Valerie Gommon Midwife’s Blog

Archive for the ‘Birth preparation class’ Category

From next year the Government has pledged that all women will be offered a choice of where to give birth including at home but so far only half of women are reporting that they were offered a home birth.

A recent survey carried out by www.netmums.com revealed that as many as one-third of all women in NHS hospitals are left alone and worried during, or shortly after childbirth and more than 30 per cent of mums polled received no NHS antenatal classes and 43 per cent did not have access to a midwife on a postnatal ward.

Women who participated in the poll were also very critical of postnatal care, including support offered for breast-feeding, this is despite the fact that the Government is now putting huge investment into improving breastfeeding rates; some women also mentioned that they felt the lack of care had led to postnatal depression.

Cathy Warwick, General Secretary of the Royal College of Midwives (RCM) said maternity services in England are at a critical point; she said that progress was being made. but went on to say that the target to give women a choice of where to give birth looked like it would be missed.  Warwick said surveys suggested full choice was only offered in about 50% of cases.  She also said services were also struggling to cope with the rising birth rate  which has jumped by 20% since 2001.

The RCM say that staffing numbers have increased, but by less than 10%, leaving the health service short of 5,000; they also highlighted that student midwives are finding it difficult to gain employment.

I have just “appeared” on 3 Counties Radio to discuss a local news item.  A Sainsbury’s employee refused to sell local woman, Janet Lehain, unpasteuried cheddar because she was pregnant!

Whilst applauding the employee for pointing out the recommendation that pregnant women do not consume unpasteurised products I have to say that I believe they overstepped the mark by refusing to sell her the cheese!  The woman could have been buying the cheese for her husband and whatever happened to freedom of choice? 

I am a firm believer in Informed Choice, we are very cautious where pregnancy is concerned because although the risks are very low there could be serious implications for the baby SHOULD the mother contract food poisoning.

The Department of Health guidance in early pregnancy is to be extra careful with hygiene; food poisoning is bad news for your baby. They suggest that women don’t eat any unpasteurised foods – most food is pasteurised, but some speciality milks, cheeses/diary are not.

The recommendation is to avoid moulded or veined cheeses and pate/salami. Eggs should be well cooked not runny. Fruit and vegetables should be washed prior to eating. It is suggested that you don’t eat swordfish or marlin and limit the consumption of “oily” fish to twice weekly. Sea food should be cooked not raw. Liver is not recommended for pregnant women.

Whilst pregnant the current recommendation is not to drink alcohol at all, and it is better to limit the amount of caffeine you take (tea, coffee, cola and fizzy drinks), and obviously it would be wise to stop smoking and avoid any “recreational” drugs prior to getting pregnant.

We are still evaluating the evidence regarding eating peanuts in pregnancy – the best current advice is that if you have nut allergies in the family it may well be best to avoid eating nuts in pregnancy; it there are no nut allergies then use your own instinct and judgement as to whether you feel safe to eat nuts (bearing in mind they are a good source of protein, particularly if you are vegetarian or vegan).

Having made a huge list of foods to avoid, you are encouraged to eat plenty of fruit and vegetables (aim for at least five a day), plenty of protein (at every meal if you possibly can) and plenty of iron rich foods (red meat, pulses, green vegetables).

You can read articles I have written at:

www.birthindex.co.uk/Planningababy.pdf and www.birthindex.co.uk/SOYOUAREPREGNANT!.pdf or

https://midwifevalerie.wordpress.com/wp-admin/post.php?action=edit&post=59

https://midwifevalerie.wordpress.com/wp-admin/post.php?action=edit&post=64

What is the definition of Natural Childbirth?  A hospital might say that a woman whose labour was induced and who had an epidural was a normal birth; others might say that induction, augmentation, analgesia, episiotomies etc do not constitute a normal birth!

A more radical definition of a natural birth might be a labour that starts spontaneously between 37 and 42 weeks gestation, and progresses to a vaginal birth without any intervention or pharmacological drugs.

Natural childbirth has been given a bad press – women choosing natural childbirth have been described as “hippy types” and indeed there has been an item in the press this week about a midwife who suggested that women would do better to avoid epidurals that has caused considerable outrage!

Pregnancy and childbirth are normal life events, not medical condition; a woman’s body is perfectly designed to give birth.

Of course some pregnancies and labours will need medical help – but the vast majority of women will go through their pregnancy and birth without problems and this process works best when interference is kept to a minimum.

For example anything we do to interfere with this natural processes has consequences – if mother and baby are well I am suggesting that we (the medical profession) should not interfere!

One example of this is the huge number of women whose labours are induced – why?  In some areas women are induced at 41 weeks (interestingly in France a normal pregnancy is defined as 41 weeks!).

Induction is not an easy option.  It is usually quite a lengthy process which makes the mother tired.  It is also usually more painful and the mother is therefore more likely to need pain relief, possibly an epidural … the mother is then less mobile … making it harder for the baby to find a way through the pelvis and consequently she is more likely to need the help of a ventouse or forceps, or even a caesarean section.

We all know that although caesareans are very safe in this country, it is still far safer for both mother and baby if the baby is born vaginally.  A caesarean section is major abdominal surgery which will take weeks and months to fully recover from – and the mother will have a demanding baby to care for too!  Babies born by caesarean also have many more problems, and are far more likely to need to receive Special Care.  There are also implications for future pregnancies – so, although fantastic if needed, caesarean sections are far from ideal.  The World Health Organisation recommends a 5 – 10% caesarean section rate, but our rate is approaching 30%, and I believe 90% at The Portland private maternity hospital!

This interference in birth has been called a “cascade of intervention”, because we do a) we have to do b) and because we do c) d) is also necessary this is also described as “iatrogenic” or hospital induced.  Whatever we do has consequences, for example a woman with an epidural will need more careful monitoring, she will need an IV drip and also a catheter – so you can see this spiral effect, because we do this, we have to do that and so on …

I believe there are several factors that lead to this escalation of intervention in childbirth:

Our cultural conditioning, fear, poor health habits and medical intervention in normal birth (perhaps because of fear of litigation) that make birth difficult often requiring more intervention, including surgery.

With good preparation, much intervention can be avoided – women who have a midwife they know and trust are less likely to need analgesia.  With good preparation they should be in optimal health for the birth – complementary therapies they may have experienced acupuncture, homoepathy, osteopathy or any number of helpful treatments during their pregnancy which will help align their body and prepare them for birth.  They may also have practised relaxation or hypnosis techniques all of which can be hugely beneficial.  There is also much a woman can do to help herself: mobilization, relaxation, support, the use of water …

The satisfaction that a woman feels when she has successfully given birth is amazing – it is empowering and is a fantastic start to the parenting journey, and of course breastfeeding is so much easier when you haven’t got a caesarean section wound on your abdomen.

If things didn’t work out this way for you, remember that you did the very best you could at the time.  Some labours do need help and some mothers and babies wouldn’t survive without the help of our medical colleagues.  If this has raised questions or distress for you I am more than happy to speak to you please do feel free to email me info@3shiresmidwife.co.uk

A difficult or traumatic birth experience has long-lasting implications for both the mother and sometimes her child.  We don’t have many babies in our lifetime and it is important to get things as right as we possibly can!

This item has been written by Hypnotherapist Emily Heale who practices in Milton Keynes.  Emily has worked with some of my clients to teach them self-hypnosis techniques which are hugely beneficial during pregnancy, birth and beyond.

Having a baby dramatically changes a parent’s life in many positive ways.  Often relatives and friends are there for support whether it is for advice or just for babysitting!  But there are other people who you don’t know personally who are eager to support parents through these special although sometimes stressful times.

As a Hypnotherapist Emily Heale works with expectant mums who want that extra support – she builds up strong, albeit temporary, rapport and trust with them and help them discover how powerful they and their minds truly are.  Along with treating children, working with mums-to-be gives her an enormous amount of satisfaction because you know at the end of it all there will be beautiful bundle of joy to look forward to.

She will of course not be there to support the mum at the actual moment of childbirth so her job is to make sure they can support themselves with the help of self-hypnosis.  Self-hypnosis is very easy to learn and the techniques she teaches can be used at any time in the future to help with situations other than childbirth.  Incorporated into the sessions with this is Suggestion Therapy – positively phrased suggestions which take root in the subconscious mind.  Being out of control is often the biggest fear a pregnant woman has – possibly with regards to the sensations in her own body or not being able to make their own choices when they need to.  Other less obvious concerns can be doubts about how they will cope.

Fears often have 9 months to build (from previous experiences, media stories etc) so by helping expectant mums overcome their fears it helps them feel so much more in control and reassured.  Prior to or during childbirth often a woman will expect pain on a subconscious level so their body produces certain hormones during labour and the outcome is a restricted flow of blood and oxygen to her uterus and tightening of muscles in the cervix – the areas which needs the most help at this stage!  On the other hand if a woman is relaxed and looking forward to the birth, there will be more synergy between her mind and her body.  When a woman feels no fear during childbirth there is little or no discomfort – the contractions come regularly and rhythmically and the baby is born more easily (and often faster).

It is important not to forget that partners often need support.  They can sometimes feel a bit left out or useless when it comes to helping support the mother and they may even have their own fears or doubts.  By being able to assess and deal with the likely weaknesses of the other person present at the birth, we can ensure the mother has the greatest possible support and that the partner feels both a part of the process and able to enjoy the experience.

So if you would like extra support from someone like Emily, all you have to do is ASK for it!

Written by Emily Heale IAPH Professional Hypnotherapist

The Hypnotherapy Practice in Milton Keynes. Free consultations available.

Phone: 07990 521266

Email: emily@thehypnopractice.com

Website: www.thehypnopractice.com

A listing of events that I am hosting or involved with over the next few months, please feel free to pass on these details to anyone appropriate.

I can be contacted on 01908 511247 if you need any further information.

Antenatal Exhibition – FREE entry
Sunday 8th March 2009
2pm – 4.30pm
The Guildhall, Church of Christ the Cornerstone,
300 Saxon Gate West,
Central Milton Keynes, MK9 2ES
info@3shiresmidwife.co.uk

Love Your Body Exhibition – FREE entry
Saturday 21st March 2009
10 am – 4 pm
Midsummer Place,
Central Milton Keynes
www.loveyourbody.me

Milton Keynes Real Nappy Show – FREE entry
Thursday 2nd April 2009
11am onwards
Chrysalis Theatre, Camphill Community,
Japonica Lane, Willen Park South,
Milton Keynes, MK15 9JY
info@3shiresmidwife.co.uk

Wedding Fair – FREE entry
Sunday 5th April 2009
11am – 4 pm
Holiday Inn, London Road,
Newport Pagnell MK16 0JA
info@3shiresmidwife.co.uk

International Week of Midwife – FREE entry
Part of John Lewis Nursery Event
Saturday 9th May 2009
10 am – 4 pm
Nursery Department
John Lewis, Central Milton Keynes
info@3shiresmidwife.co.uk

National Breastfeeding Week – FREE entry
Saturday 16th May 2009
10 am – 4 pm
In store at Boots Baby Department,
Central Milton Keynes
info@3shiresmidwife.co.uk

Love Your Body Exhibition – FREE entry
Saturday 13th June 2009
10 am – 4 pm
Excape, Central Milton Keynes
www.loveyourbody.me

Antenatal Exhibition – FREE entry
Sunday 28th June 2009
2pm – 4.30pm
The Guildhall, Church of Christ the Cornerstone,
300 Saxon Gate West,
Central Milton Keynes, MK9 2ES
info@3shiresmidwife.co.uk

MK Baby and Toddler Show
Sunday 6th September 2009
The Stadium, Denbigh,
Milton Keynes
info@3shiresmidwife.co.uk

Antenatal Exhibition – FREE entry
Sunday 4th October 2009
2pm – 4.30pm
The Guildhall, Church of Christ the Cornerstone,
300 Saxon Gate West,
Central Milton Keynes, MK9 2ES
info@3shiresmidwife.co.uk

Despite Government policy to increase the number of births taking place at home or birthing centres, figures produced by the Office for National Statistics (ONS) show that the number of births taking place at home fell from one in three in 1955, to just one in 40 by 2006.  This is partly because the shortage of midwives often means that women are not offered a home birth, or have it cancelled at the last minute and are forced to go into hospital.  Only this week I have heard that homebirths have been cancelled in some areas.

Since 2006 there has been an increase in home births however, despite the rise, only 2.5 per cent of births in 2006 were at home, compared with 30 per cent in the Netherlands.

As a midwife I know that not all women and offered the option of home birth, and there certainly is a shortage of antenatal appointment time to facilitate adequate discussion to enable couples to make an informed choice about where to have their baby.  Indeed in recent years the NICE Antenatal Care Guidelines have recommended a reduction in the number of antenatal visits for low risk women. http://www.nice.org.uk/nicemedia/pdf/CG62FullGuidelineCorrectedJune2008.pdf

With the many benefits to being at home:

* Shorter labours

* Increased likelihood of normal birth

* Less likelihood of needing forceps/ventouse/caesarean

* Less need for pain relief

* More likely to breastfeed

* More likely to be happy with experience

* Less likely to experience postnatal depression

it is hard to understand why more babies are not being born at home.

A common concern from my clients is “what if something goes wrong” – my answer is that things rarely go wrong in a hurry during a labour – midwives are trained to monitor the progress of labour and if things are not progressing normally then it is perfectly possible to calmly transfer to hospital, no drama.  There is no evidence that it is safer for women with low risk pregnancies to give birth in hospital.

Women giving birth at home are more likely to have one-to-one care from a midwife they know and who has contributed to their antenatal care.  This can help labour develop normally, reducing the risk of “failure to progress”, fetal distress and the associated medical interventions.

I often find that during the course of a pregnancy the couple gradually learn more and recognise the benefits of remaining at home.  Another thing I often say is that they can decide where to give birth in labour.  They can start out at home, if things progress well and they feel comfortable they can decide to stay at home, but if at any time they feel they would prefer to transfer to hospital then that is fine.  I believe the best place to give birth is where the mother feels safest and most relaxed and for many women that is at home, after all hospital is not a relaxing, intimate place.

I would encourage you to learn all you can about birth, ask your midwife, attend good birth preparation classes, have a look at www.homebirth.org.uk and consider having your baby at home.  If your local hospital says that homebirths are cancelled, as difficult as it is I would urge you to tell them that you are having a planned home birth and ask them to send you a midwife.  Unless women (and midwives) get political nothing will improve.

When out and about doing promotional work for my Independent Midwifery Practice www.3shiresmidwife.co.uk I am often asked what is involved to become a midwife.  It is obviously a profession that many women are called to; for some it is just a whim, they have a baby and think that it is such a wonderful job that they might have a go, but for others it becomes a serious intent.

Midwifery is not just about “delivering” or facilitating a birth.  Midwives are often the first person a pregnant woman will see; we give information and support throughout the pregnancy, labour and birth and postnatal period; we help mothers make informed choices about the services and options available.

The role of the midwife is very diverse; we undertake clinical examinations, provides health and parent education and support the family through pregnancy, birth and early parenting.  We also work in partnership with other health and social care services and midwives are responsible for their own individual practice and have a statutory responsibility to keep up to date with current knowledge.

I have had four children, three born at home and I read voraciously and set about informing myself to achieve my homebirths at a time when homebirth was definitely discouraged.  Having successfully achieved (challenging) but wonderful births at home I have to admit that I did become slightly evangelical about birth and homebirth and wanted other women to feel the same empowerment that I felt.

I was fortunate to have a midwife friend and I began teaching birth preparation classes alongside her, eventually teaching myself, never really thinking that I would be a midwife.  To be honest, I thought I knew too much; I didn’t think that I could bear three years of training to teach me something I already knew!

Time moved on, and I decided that I did want to be a midwife.  It was a long process.  I needed to undertake some up-to-date studying as it had been sometimes since my O levels.  I honestly don’t remember now how long it took, but it was certainly several years – I did an A level, I did an aptitude test, I applied, was rejected, waited a year and applied again (may even have been rejected again), the selection process was hard.  I think 250 applicants for 12 places.  They asked me what I thought were really stupid questions, really difficult questions.  I thought they were mad to turn me down; I was committed, knowledgeable and knew that I would make a good midwife!  Eventually I got lucky and gained a place to study.

The course itself was challenging.  A roller-coaster of a ride; highs and lows; lack of self-belief; difficult things to encounter and teachers that I disagreed with – but three years later I did it, I emerged as a brand new midwife and guess what, I did need those three years (and more) to become a midwife!

The process of applying for midwifery training has changed somewhat since I did my training.  Training is now a University Degree course; usually 3 years unless you are already a Registered Nurse and the minimum requirement to train is two A levels, science subjects are preferred. NVQ/SVQ Level 3, the BTEC National Diploma, or equivalent access to higher education programmes run by colleges of further education, are alternatives. Application is through UCAS www.ucas.ac.uk and you will gain a degree and Registered Midwife qualification.

It is important that you carefully check the financial status of being a student midwife.  The situation is under review, but some recent students have been unable to claim any financial support whilst training and have completed their training in considerable debt.  You will also be expected to attend University and work as a Student Midwife in a clinical setting, this will include shift-work and unsocial hours.  There will be many moans and groans along the way, it is not an easy job – it is challenging and exhausting, you will have to deal with staffing shortages and bureaucracy, but it is still the best job in the world!

More information about midwifery training can be found at:

www.nmc-uk.org/aArticle.aspx?ArticleID=2100

www.rcm.org.uk/jobs-and-careers/becoming-a-midwife/

Heartburn is one of the unpleasant side-effects of being pregnant; it is caused by the hormone, progesterone, which relaxes the valve at the top of your stomach, causing a small amount of stomach acid, sometimes with partially digested food, to surge upwards into your oesophagus (gullet).

Sometimes sickness in early pregnancy can be worsened by heartburn, or indigestion can make you feel sick. If you are expecting more than one baby or your baby is very large this will make your heartburn worse. If your baby is in a breech position in late pregnancy, his head will press up under your diaphragm and may trigger heartburn. Eating certain foods and smoking will also make things worse.

Eating small meals more frequently will prevent your stomach becoming overfull and pushing up under your diaphragm. Try to eat your main meal of the day at lunchtime if at all possible and eat your evening meal early in the evening, so that your body has time to digest it before you go to bed. Avoid spicy, rich, fatty and fried foods and anything else which triggers the symptoms. Sugar, tea, coffee and certain food additives may also exacerbate heartburn. Don’t drink liquids with your food as this causes your digestive juices to become diluted and therefore less effective, but do drink between meals.

Lying down to relax after a meal is likely to cause regurgitation, so it is a good idea to sit upright for a while; you may also find you have to sleep propped up on two or three pillows at night in later pregnancy if the problem gets worse. It may be worth trying complementary therapies such as homoeopathy, aromatherapy or acupressure, or try the following suggestions:

– peppermint, fennel, chamomile or dandelion tea (do not take dandelion tea in large doses or if taking antihypertensives)
– ginger
– milk
– malt drink
– 3 umeboshi plums (health food shop) boil in a pint of water, keep juice in
fridge. Drink as required. Ask for advice.
– Slippery elm “Thompsons” old fashioned stomach soothing drink (health food shop) – Ask for advice.
– Raw garlic or garlic capsules
– Cardamom seeds – chew!
– Cashew nuts – chew well into a paste before swallowing

– extra strong mints

-antacid from the pharmacy (rennies, gaviscon etc) try to avoid taking in large quantities if possible as they can impair your body’s ability to absorb iron

For the room

* Clean old sheets, ?old PCV/woven back tablecloth
* Pillows, cushions, beanbag and/or birth ball
* Adequate heating especially in winter, in no central heating mobile heater suggested
* Adequate lighting, spare bulbs, angle poise lamp, side lamp or good torch
* Bin liners for rubbish and dirty laundry
* Bucket in case you are sick
* Small waterproof mirror (e.g. shaving mirror or mirror tile)
* Pampers changing mats
* Kitchen roll/tissues
* 2 clean hand towels and soap
* Worksurface or tray to lay out equipment
* Hospital bag packed in case of transfer to hospital

For the mother and baby – for the birth

* Easily digested food e.g. bananas, yoghurt, toast, biscuits
* Fruit and/or vegetable juices
* Jar of honey/dextrose tablets
* Tea – herbal or ordinary
* Ice cubes (can be made from fruit juice and/or water
* Bendy straws
* Several clean face flannels
* Plenty of large clean towels – for you after using bath/pool
* Plant spray container for water – really refreshing!
* Old or disposable pants
* (At least) 2 packets of thick sanitary towels
* Nightie or t-shirt if you like to wear one
* Hot water bottle or wheat sack (for backache or afterpains)

For the baby/afterwards

* 2 smaller, soft towels for the baby
* Nappies and cotton wool of choice
* Warm clothes – vest, babygrow, hat, cardigan and blanket
* Breast pads and Savoy cabbage – to relieve engorged breasts

Optional

* Camera
* Chilled champagne/chocolate
* Light easily digestible food (e.g. pasta) for after the birth

When the big day comes you will have learnt lots of things that can help you, for example you might like to have a bath or shower which can really help you to relax. Early labour will probably feel a bit like period “cramps” and bathing or a hot water bottle may well help as can taking a couple of paracetamol if you wish.

Moving around and adopting different positions is also another useful thing to do – you might find that walking, marching or crawling around on all-fours might help. It is fine to go out for a walk in early labour if you feel up to it, and it is a good idea to find something constructive to do – perhaps watching a film. If you possibly can you should also try to have a nap – you will probably be working very hard for the next 24 hours, another tip is to have something light to eat and drink plenty as you will need the energy later!

TENS which is a small, battery operated machine can help; the idea is that you put the electrodes (or sticky pads) into four specific places on your back and the machine sends an electric impulse to the pads which are placed over nerve endings. TENS works in several ways, it boosts the body’s endorphin production (endorphins are our natural pain killers), it also blocks pain messages to your brain and lastly it is a distraction! Many women find TENS helpful – the trick is to put in on fairly early in your labour – TENS machines can be hired fairly inexpensively from some supermarkets, pharmacies and even some hospitals.

Soft lighting, music and massage can be relaxing – especially massage to the lower back as many women experience backache in labour. Either using hands, a nice oil or even rolling a tennis ball around on your lower back will probably feel really helpful. This might be something that you can practice with a birth partner prior to labour.

Most women find that staying active, listening to what their body tells them, is helpful. If your body is telling you to rest, then rest, if you feel better pacing around then pace. Having a supportive birth partner (or partners) is also invaluable – having a woman who has successfully given birth before is really helpful and can allow your partner time to eat, rest or even pop to the toilet! Speaking of toilet – remember to pass urine frequently yourself, ask your partner to remind you to wee every couple of hours at least as a full bladder can hamper descent of the baby’s head.

During the labour, use any breathing/relaxation techniques you have learnt, sit on a birthing ball, practice hypnotherapy, use your TENS machine, be active, sing, chant, make a noise, use massage, visualise your baby, your cervix opening – ask your partner to encourage you and to look deep into your eyes and breathe with you or use any complementary therapies that you have prepared (homoeopathy, oils, acupuncture etc).

I would encourage you to consider not using the birthing pool until the “going gets tough” and then you have somewhere else to go, somewhere that may be blissfully relaxing.

So you can see there really is quite a lot that you can do to help yourself in labour!

If you have tried all these techniques but still need more help there are drugs that the midwife can give you, for example entonox (known as gas and air) – this is not thought to harm either mother or baby and if you don’t like it you can just stop using it at any time. Most women think entonox is really helpful – it is just a mixture of oxygen and nitrous oxide which you breathe in through a mask or mouth-piece. It can occasionally make women nauseous and may make you feel a bit drunk!

The next level of pain relief available is an injection (usually given into your leg or bottom); the type of drug varies in different areas, but is usually meptid, pethidine or diamorphine. These drugs can make you feel drunk and a bit “spaced out” – some women really find them helpful, but other women don’t like them – I guess if you are needing help at this stage the answer is to try them and see what you think. The disadvantages are that they can make you sick (they are usually given with an anti-sickness drug for this reason) and may make you feel “out of control” and the effects of the drug will last for some time. The baby will also get a dose of the drug and this may make the baby sleepy at birth and make feeding slightly harder to establish.

If you require something stronger an epidural may be the answer, this is when a local anaesthetic is injected into your back. The advantages are that this usually offers good pain relief, especially when labour is long – you can usually sleep and rest once you have an epidural. However there are also disadvantages in that you have to stay very still whilst the epidural is sited and you will need a drip and probably a catheter to help you to pass urine. Your movement will be restricted and your baby will need to be continually monitored as very occasionally the baby can become distressed. Other disadvantages are that the epidural may not be 100% effective, some women experience “break-through” pain and occasionally further complications, also because there is a lack of sensation to “push” the baby out you might be more likely to need additional help with the birth.

In summary, you can see that there are lots of things you can do to help yourself during the labour, but if you need additional help there are drugs onoffer to help you.

 


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