I stated, “Okay, fantastic.” And so they stated, “We don’t have the wi-fi monitor, however you are able to do the exterior monitoring,” which I had been doing and never loving, or we might do inner monitoring. And I don’t bear in mind which EBB podcast it was, however I bear in mind you interviewed somebody about their start story they usually had had inner monitoring. And that was in my thoughts, and I believed that’s what I need. It’s not going to be nice, however I don’t need these straps wrapped-
Rebecca Dekker:
In that method, you don’t have the straps belted round your stomach.
Emily Chandler:
Yeah. So I believe we did take a pair minutes to speak about that, after which informed the physician that’s what we wished to do. And I wouldn’t say that was probably the most snug factor on the earth, however it was definitely higher than having the straps.
Rebecca Dekker:
So inform me somewhat bit concerning the pushing section, Taylor. What have been you doing? And I do know you have been fascinated with catching the newborn, so did you need to quick-tell the physician that? How did that dialog go?
Taylor Washburn:
When he first got here on, we had a dialog with him about that, and he stated, “Let me give it some thought,” and left the room, however got here again in and in the end stated, “So long as issues are going okay, so long as there’s not some emergency, I’m very pleased to have you ever participate in that method.” He was actually supportive of it.
Emily Chandler:
And we talked about it with our common OB who was truly on trip that week. So we knew we weren’t going to see her, however she had stated, “Yeah, that’s fantastic,” principally the identical factor. I don’t assume he knew that. He wasn’t conscious that we decided-
Rebecca Dekker:
You could have on-call doctor-
Emily Chandler:
… to ask for instruction.
Rebecca Dekker:
Yeah. Didn’t have a heads-up.
Emily Chandler:
Proper. However he rapidly bought on board with it, which was cool.
Taylor Washburn:
Yeah. After which when it comes to the pushing, I used to be there to assist as finest I might when it got here time. One of many strategies was we had a towel or a sheet that Emily was bearing down on, and so I used to be holding the opposite finish, however it was such a wierd… As a result of as Emily stated, through the contraction, she was going so internally between contractions. However through the pushing section, she was very social and talkative, and chatty, and having these full-blown conversations, and you wouldn’t have thought she was within the midst of delivering a child. So there’d be these intense moments after which she was like, it was simply another day, and she or he was speaking to the folks within the room, and it was very humorous.
Emily Chandler:
The opposite factor, I bear in mind feeling like, “Wow, I really want to learn to push.” Clearly, I’d by no means carried out it earlier than, and it took me a short time to determine methods to do it successfully, which isn’t a shock, however one thing I skilled going by way of it.
Rebecca Dekker:
Yeah, it’s undoubtedly a type of issues that’s exhausting to be like, you’re going to really feel this and also you’re going to do this, as a result of it’s very a lot a sensational factor you need to expertise. So, what occurred subsequent? How lengthy did you push for?
Emily Chandler:
I believe it ended up being about two hours, perhaps somewhat bit extra, however that appears like an agonizing period of time. And time nonetheless was probably not shifting for us, and I wasn’t tremendous uncomfortable, so I didn’t really feel like I used to be operating out of power, and the newborn was fantastic. And so it was nice to not really feel like I used to be being rushed. The physician actually wasn’t within the room in any respect. It was simply the nurse and the doula, and the 2 of us, which was very nice. Proper round when she was born, he got here again in and… I don’t know, put his gloves on and stood there. And-
Taylor Washburn:
I had this second of like, “Whoa, wait a second. You haven’t given me directions. I don’t know what to do. I’m not ready this.”
Emily Chandler:
And it was nice, she got here out fairly uneventfully. Taylor caught her. We didn’t know if it was a boy or a lady. So Taylor had caught this child but additionally, scorching potato, handed her as much as me actually quick. And I bear in mind seeing this little individual coming at me and I couldn’t persuade myself whether or not or not it was a boy or a lady. I used to be simply in whole shock and in disbelief that we truly had a lady. There are a variety of boys in Taylor’s household, so I used to be very ready that we have been going to have a boy. And we had informed everyone that we wished delayed twine clamping. That was fantastic. They have been snug with that. I nonetheless don’t actually have any sense of how lengthy they waited aside from I believe the physician stated, “Okay, it’s been some time.” And we have been like, “No, no, no. It hasn’t been lengthy sufficient.”
So that they waited a bit longer. She was on my chest. We have been doing pores and skin to pores and skin. They didn’t wipe her down or something. She was a wholesome screaming little child. Taylor did reduce the twine after we bought to that time. After which I believe as is fairly regular, hastily the room emptied out and it was simply us, and the doula was ensuring we have been each consuming. And I believe we had just about an hour or two of just about completely uninterrupted time with simply our child immediately. That, which was weird, but additionally nice. In direction of the top of it, I used to be like, “Okay, I’m able to stand up and transfer,” and the nurse got here again in, I believe, after she’d been in a position to seize us a chew to eat or one thing, as a result of she actually had not left our aspect since her shift began.
And they also moved us over out of the labor and supply house to postpartum, and we have been simply soaking all of it in like, right here, we have now this little individual caring for her, and breastfeeding was sluggish to get began. Should you haven’t carried out it earlier than, it’s a talent that all of us should study. And there have been some nurses that have been extra hands-on about serving to me determine that out, and others who I believe simply assumed the whole lot was okay. And I bear in mind it was the midnight, so she was born at about 11:45 within the morning.
And I saved saying, “Oh, yeah. We’re making an attempt to feed.” I used to be making an attempt repeatedly, however she wasn’t actually latching, and I don’t assume I actually found out that that’s what was happening till that evening someday. And I bear in mind having this glorious little nurse who was arms throughout me serving to me determine methods to breastfeed and get this little child latched. And we have been making progress, studying as we each have been. After which it was the subsequent morning when the docs or whoever got here in for the pediatrician got here in and stated, “Oh, it seems like we have now a yellow child.” And that’s after we began studying about jaundice and that we have been going to be within the hospital somewhat bit longer than we thought.
Rebecca Dekker:
Earlier than we get into studying about your expertise along with your child having jaundice, can we simply rewind somewhat bit to the second your child got here out. Taylor, what did that really feel wish to catch your personal child?
Taylor Washburn:
It was a very neat factor. I wasn’t ready for it, and it’s not so simple as similar to, “Right here it’s,” and it’s coated, and slimy. And I used to be so anxious about, “Am I going to drop the newborn?” So there was this honest quantity of stress, and it doesn’t simply come out tremendous simply. So I believe I used to be so targeted on not making mistake and never dropping the baby-
Rebecca Dekker:
Not dropping the newborn.
Taylor Washburn:
So I don’t assume I embraced it fairly like I might if there have been one other alternative to do this.
Emily Chandler:
However I believe there’s a good quantity of… I don’t know, delight. It’s actually cool to know that you simply have been the primary individual to the touch that little child when she came-
Taylor Washburn:
Proper. I wouldn’t have carried out it any in another way.
Rebecca Dekker:
You’re saying it’s one of many stuff you do it as soon as after which like… However for those who might do it once more, you’d have extra confidence, most likely.
Taylor Washburn:
Proper, proper, proper. I’ve by no means held a child at that stage in its life. You’re carrying rubber gloves and simply not fairly positive what’s going to occur. I didn’t really feel completely ready for it, however wouldn’t have modified them a minute up.
Rebecca Dekker:
After which, Emily, how did it really feel when your child was in your chest after that complete expertise?
Emily Chandler:
I believe I used to be in a good quantity of disbelief of like, “Oh my gosh, I simply did this. We simply did this. There’s this little individual.” I didn’t actually imagine it was actual till she was on my chest. It was very cool to be there along with her, with Taylor. She was nonetheless slimy and greasy, and I didn’t care. I used to be pleased simply to take a seat there along with her and begin attending to know this little individual on the skin.
Taylor Washburn:
Effectively, I imply that was my favourite second, was seeing Celia on Emily’s chest. And Emily’s simply labored for nearly 12 hours, and exerted herself, and she or he was simply radiating and glowing, and also you couldn’t inform that she had simply gone to this actually bodily factor, the place I consider myself, whenever you run a marathon or one thing, you end the race, you don’t look put collectively, you don’t look stuffed with power in life. You look completely overwhelmed down. And that couldn’t have been any farther from the reality. So only for me, that was the second, was seeing the 2 of them collectively, and simply that there was this glow and this radiance which is fairly particular.
Rebecca Dekker:
It’s. So quick forwarding to the subsequent morning, about 24 hours after your child was born, you have been informed that they had jaundice and what occurred subsequent?
Emily Chandler:
So that they introduced within the bilirubin cart, I suppose it’s, and we have been principally informed that we would have liked to attempt to feed her each three hours, however aside from that, she must be beneath the lights. And so they have this little blanket that they wrap them up in, that the sunshine can nonetheless undergo, and somewhat masks for his or her eyes. It wasn’t tremendous scary. We knew that jaundice is comparatively frequent. It’s one thing that occurs. However, yeah. It wasn’t nice. They began doing blood assessments. They have been pricking her heel to get blood samples, I take into consideration each 12 hours to test the bilirubin ranges.
And that was actually, most likely, probably the most agonizing a part of it for us was having the blood attracts since you had a spectrum of nurses and phlebotomists with totally different abilities and totally different strategies for doing that. And a few of them did it actually successfully and a few of them didn’t, or they wouldn’t get sufficient blood they usually’d have to come back again and do it once more. In order that was actually exhausting. After which additionally, she didn’t look very snug in that little blanket and the little goggles or the attention masks saved coming off, and we have been nervous about that complete state of affairs. I don’t assume we have been ever actually anxious about her security, however it was simply irritating that it was taking a very long time.
Rebecca Dekker:
Did they ever let you know what her bilirubin ranges bought as much as?
Emily Chandler:
They did, and I don’t recall them off the highest of my head. I might most likely look that up.
Taylor Washburn:
Yeah, they shared a variety of data with us. I believe the nursing workers was actually nice, and we really feel lucky that how intently they labored with us. And there was a silver lining ultimately. Within the time that we spent within the hospital, we had actually nice care and we discovered quite a bit watching the best way they interacted with Celia, and the best way they did issues that simply helped us really feel extra ready after we left, after we went dwelling.
Emily Chandler:
Yeah. So it was each day, they’d test the degrees and say, “Okay. Effectively, you’re going to be right here in a single day.” They did clarify to us that the edge for what is taken into account a difficulty will get increased as they become older, or perhaps I’ve that backwards, however that the precise values they have been searching for change as you get farther from the time of start. So we understood that that was a part of what was occurring and we have been making an attempt to feed her. So, the difficult half for me was then I might attempt to breastfeed her each three hours, then they’d have a syringe feed her, after which they’d have me pump.
So it was this complete course of, and I’ve by no means breastfed, I’ve by no means used a pump earlier than. All of it took a very long time, however they wished to verify she was getting some vitamin to assist transfer the bilirubin and jaundice alongside, however it meant that I used to be pumping for quarter-hour or so after each time I attempted to feed her. And that launched me, or us, right into a not nice cycle. It was exhausting work within the second, however then it additionally, I believe, put me able the place my milk got here in actually quick and there was a variety of it, which is clearly factor on some degree, however then, it made breastfeeding more durable with this tiny little child who couldn’t latch very nicely.
Rebecca Dekker:
Okay. So that you ended up with virtually like an oversupply from overstimulating your breasts or nipples?
Emily Chandler:
Yeah, and I didn’t get any good lactation assist immediately. They simply stated, “Right here’s some flanges, right here’s a pump, pump.” And I used to be like, “Okay.” The opposite factor I bear in mind is that nobody informed me to show the suction down, so I additionally was in a variety of pain-
Rebecca Dekker:
Ouch.
Emily Chandler:
It’s fairly totally different.
Rebecca Dekker:
Yeah.
Emily Chandler:
And was like, “Oh my gosh, what is that this? I didn’t know that is what pumps give”-
Rebecca Dekker:
Hospital pumps might be actually highly effective to you.
Emily Chandler:
Yeah.
Rebecca Dekker:
Yeah.
Emily Chandler:
So, yeah. It was difficult. We labored by way of it, and now I really feel like I discovered quite a bit. If we do it once more, I wouldn’t ever sit hooked as much as a hospital pump for that lengthy with that top suction.
Rebecca Dekker:
And what day did you go dwelling then along with your child?
Emily Chandler:
So we ended up going dwelling on the fourth. I believe we spent 4 nights-
Taylor Washburn:
Nights.
Emily Chandler:
… within the hospital along with her. So we went in late one evening. We have been within the hospital, principally, for 5 nights, however 4 along with her. And it felt like perhaps they have been maintaining us for too lengthy, however as Taylor stated, there actually was a silver lining to it. We had a very great nurse who we ended up having for, I believe, at the least half of these days, if not, extra. And there was one thing actually comforting and having that acquainted face, and she or he was an excellent useful resource.
Rebecca Dekker:
What questions do you may have for me, if any, concerning the expertise you had with jaundice?
Emily Chandler:
So, continued to be fascinated with start and skim it, and hearken to a good quantity. And someplace alongside the best way, I believe when our daughter was 4 or six months outdated, I got here throughout one thing that stated perhaps there’s a hyperlink between delayed twine clamping and jaundice, and bilirubin ranges. And I’ve seen that referenced on quite a few tutorial or skilled web sites. And I used to be simply questioning, I do know there are such a lot of advantages to delayed twine clamping. Are there any dangers in them because it pertains to bilirubin and jaundice?
Rebecca Dekker:
Yeah, so the timing of when to clamp the umbilical twine has been debated for at the least the final 200 years. It first began out reverse of the place it’s in the present day. They used to actually imagine that you simply don’t need to clamp it too quickly or tie it off too quickly. There’s truly a quote from the grandfather of Charles Darwin about how you shouldn’t clamp the twine too quickly as a result of it leaves the kid weaker. And I’m positive one of many causes you selected it’s since you knew the proof that for those who delay it for at the least three to 5 minutes, the infants get extra fluid quantity, extra crimson blood cells, extra stem cells. A 3rd of their blood provide is within the placenta after they’re born, and that goes to assist with the lungs. As a result of whereas the newborn’s within you, solely about 10% of their blood is flowing by way of the lungs after they’re born.
It’s about 50% of their blood provide, at anyone level, is circulating by way of the lungs. So at that second of start, it’s necessary for them to have that additional blood stream. After which within the Nineteen Sixties, that’s when it grew to become common to right away clamp the twine to attempt to forestall postpartum hemorrhage. And now, we have now newer proof after they truly studied that they usually discovered that there is no such thing as a profit when it comes to it doesn’t forestall postpartum hemorrhage within the birthing individual to clamp the twine early. And I believe the place you noticed the information about jaundice, it’s actually attention-grabbing, as a result of in 2013, there was a Cochrane evaluation the place they mixed a bunch of research on this they usually included 15 research, and there was one examine on this Cochrane evaluation that was an unpublished non peer-reviewed dissertation examine from a scholar.
However I believe that scholar was by some means working with the creator, so that they included that scholar’s work in there. And that single examine is what discovered there was a better threat of needing mild remedy for jaundice. It was 4.4% versus 2.7% with delayed core clamping. However they didn’t measure bilirubin ranges. It was very subjective, and it was by no means peer-reviewed research. We don’t actually have any concept of the standard of it. And since that time, each different analysis group that’s excluded that knowledge and never used that examine has discovered no relationship after they randomly assign infants to delayed court docket clamping or speedy court docket clamping. So it’s attention-grabbing as a result of although that one publication then bought into lots of people’s minds as this causes jaundice. And I believe the rationale they assume it causes jaundice is as a result of for those who return to what jaundice is brought on by, so for these of you who’re listening who don’t perceive, jaundice is yellowing on the pores and skin or the eyes, or the gum, or the interior lips resulting from elevated bilirubin.
And virtually all infants have what they name benign excessive bilirubin ranges. This was once referred to as physiologic jaundice. However bilirubin comes from the breakdown of hemoglobin, which is a part of your crimson blood cells. And since infants are born with an immature liver, the hemoglobin shouldn’t be as nicely eradicated from the physique. Most of us adults have blood ranges of lower than one, and it’s regular for newborns born at time period to have a peak degree of eight to 9, it peaks at about three to 5 days, and that’s most likely why they have been being actually cautious monitoring round day three. And usually, additionally, crimson blood cells in newborns, they’ve a shorter lifespan, so that they’re breaking down extra regularly, and their livers aren’t mature sufficient to deal with it immediately. So there’s this pure surge, plateau, after which decline. And that’s why it’s so necessary to measure or to verify they’re not having jaundice as a result of regular benign excessive bilirubin is regular, but when it will get above a sure level, it places the newborn at a better threat for experiencing mind injury.
And in order that’s what they’re involved about. In the event that they’re monitoring the degrees, and it’s not just a bit little bit of gentle jaundice, however the bilirubin ranges are dangerously excessive, that’s after they need to take motion to stop mind injury. And there’s totally different classes of how excessive it will get. So the extent at which jaundice must be handled, and the remedy I’m not going to actually go into, however I can let you know what does put infants at increased threat for jaundice. And you may take into consideration if any of those occur to you. However for listeners, RH or ABO blood incompatibility along with your child, there’s numerous hereditary situation, experiencing an infection, having bruises or start accidents similar to may occur with a vacuum assisted supply, a really massive child that’s born to somebody with diabetes, intestinal obstruction, after which one of many extra frequent causes is simply inheriting a bent that makes it much less simple so that you can clear bilirubin out of your physique.
And that may truly be fairly frequent to inherit. One of the vital frequent is one thing referred to as Gilbert’s syndrome, which about one in 10 folks in america carry each mutations of that, and 42% carry one gene of that. In order that’s a reasonably frequent cause. After which one thing you have been mentioning about is insufficient milk consumption. So if there are feeding difficulties within the first days or the primary weeks, you’ll be able to have insufficient fluid consumption, which slows the newborn’s capability to eradicate bilirubin from their physique and might trigger jaundice. And that is extra frequent with late preterm infants. So infants born round 37 weeks, you may have problem feeding. There’s additionally one thing referred to as breast milk jaundice, which is a selected situation, which is often gentle however requires monitoring. And it’s very poorly understood within the analysis, and it’s presumably associated to a genetic situation, however the insufficient milk consumption within the first days of life.
After which I believe it’s additionally necessary to level out that jaundice, I need to be certain that folks know that if infants have darker pores and skin colour, jaundice is usually missed or not acknowledged. And Black and brown infants usually tend to expertise mind injury from jaundice as a result of clinicians don’t know methods to search for it. So some folks get the suitable remedy and others don’t. And in order that’s one thing to simply pay attention to, for our listeners. However docs assume… All proper, that is the reasoning. We predict extra blood is transferred to the newborn with delayed core clamping, so which means the newborn has too many crimson blood cells, they’re going to interrupt down and trigger jaundice. And after they say it like that method, it does make sense. However the analysis doesn’t pan out. They nonetheless haven’t ever discovered that to be true within the analysis, within the peer-reviewed analysis at the least. And even UpToDate, which is an internet site a variety of docs get their data from, additionally they declare that delayed twine clamping causes this downside, however they don’t checklist any scientific references for it.
That one examine got here out, it bought into everyone’s thoughts, they usually’re like, “Effectively, physiologically, it will make sense. The extra blood you may have, the extra blood breaks down, the upper degree of jaundice.” However after they truly randomly assign like flipping a coin, you get delayed core clamping, you don’t. There’s no distinction in bilirubin ranges. So I believe you’ll be able to relaxation guarantee that it was nothing that you simply did. It sounds, from listening to your story, it may need simply been that that first 24 hours, the newborn wasn’t taking in any colostrum. Does that sound prefer it to you?
Emily Chandler:
Yeah, that has been my assumption. And even when there have been a foundation to that declare about delayed twine clamping, I believe we have now felt completely assured that the advantages of delayed twine clamping have been extra necessary to us.
Taylor Washburn:
Proper. I don’t assume we’ve ever doubted any of our selections in phrases what we… Every thing we did, we felt very assured and comfy within the data we had.
Emily Chandler:
And I might say, fairly nicely supported by the hospital workers that we labored with. Notably, the nurses. We simply had actually great nurses caring for us.
Rebecca Dekker:
Yeah, it sounds such as you had a tremendous nursing workforce, after which your child bought the remedy they wanted after they had jaundice. It’s humorous listening to your story as a result of I felt somewhat little bit of flashbacks. My water broke first, my contraction began within the automotive. I turned down Pitocin after I bought there, they usually have been somewhat flustered like, “Okay.” After which my child had jaundice as nicely. And mine didn’t want the sunshine remedy, however we did daylight remedy. The infant’s ranges weren’t excessive sufficient to trigger concern, however they stated, “Simply ensure you sit outdoors within the solar along with your child for sure durations of the day.” And it was ok to do this. So-
Emily Chandler:
After I bear in mind speaking to my grandmother saying, “Oh, yeah. We’re coping with jaundice, we’ll get dwelling quickly.” She was like, “Simply take the newborn outdoors. That’s what I did along with your uncle.” And I used to be like, “I might if I might.” However I believe they have been additionally simply fairly conservative with us as first time mother and father. In fact, we’d’ve preferred to go dwelling. And it was additionally good to get the assist that we bought within the hospital.
Rebecca Dekker:
And I simply need to be certain that our listeners know that in case you are discovering this episode since you Googled jaundice or one thing like that, the Facilities for Illness Management has a very good article or handout for folks concerning the warning indicators with jaundice. Tips on how to know your child has it, and that there are warning indicators in case your child’s exhausting to get up or is not going to sleep, or shouldn’t be breastfeeding or sucking nicely, or in the event that they’re very fussy, they’re not having sufficient moist diapers, you have to get assist that day. And the CDC says to get emergency assist in case your child is crying inconsolably or with a excessive pitch, if they’re arched like a bow, their head and neck, and heels are bent backwards, if they’ve a stiff, limp or floppy physique, and if they’ve unusual eye actions.
And I believe we simply have to get that data on the market as a result of I’ve met mother and father who’ve skilled that, the place they didn’t get the remedy, the medical professionals dismissed it, after which infants had unhealthy outcomes. So I believe it’s necessary for folks to know that jaundice, most infants are going to have this benign enhance in bilirubin, but when ranges get excessive sufficient that there’s concern, undoubtedly, remedy is required. Effectively, Taylor and Emily, thanks a lot for approaching the podcast and sharing your story, and letting us speak about your lovely child, and we admire you. Are there any last phrases of knowledge or recommendation you may have for our listeners?
Emily Chandler:
I believe, thanks a lot for having us. This has been such an necessary useful resource for us all through our being pregnant and having a small child, so it’s actually cool to talk with you. After which I might say, my recommendation could be, study as a lot as you’ll be able to so that you’re assured and ready to welcome a child into the world in no matter method feels best for you.
Taylor Washburn:
Yeah, I might echo the whole lot Emily stated. I by no means imagined that I’ve discovered a lot, however with the entry to podcasts and different sources of data, it’s simply been really easy to study quite a bit, and I believe that that data actually impacted our expertise in a very optimistic method.
Rebecca Dekker:
Effectively, thanks once more for taking the time to come back share your story. We admire you each.
Taylor Washburn:
Thanks for having us.
Emily Chandler:
Thanks a lot.
Rebecca Dekker:
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