Archive for the ‘Birthing Industry’ Category

Do’s and Don’ts in Labor & Delivery (a.k.a. Getting What You Want, Kindly)

Monday, April 20th, 2015
Created using canva.com

Created using canva.com

Birth plans. Epidurals. Natural Childbirth. Doulas. Induction. Cesareans. And more…

The list of decisions about birth goes on and on…

More women are becoming dissatisfied with the status quo in American maternity care, and are asking for something outside the norm for the hospital where they plan give birth. Naturally, this might make for some conflict between a birthing mother and her care provider and nursing staff.

Conflict.

There. I said it. Right out loud.

There might be conflict in the labor and delivery room when a mother is giving birth. I am not writing this post to tell anyone how to avoid conflict, but how to manage it in a healthy way, so that the birth experience is not characterized by the conflicts that arise, but by the solutions everyone involved is able to come to.

Here are some do’s and don’ts that may help you in the labor and delivery room to self-advocate effectively, while creating a human connection with the nurses and provider caring for you and your baby.

DON’T: Expect care providers or nurses to offer much in the way of comfort during labor.
It is not the responsibility of a care provider or nurse to make a birthing mother comfortable. Their first priority, and indeed, their entire job, is the safety of mother and baby. Period. Your comfort is a distant second to safety, and that’s exactly the way it should be.

DO: Hire a doula to offer you comfort and support.
Your comfort is the entire responsibility of your doula. Period. That is all that she is there for. Emotional, physical, and informational comfort and support are her expertise. You will not be disappointed if you lean on a doula for this need.

DON’T: Make demands.
This only causes a heightening of conflict. If you want something different than protocol, shaking your fist and demanding it is not the right tack. You might get your way, but you may not end up getting the best care if you treat the nurses as if they were there to grant your every wish.

DO: Ask for exceptions.
Think about it. How would you feel if a stranger came to your house, and began to dictate to you how to load your dishwasher, feed your kids, or fold your towels? You would be offended. This is what we do when we demand our way in labor. When you want something outside protocols, try this: “I understand that this is your normal protocol, but I need you to make an exception for me this time. Thank you.” This invites conversation and cooperation, and is less likely to put a nurse (who is technically your advocate) on the defensive.

DON’T: Be rigid.
Refusing to budge on the smallest things is unfair, especially when you are asking for things outside the box. Remember, you are a rare breed to these nurses. Asking them to step outside their norm is a big deal. Respect that.

DO: Be flexible.
Compromise is the name of the game. For example, here in Colorado Springs, a Hep lock buys you pretty much anything you want in most of the hospitals. It helps them to see that you are reasonable, and that you understand why they do what they do. It makes them far more open to your requests and out-of-the-box needs.

DON’T: Wait until you are in labor to make your birth plan known.
It is completely unreasonable to spring a birth plan on unsuspecting staff and providers. You can’t count on appointment conversations to be remembered, simply because of the sheer volume of patients a hospital-based provider might see in any given month. Not to mention the fact that you are likely to have a care provider you’ve never met catching your baby!

DO: Discuss everything on your birth plan prentally.
Write your birth plan early, in second trimester, and tackle one issue at a time in those 7-10 minute appointments. Discuss the benefits, risks, and alternatives ahead of time, and really make sure you and your provider are on the same page. If they are willing, have them sign it–this doesn’t make it a legal document, but it proves to the staff and on-call doc that your care provider is on board with all your requests.

In short, it pays to be kind. Always be kind. You never know what kind of day your nurse or care provider has had. You have no idea what is going on in the room next to you. I am not making excuses for bad or disrespectful or hurried care. I want to remind you that everyone in scrubs is a human being, just like you. There is rarely a reason to walk into a labor and delivery ward with guns blazing. Even if you had no other choice in your care. The ones providing it are just as human as you are, and if you can leave them feeling respected and understood, you are helping to pave the way for the next woman who wants out-of-the-box care.

It may be your birth, but it has ripple effects. Whether it’s for the positive or negative is, at least in part, up to you.

How do you handle differences of opinion in your care? What are the most diplomatic ways you have used to self-advocate without a situation erupting into WWIII?

Grace & Peace,
Tiffany

Book Review Friday: “Giving Birth” by Catherine Taylor

Friday, May 23rd, 2014

Giving BirthGiving Birth by Catherine Taylor
My rating: 5 of 5 stars

This is one of those books which I wish I would have taken notes throughout, to better enable me to review it accurately. Her tone, her writing style, and the content were all excellent.

Her writing style is accessible, honest, frank, and open–the way a good journalist’s should be. Her descriptions of the various women she meets, the places she goes, and the births she attends as an observer or doula are vivid without being wordy.

I found myself moved to nearly to tears several times (I’m not much of a crier, so “almost to tears” is saying a lot) throughout the book.

It’s picture of midwifery as a profession, from Certified Nurse-Midwives to direct-entry midwives is respectful and unbiased. She shares the reality of the political landscape all midwives must work in, the challenges they face, and the little triumphs on behalf of women and their babies.

Even if you are not into birth, I would recommend this book to every woman – whether you plan to have children, have children already, or plan to never have children. It can speak powerfully to any of us.

View all my reviews

Doulas Benefit Care Providers, Too.

Monday, October 28th, 2013

Image credit: apperson.com/support

I’ve written a lot about the measurable benefits of trained labor support for women and their families, which is important. However, I believe firmly that doulas have great potential to benefit care providers and staff as well. As one more important piece of the birthing puzzle, doulas can either add to or detract from the big picture of any birth they attend.

When a doula is at her best, when she understands her role and her scope of practice, she brings freedom, communication, and peace to the place of birth.

Part of my Scope of Practice as a CAPPA-certified Labor Doula reads as follows:

During labor and birth, the labor doula provides the mother and her partner with physical, emotional, and informational support. She facilitates and promotes self-advocacy, informed choice, and effective communication between the family and care providers. She seeks to foster a cooperative, respectful, and positive atmosphere with all members of the birth team so that the mother can birth with confidence. (emphasis mine)

What does “effective communication” look like at a birth?

It looks like a bridge. A sturdy, well-built bridge that begins with openness, humility, and an extended hand from the doula to the staff member or care provider that does not interrupt their conversation with the client.

It’s remembering that the client chose her care providers just as much as she chose her doula.* That fact alone should elicit basic human respect from the doula toward those caring for her client. Period. Regardless if that respect is returned or not. Doulas do no one any good unless we do our best to leave those chips on our shoulders at home. We do best when we take the high road, and treat everyone on the birth team with dignity and respect.

Side note: respect doesn’t mean agreement or likeability. It simply means getting along, and choosing to work together toward a common goal: The safety and health (physical, mental, and emotional) of both mother and baby.

When a doula sees herself as an integral part of the birth team, and understands that everyone else there has their place (as long as her client chose them), there are a lot of benefits she has to offer to the care provider and staff she is working with.

Among those benefits:

  • Added perspective–Doulas can often get very creative when coming up with ways to help a labor progress effectively before medical interventions are truly needed. Care providers often appreciate suggestions that don’t interfere with safety, and that seem to help the mother.
  • Someone labor-sitting–Care providers are rarely available to labor sit as long as a doula can. Even home birth midwives may not have as much opportunity to do so, and usually arrive later in labor than a doula would. This means that a doula can fill in the provider and staff on what has been going on, what tricks have been tried, and things that may be relevant to improving her client’s care. The doula can often provide clarification where the mother’s or partner’s recollection is fuzzy. This helps the care provider have a more accurate picture of how labor is going.
  • Continuity of care for patient–This is one of the hardest things to provide as a care provider. Nurses, doctors, and hospital-based CNM’s change shifts–no matter what. Even home birth midwives may have to send a backup if two births are happening simultaneously. The doula provides one continuous thread of care, and we all know that this works out to better quality care in general. Also, can bond more quickly with the new people on shift, making her care easier for the staff and/or care provider, as they have to spend less time establishing trust.
  • Bridge of communication with patient–Doulas teach their clients to ask good questions, relevant to their own care, and how to understand the answers they’re given. This helps the client to build trust in her chosen provider, which makes caring for her easier for the care provider. A doula’s presence should facilitate togetherness at a birth, not a sense of “us vs. them.”
  • Extra set of hands–As much as care providers love to do hands-on care, many times they are simply not able to do so. Doctors, nurses, and even home birth midwives and their assistants, can easily get bogged down by charting, checking and setting up needed equipment, and (in hospitals) caring for other patients. This is as it should be, since the safety and health of the mother-baby dyad rests on their shoulders. Any non-clinical care they get to do is icing on the cake. Doulas have no such worries impeding their care. Non-clinical care is their only focus.Therefore, care providers are able to focus solely on their number one priority: the health and safety of mom and her baby.

I know that the above benefits are really more indirectly beneficial to the care provider. However, when there is benefit to the birthing woman, there is benefit to her care provider as well. The patient load of most OB’s is such that it can be extremely difficult for them to individualize care. After all, the care provider has as little time, per appointment, to get to know their patient as the patient has to get to know them.

Therefore, if there is any way for a doula to help build bridges, encourage their client to ask good questions, and utilize whatever time they have with their care provider, it enables and empowers the care provider to do what they want to do most: Provide evidence-based, individualized, humane care to their patients. This results in good feedback for them, and encourages them to be more open to the next client asking questions or wanting something different than the basic standard of care.

In short, the presence of a doula can mean heightened communication, empowerment, and a positive experience for everyone on the birth team, not just the mother.

*I understand that many women only have very limited, or no choice, when it comes to their care provider, due to geography, local/state laws, financial constraints, or other factors. Still – they ultimately still have chosen their care provider, rather than birthing unassisted at home. Therefore, they are placing some modicum of trust in that care provider. I appreciate feedback on this.*

Care providers: How often do you work with doulas? What do you appreciate most about good doulas? What tips might you offer to doulas who are still learning, or who need to understand your perspective better? What ideas do you have to foster better relationships between clinical and non-clinical professionals?

Thanks for reading!

Grace & Peace,
Tiffany

Birthy Weekend Links

Saturday, September 7th, 2013

This weekend is coming up fast! What plans do you have? I have family coming in for a five-day visit, I’m on call for a midwife, and I’m trying to put together some bouquets for my sister’s upcoming wedding. In the meantime, here are a few things worth reading this weekend.

Interested in reading more? “Like” my Facebook page, since I tend to share a lot more of these on my Facebook page, almost daily!

Happy weekending to you!

Grace & Peace,
Tiffany

Every Parent Should Know The Scandalous History Of Infant Formula

Saturday, February 16th, 2013

Before I share the article I’m about to link, I need to make a few things clear for you:

1) Formula, in and of itself, is not bad. Neither is it anywhere near what breastmilk is. That is not insulting, it’s simply the truth. Breastmilk is not the “best” option for feeding babies, it is the biological, expected norm. It is part of the normal, physiologic progression of the childbearing year.

2) I am NOT anti-formula, and this post is NOT intended to insult those who have used formula, or have used it in the past. In fact, breastfeeding is one of the things I knew very little about when I was feeding my own babies. I have used formula. For three of my four children, yet somehow I manage not to take offense when the risks of formula to babies are spelled out. I ask you to do the same.

3) The purpose of this post is to highlight the horribly unethical marketing practices of formula COMPANIES. Especially in the developing world.

Read this with an open mind, and try to understand that this is not a commentary on your parenting. You are still a good mother, no matter how you choose to feed your baby. But please remember that the majority of women in the world do not really have a “choice.” It literally means life or death for their babies.

Thank you.

Every Parent Should Know The Scandalous History Of Infant Formula

Grace & Peace,
Tiffany

Do Moms Planning an Epidural Need a Doula?

Friday, May 25th, 2012

This question was posed on her facebook wall by my mentor, Desirre Andrews. I appreciate the thought that her questions provoke, and the way she challenges me to dig a little deeper and search out what my answer would be to this question.

I think, overall, there is an assumption in our country that an epidural is a panacea. The concept of labor with an epidural on board is one of passivity and a desire for separation from the experience because of fears about the process of labor. Whether those fears are well-founded or not really does depend on the individual, and is not the subject of this post. I would very much like to see a more realistic, knowledgeable view of epidurals begin to take prevalence in my community, and the world at large.

As a doula, I know that I can bring my community closer to that vision, one mother at a time. So, here is my answer to the question posed in the title of this post:

I usually tell someone that they don’t “need” a doula (if they want to get all technical), in that they can definitely have their baby without one. Yet, I would never say that a doula is a luxury, either. There is too much benefit to the presence of a doula, supported by scientific evidence, to label them luxuries. Not to mention the fact that women, for all of our world’s history, have always supported women during birth. Women need women who believe in them at their births. Period. Again – a subject for another lengthy post.

Moving on.

In the specific case of a mom planning an epidural, a doula can really help to optimize the use of this particular tool — maximizing its benefits, and minimizing the risks associated with it — if that’s what she wants.

A doula can help a mother stay calm through the procedure, and prepare her ahead of time to have realistic expectations of what epidurals do and do not do. Contrary to popular belief, epidurals are not a panacea. They vary in effectiveness for many women, and come with some side effects that are common enough that every woman who wants one should know about them.

A woman with a doula who has educated her ahead of time who experiences, for example, the drastic drop in blood pressure that can go along with an epidural, will know that the nurse will come in, place her on her side, put an oxygen mask on her face, and give her medication to raise her blood pressure immediately. The nurse will act, she will not ask. This prepared woman will be less susceptible to fear as the nurse takes quick action. The unprepared woman may end up scared out of her wits, and experience fear for her baby because of this process, if she did not know ahead of time that it could happen. A doula can prevent the latter circumstance. Doulas can help take fear out of the equation for women.

Along the same lines, a doula can assuage the fears of a woman’s partner, and reassure him/her that what’s going on is common, normal, and that mom and baby are likely to be okay. Partners who love these women so much often forget all they learned, as their gut takes over, and having a doula there for reassurance can really bring a sense of peace to the partners, freeing them to be fully present in their relationship to the laboring mother.

Doulas can also give women tools to cope with labor up until the time the epidural is placed. Mom is having a natural birth up to the point the epidural is in place, after all! A woman and partner equipped with basic labor coping skills and techniques will be able to handle whatever their labor throws at them up to the point the epidural can be placed.

Many moms, without the presence and preparation of a doula, may not know that the timing of an epidural is critical in avoiding some of the risks (both for herself and her baby), and maximizing its benefits. For one thing, an epidural placed too early can cause labor to slow down enough that Pitocin will be needed, beginning the lovely “Cascade of Interventions” all of us in the birth community are familiar with.

Without a doula, a mom may not have the confidence to believe she can handle labor beautifully until the time comes that an epidural would be more to her and her baby’s benefit than a risk. A doula can bring a strong sense of “I can do it” to the labor room, and help a mother to gauge when the time is right for her epidural.

Once the epidural is in, a doula will help a mother assume multiple positions that can keep it working well, keep her pelvis moving, and encourage progress. Progress in labor is directly linked to the amount of movement mom is able to do, and a doula knows this. She can help a mother and her partner work to keep an active role in her labor by maneuvering mom into alternating positions. Since epidurals are gravity-based, this also helps keep the pain relief on a more even keel, and minimizes uneven sensation.

A doula can also walk moms through what pushing with an epidural might be like, and teach them about different options for that stage. She is equipped to help them advocate for the option to “labor down” (a technique that can help preserve mom’s energy for more active pushing when baby is much further into the pelvis/birth canal), instead of beginning active, hard pushing as soon as she reaches full dilation. She can help mom assume different positions every few contractions, to maximize baby’s ability to descend and rotate well. This can also minimize the risk for forceps or vacuum extraction being needed.

After the birth, during the postpartum visits, a doula can help walk moms through any after effects she may be experiencing. She will have prepared the mother to recognize signs of a spinal headache (one possible side effect that is fairly common, but not overly so), and to get help quickly for it. She can help moms understand the back pain that may come along with it; the longer recovery time often associated with it; and – if it was on board for more than four hours – the side effects that her baby may experience. Usually, a baby might be sleepy, and have trouble latching on for the first time.

Once a mom is fully equipped with all the information about an epidural, she is equipped to take any side effects in stride, without fear. She knows that they may happen, and she accepts and owns her decision. She can come out on the other end still satisfied with her experience, even if she has experienced some negative side effects, when she is fully informed and fully supported in the way that only a doula can really do.

So, do moms planning an epidural need a doula?

You tell me.

This is just the tip of the iceberg regarding the knowledge a doula can bring to an epidural birth. If you are a birth professional, what would you add to this? If you are a mother who chose an epidural: Did you have a doula? If so, how did she help you? If not, would you want a doula the next time? What was your experience – doula or no doula?

This is a safe place for you to share – so, please do!

Grace & Peace,
Tiffany

Midwives Stand Up for Women – We Owe Them the Same

Friday, May 14th, 2010

“The king of Egypt said to the Hebrew midwives, whose names were Shiphrah and Puah, “When you help the Hebrew women in childbirth and observe them on the delivery stool, if it is a boy, kill him; but if it is a girl, let her live.” The midwives, however, feared God and did not do what the king of Egypt had told them to do; they let the boys live. Then the king of Egypt summoned the midwives and asked them, “Why have you done this? Why have you let the boys live?” The midwives answered Pharaoh, “Hebrew women are not like Egyptian women; they are vigorous and give birth before the midwives arrive.” So God was kind to the midwives and the people increased and became even more numerous. And because the midwives feared God, he gave them families of their own. Then Pharaoh gave this order to all his people: “Every boy that is born you must throw into the Nile, but let every girl live.”

~Exodus 1:15-22 (NIV)

These midwives reflect the attitude of most midwives throughout history. They know that women are “vigorous,” and are very capable of birthing their babies. They respect the autonomy of these women, and hold life to be sacred. They exercise civil disobedience, rather than allowing harm to come to mothers and babies.

They strive for safe, evidence-based practices, and are truly examples of what it means to serve humbly. They are not voodoo witch-doctors, waving incense and hoping everything turns out alright. They are highly skilled, intelligent, and competent women who understand that birth is much more than a physical action. It is tied closely to our emotional, mental, and spiritual health. Knowing this, they are quick to refer to obstetrical care when they see that it is needed.

They deserve respect, recognition, and a greater place in our maternal health care in this country. Period.

No, home birth isn’t for everyone, but it doesn’t matter if the option gets taken away from the less than 1% who want it in this country. The evidence backs it solidly as a viable option, and if we lose midwifery care…I don’t even want to think about it.

The travesty in NYC is horrific. Let it not come to pass anywhere else, and may this lapse in judgment end swiftly!

I had no idea how deeply this would affect me – and I don’t live in NYC. Being a part of that under 1% population is why this angers and saddens me so much. Cuts me to the quick how poorly midwives are viewed in this country. The more I learn about typical birth in this country, the more stories I hear that should have gone differently, the more women I see hurt…I can’t explain it.

This just makes me weep.

That a highly trained professional could be prosecuted for providing evidence-based, loving care to a woman and her baby is just sick.

New York midwives lose right to deliver babies at home.

To my favorite midwife, Merrie: THANK YOU so much for what you do. I am more grateful than I can say that your care is legally available in this state. May it always be so…

I’m a Danger to Pregnant Women and Their Babies…

Monday, October 19th, 2009

…according to this sign posted at an OB clinic in Utah.

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Too bad they don’t know the truth:

“”Continuous support during labour should be the norm, rather than the exception. All women should be allowed and encouraged to have support people with them continuously during labour. In general, continuous support from a caregiver during labour appears to confer the greatest benefits when the provider is not an employee of the institution, when epidural analgesia is not routinely used, and when support begins in early labour.”
(Hodnett and colleagues 2004).” ~Childbirth Connection

Also from that same site:

This largest and most recent systematic found that when compared to women who did not receive continuous support, those who received continuous support were:

  • less likely to have an epidural or other “regional” analgesia
  • less likely to use any type of pain medication (including narcotics)
  • less likely to give birth by cesarean section
  • less likely to give birth with vacuum extraction or forceps
  • less likely to be dissatisfied with or give a negative rating to their childbirth experience (Hodnett and colleagues 2004).

And:
Several reviews have found that the type of person providing the care appears to make a difference. Labor support provided by caregivers who come to the labor setting expressly to provide this care appears to offer women more benefits than labor support provided by nurses or other clinical caregivers from that setting (Hodnett and colleagues 2004, Simkin and O’Hara 2002, Scott and colleagues 1999).

In the most recent and largest review, when compared to women who did not receive continuous support, those who received continuous labor support from someone present just for this purpose were

  • 26% less likely to give birth by cesarean section
  • 41% less likely to give birth with vacuum extraction or forceps
  • 28% less likely to use any pain medications and
  • 33% less likely to be dissatisfied with or negatively rate their birth experience (Hodnett and colleagues 2004).

The reviews identified several other factors that seem to make a difference. Benefits of continuous labor support appear to be greater when women receive it

  • beginning earlier rather later in labor (Hodnett and colleagues 2004, Simkin and O’Hara 2002)
  • in settings that do not allow them to bring companions of choice (versus settings that do allow husbands, friends, etc.) (Hodnett and colleagues 2004, Simkin and O’Hara 2002)
  • in settings where epidural analgesia is not routine (versus settings where epidural is routine) (Hodnett and colleagues 2004).

These patterns suggest that the more labor support a woman receives and the better its quality, the greater is its favorable impact. Because of this, women who work with a trained doula in usual (non-study) conditions may experience even greater benefits than the studies show. [emphasis mine]

Usual conditions include choosing a compatible labor companion, meeting with her during pregnancy to develop a relationship and discuss preferences and concerns, working together continuously from early labor onward, and – in many cases – having face-to-face and/or phone contact after the birth.

Not to mention the old faithful Klaus, Kennel, and Klaus statistics from 1993:

  • 50% Reduction in the cesarean rate.
  • 25% Shorter labor.
  • 60% Reduction in epidural requests.
  • 40% Reduction in analgesia use.
  • 40% Reduction in forceps delivery.
  • Improved breastfeeding.
  • Decreased post-partum depression
  • Greater maternal satisfaction.
  • Enhanced mother/baby bonding.

So. Exactly how is having a doula at a birth dangerous? I think the burden of proof rests on the OB.

Links for Your Birth Junkie Fix

Friday, September 18th, 2009

Disclaimer: The views expressed in anything I link to, while I may agree with the position, I am not always in line with the words and tone chosen to express the position. So, if you read something you disagree with – don’t slam me. Be open to new information. Thank you.

More About Midwifery: Hoping to Educate

Thursday, January 8th, 2009

For those of you who responded to my earlier Midwives Deliver post, I wanted to back up some of what I said there.

However, I want to make it very clear upfront, that I don’t post this stuff because I think using a midwife or having natural birth is the only right way to have a baby. I believe firmly in a woman’s choices for childbirth – but I also believe firmly that women have given control of their choices (unintentionally) to caregivers, and too often settle for the status quo, when there’s so much more out there for them.

I believe that most women simply don’t know all their options, and my aim is purely to educate and show “the other side.”

I believe that women need to take responsibility for their choices, and that means knowing EVERYTHING you can before you decide what is best for YOU. This, of course, mostly applies to women with low-risk, healthy pregnancies. Outstanding medical circumstances really limit your options, but I still believe that you need to educate yourself about different options for your situation – if there are any. 🙂

I hope that dispels the myth that all natural childbirth and midwifery advocates are self-righteous, holier-than-thou brow beaters (although some are – just like some Dr’s are).

I truly and sincerely hope that the information I post is beneficial, interesting, and helpful to you – not preachy. Although, some of the articles I will post will have a clear bias. It’s impossible to avoid on either side.

Just take everything here with a grain of salt, and look it up yourself. Don’t take my word for anything either. If you have questions, ask. You can’t offend me.

Anyway, here are a few more links from what I believe to be reliable sources:

Infant Mortality: US Ranks 29th

“Evidence-based maternity care uses the best available research on the safety and effectiveness of specific practices to help guide maternity care decisions and to facilitate optimal outcomes in mothers and newborns. Although the field of pregnancy and childbirth pioneered evidence-based practice, resulting in a wealth of clear guidance for evidence-based maternity care, there remains a widespread and continuing underuse of beneficial practices, overuse of harmful or ineffective practices, and uncertainty about effects of inadequately assessed practices.”
-Introductory paragraph from: Evidence-Based Maternity Care: What it is and what it can achieve

CDC Releases New Infant Mortality Data

I got all of the preceding information from Change.org, a reputable activism website. Here is the short article from that site: Legalize and Endorse Certified Professional Midwifery Nationwide

Only 1% of women in this country birth out of hospital. That’s fine with me. I just hope to be a part of bringing evidence-based maternity care into the hospital environment. But never by bringing my own agenda to the birth of a client. My desire, again, is to educate my clients, one at a time, so that they are empowered to make the right decisions for themselves, and come out of their birth experience (no matter what it is) satisfied and at peace with their choices – and with full support from their entire birth team.

I hope this helped you. 🙂