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Bumpkin

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Discussion regarding birth choices is always coloured by our own anecdotal experiences - which even when they are larger than the average sample (i.e. a doula, or a much wider sample of an obstetrician) are still anecdotal. That's why this study is so interesting and so overdue. I think this thread has such a great range of perspectives.


SBryan-I agree (and indeed talk about it in my post) that the vast differences in homebirth team set-ups is something that warrants investigation - and, if homebirth is to be a viable and expanding option for women, real homebirth teams need to be used.


I'd like to clarify that, as my post was in relation to the Birthplace in England study, my comment that 'giving birth is safe' relates entirely to our contemporary birth culture and location. I am simply echoing the words of the study authors themselves and would strongly contest your statement that this is nonsense. I would be interested to hear which other points in my post are nonsensical - I am keen to keep learning.


MonkeyI do fail to see why anyone - even if they have never given birth let alone been at quite a few - shouldn't opine. You are of course giving your opinion here re: the need for proximity to medical equipment and, all likelihood is you experience of birth is less than mine. I'm sorry that the phrase 'awe-inspired' put you off reading my post too. Maybe it is a bit cringe-y come to think of it. Maybe I'll change that. I guess that being with lots of women through pregnancy and birth and seeing them doing amazing things makes you feel a bit gushy.

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sillywoman Wrote:


> Edited to add that I would be gutted, just gutted

> if I felt that I was leading women to feel that

> they had 'failed' in any way whatever kind of

> birth they have.

>

> Retiring now to consider whether I'm in the right

> job, & lick my wounds.


Sillywoman having been to your classes I can honestly say that I feel that the very last thing you did was to make any of us feel that way, you gave a very balanced and honest account of the potential pros and cons of home / hospital birth, including the potential risks, and you were very supportive about whatever kind of birth people were hoping for / ended up having, always being at pains to reassure us all that there was not a 'perfect birth' that we would have failed in some way if we didn't achieve, or that home birth or natural birth was in some way a 'superior achievement' to hospital birth, a birth with intervention, c-section etc..


Littlemoo, thank you for sharing your story on this thread, Im so sorry for you loss

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I also want to thank the NCT teachers for the work they do - I know they aren't paid alot particularly for all the preparation they do and I found my NCT teacher very supportive of whatever kind of birth we were planning on. I also felt great support afterwards when I had the 'baby blues' and my NCT teacher listened to me without any judgement what-so-ever I never felt any pressure to conform to a certain birth expectation by anyone in the NCT.


I think that as women we can be really hard on ourselves and then by extension on others for the choices we make in terms of whether we have kids or not and then, what kind of birth we choose. Compassion for ourselves first, then compassion for others. And, I am so sorry to hear about the loss of your baby littlemoo.

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Sillywoman, you most certainly did not persuade me to go down one route or another as mind was made up by then (attempted home birth x 2 but ended up in hospital due to long labour first and was 43 wks with 2nd so thought should go in) and your advice (so good I went back for it twice) is brilliant at laying out for facts for people to reach their own conclusions to.

SBryan, great to add someone of your position to the debate. Shame about picking on an NCT teacher who is clearly supportive of the type of work you do. No need.

Littlemoo - you are a brave lady. Good luck with LM3.

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Thank you all for your kind words. I am really pleased to see that my post didn't stop a continued healthy debate.


Sillywoman, I just wanted to say that in no way are you in the wrong job. You have been an incredible support to me and I am sure many other women. Sadly, from what I hear of other women's NCT teachers that is not always the case. I am very lucky indeed to have had you there through all of this.

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SW, you are one of the very few professionals mature enough to publicly consider, respect and discuss all perspectives on a topic. How many people aren't out there that get all scientific and statistical about a research publication but only when the outcome matches their views. I'm not talking about pregnancy and childbirth/childhood related professions in particular. It applies to everyone, ranging from professions with a relatively low controversy factor like computer programming, tailoring and architecture to more blatantly subjective professions like homeopathy, pharmaceutics, Fox news reading and Greenpeace activism.


Hey, look how apes love to carry their young around, it's natural, humans should do it too, let's publish it. Oh but look, the same apes also push their young away and even hit and bite them during the weaning stage, let's not use that in our discussion. I've seen the first half of the observation used over and over in parenting articles and on forums but the second half is almost always ignored. Yes we should take the best of all worlds but we shouldn't ignore the inconvenient facts when trying to convince others to do something.


I have incredible respect for people who will say "oh no, this doesn't match my views, but it appears to be true in some way or another, let me not shove it under the carpet but discuss it". Or "this is fantastic research that fits my views but if I had to take a step back I'd have to admit that I'm not sure it gives the complete picture".


We need more of these people in professions that have a broad audience such as teaching and publishing.


Sorry bit off topic but had to say it.

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Dear Sillywoman, I'm sorry you were so hurt by my post, it certainly wasn't intended as a personal attack, and I certainly wasn't referring to the NCT. It was a direct response to your post:


"Part of what Midwives, Doula's and Antenatal teachers do is to protect the culture of birth. We only have to look across the pond to see what happens when fear of birth & fear of risk is allowed to escalate and an Obstetric, risk averse culture prevails."


which I'm afraid in black and white print implies that the aforementioned professions are protecting women from obstetricians. I'm sure this isn't representative of what you think, and reflects the difficulty of discussing highly emotive matters on an anonymous internet forum.


I certainly wasn't accusing you personally of not supporting women and their birth-choices, and making women feel like a failure, I was commenting on the prevailing culture. I don't think any healthcare professionals, be it midwives, doctors, or antenatal teachers make women feel like failures; they do it themselves. I see women in both the immediate postnatal period, and at 6 weeks postnatally, and the amount of guilt felt is huge (and don't forget I am a young woman most of whose friends has recently been through childbirth). Part of that guilt is due to the huge pressure we put on ourselves to have the perfect birth. I am not accusing you, or the NCT of doing this, it's a societal issue.


There is, amongst a small number of people, an "us and them" culture; I know, because I face it every time I work on delivery suite; I have watched babies develop brain damage and even die due to a refusal to allow medical intervention. The culture is due to a large variety of reasons. There has been a reasonable backlash against old-fashioned patriarchal medicine, giving women back control in their births, and wanting to move away from unnecessary intervention. What people don't realise is that obstetricians are at the forefront of these changes, rather than the enemy of them; that's why many of us went into obstetrics in the first place. You only need to look at the recent publications from the RCOG to see these changes. The culture has changed; the majority of labour ward leads and head obstetricians across London are women, most of whom have had babies themselves. I can't comment on Kings, but the unit I work at is generally not defensive or patriarchal, and really has women's and their families needs and wishes at the centre of everything we do. The reality currently though is that the majority of women have obstetric involvement at some point in their antenatal period, labour, or delivery, as you can clearly see from the results of the NPEU study. At any given time on delivery suite I may have up to 14 women under my care, all of whom we are doing our best to achieve vaginal deliveries for; obstetricians will probably deliver about 40 - 50% of these. Up to 4 or 5 labouring women will be at home or on the birthing unit, with a transfer rate of 50% in first pregnancies and 10% in subsequent. So, we need to be a bit more realistic about what may happen (without frightening the life out of people, not easy!) and I'm not sure we always are. That's the fault of everyone involved in maternity, certainly not the NCT alone or any individual teachers. For example, how many of you know that if you have an induction, in your first pregnancy, because you're overdue (and were previously low risk) you have a 50% chance of needing a caesarean?


Sorry, it's another long post, I'm going to bow out of the discussion at this point, but felt it important to put forward the views of a member of the medical profession as it's our low visibility that leads to a lot of misconceptions.

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Thanks for all the informative comments and points of view, it is really interesting to hear from an obstetrician SBryan so thank you.


I did know that about inductions, hence why I held off (til 13 days late) before going in and was quite distressed to have to be induced. I had a very low Bishops score too so while I did everything in my power to avoid a c section I ended up with one, which I now feel was the right thing for me as I would never have been able to go beyond 43 weeks pregnancy for fear of something bad happening in utero, again counting my blessings. Out of our NCT group, 3 had inductions, all of which ended in c sections. Sillywoman was fantastic pre and post birth to all of us, don't hang up your NCT gloves yet please!!

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I would like to thank everyone for their contributions to this post especially littlemoo (thank you for sharing your story and I'm so sorry for your loss. I am so glad you felt brave enough to tell your story as it was an important story for us to hear), sillywoman and Sbryan (for both of your views and the ongoing support, you both share, in women having the information required to make the choice that's right for them and their babies). I am a first time mum to be and have found the information on this discussion helpful in thinking about my own options. It has reinforced my own wish that I not put any expectations on myself about how the birth may go. I watched one of my best friend make a detailed birth plan for the birth of her first child. The birth did not go to plan and she ended up having an epidural and a forceps delivery. She has a beautiful baby boy but after the birth felt that she had failed in her first steps as a mother because she had not been able to have the birth she had planned for. It took some time for her to overcome this. This really changed my own view for my birth plan. I am choosing to have a hospital birth and my only want for the birth is the safe and healthy delivery of my beautiful baby. I believe as women we have the right to choose what is right for us individually and for our baby without guilt or worry that we are failing in some way if that includes or does not include medical interventions. I strongly support anyone choosing a homebirth and I hope this will be an option for me next time round. I also agree that there needs to be an increase in funding and resources for maternity services and that all hospitals should include a home from home birthing centre. I also agree that there needs to be better post natal care offered at hospital immediately after the birth. I am already considering requesting discharge as soon as possible after birth rather than being admitted to the post natal ward as (from what I hear)the level of resourcing on the ward is not conducive to providing the support that you need to rest and recover after birth and the support that may be needed to establish breast feeding.


Thanks again for everyones contributions so far. They have been really helpful and thought provoking.

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Having discussed all the options with my partner, NCT teacher, and the very experienced community midwives, and done a lot of research, I opted for a home birth, for the following reasons: one-to-one and two-to-one care from a team of familiar faces, the idea of being in my own space, and the fact that, if necessary, I could be in Kings in minutes. As it was I did end up in Kings, being induced, and eventually having a forceps delivery. I don't feel that I failed, but I also don't think that this was the nicest way for my baby to come into the world. It certainly wasn't the gentle birth I had hoped for. I find it interesting that a lot of people say its not about the mother, its about the baby - medicalised births may be safer for the baby but they are not without their problems. I'm not talking about the bright lights and beeping machines here but the effects of the drugs the mother is given, ongoing trauma from forceps etc, while the post-natal ward is just a horror, unless you are lucky enough to get one of the private rooms. Even then, staffing levels are barely adequate.


There are pros and cons to home birth and hospital birth; if a home from home birthing centre was available to all then I think it would be very different. Sadly, under the current regime of cuts, I can't see this happening, and were I to have another baby I'd go for a home birth again.

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Just to comment on this point from SBryan:


For example, how many of you know that if you have an induction, in your first pregnancy, because you're overdue (and were previously low risk) you have a 50% chance of needing a caesarean?


Didn't know the stat but was certainly aware that induction is the first step towards a much greater likelihood of everything going pear-shaped, and those figures do not surprise me. I find the whole concept of 'overdue' for first babies quite arbitrary until at least 42 weeks. Perhaps you can shed some light on why full term is 40 weeks here and (as I understand it) 42 weeks in France for a first baby.


I would say most women do not genuinely believe they are going to have a perfect birth - the majority of us simply are not that deluded. It is completely right and natural that many women do everything in their power to chase that dream - and why not? Why be defeatest about it? It's a terrifying process if you think about it - there is so much at stake - and we go into it after a lifetime of negative images we see of labouring women in movies and TV, not to mention the 'horror' stories we women share socially. Particularly in view of this, I think it is wonderful and quite amazing really that hope for something better prevails.


And if guilt is a side effect of the reality of that dream not materialising, that has got to be better than we women going into pregnancy and labour feeling like powerless victims at the mercy of fate and medical professionals, bogged down by the statistics and dire warnings about what may go wrong (and therefore at much greater risk of the prophecy becoming self fulfilling). I certainly had luck on my side with my births, but I honestly believe I would not have had the positive outcomes I did without the encouragement of NCT teachers like sillywomen, experienced midwives (including my a particular midwife in my team and people like Ina May Gaskin). Had I been in the US under the care of an obstetrician (even a very nice, forward thinking one like you seem to be SBryan), I think it is very likely I would have had intervention and a medicalised birth. This may not be the end of the world, particularly if mum and baby both survive unscathed, but it is certainly not something to aspire to or resign oneself to. The unique perspective and skills of obstetricians are obviously crucial in certain situations, but it is not the gospel.

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I had a French registrar at my recent birth - she clarified the French thing for me Little Ed Family: they count full term as 41 weeks but that does NOT mean that women go to 43 weeks before induction - in fact induction post dates there (Or certainly in her previous hospital in the South of France)is earlier than it commonly is here. I'm struggling to remember (she was errr... doing my stitches at the time!) but think she said something like 41 +3. My (community) midwives were suprised to hear from her that c-section rates at her previous hospital were actually slightly lower than the average here, and quite a bit lower than Kings. She mentioned that 'maternal request' c sections were provided at Kings (and as someone mentioned earlier, this was part of recent NICE guidelines) - and despite my midwives' obvious horror at this, I must say I fully support it, in the same way as I support women requesting a homebirth. I considered asking for an elective c section this time, based on various difficulties first time round, and unfortunately I think it's an option I should have perhaps pursued (or at least considered a planned hospital birth). Not because of any serious medical outcome as others have sadly experienced here, rather the emotional outcome - for me having to transfer in was pretty traumatic, and the second part of my birth really affected me badly.
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Oh blimey, I was about to post something here, but in the mean time littleEDfamily has posted almost the opposite, rather anxious about this copy paste now, but heck I've had a glass of wine and it took a while to write!...



I've been wondering if I should comment on here as well, I'm afraid I'm being a bit chicken and doing it under a different name to the one I normally use as I'm not happen going public just yet with some of the stuff that has happened to me.


First I'd like to be clear that sillywoman wasn't my NCT teacher, I wish she had been though!


Our NCT teacher started of the first class by making couples publicly justify their decision not to have a home birth, by the end of the course we'd been told:

-Humans are perfectly designed to give birth easily and naturally, just like every other mammal

- All doctors were far too keen to perform interventions, best not to let any of them anywhere near you

- Interventions are almost always unnecessary and very unpleasant

- We should all tell our GPs we wanted home births, even if we didn't, so we'd get more attentions from the midwives - if we still insisted on hospital we could always chicken out in labour.

- We could all have the birth we wanted, all we needed was confidence in our bodies' abilities.


I didn't buy into everything she said but I went into labour fit, healthy, low risk and completely unafraid. I'd intended to have a home birth second time round if it all went well. I was in a midwife led unit at a hospital , lovely midwives, great room, birthing pool etc. all the confidence in the world. Two days later I'd had an emergency C-section after every intervention in the book, many of which had failed at least once.


At our NCT meetup the teacher made it quite clear that she didn't think I had really needed a C-section, I was made to feel like a complete failure.


Following the birth I developed PND and a form of PTSD, which I hid from everyone for almost two years as I didn't feel I deserved help and thought that if I told anyone they'd just think I was being pathetic. I lied to the health visitors when they did their PND form, as I knew the honest answers would make them think I had it, but in my mind I didn't deserve that diagnosis or any sympathy that came from it, it was my fault I felt that way and I shouldn't be taking up their time when their were real sick people for them to see. I did finally manage to confide in my husband and have now had proper diagnosis's, am being treated and am very much on the mend.



I don't think for a minute that the NCT teacher is completely to blame, but I think it was certainly a contributing factor, as is every comment I hear about how birth is a wonderful, life enhancing, easy, experience. For many this is certainly true and I'm genuinly happy for anyone who's had that experience, but I worry that far from being given scare stories we can have an overly romatacised idea of birth and are then looked down on if we don't live up to it.


We are not perfectly designed/ evolved to give birth, we are a careful compromise. We walk upright and have massive brains, because of this (as someone said earlier) we must give birth to our babies while they are still incredibly underdeveloped, our pelvises are only just big enough to get them out and only then if they perform a serious of complicated manouvers in just the right position. We are the only animal that needs help to give birth as our babies need to come out the wrong way round (facing away from the mother). We are designed/evolved so that enough mothers and babies survive all this for the human species to continue, enough - not all.


That's not to say that birth in a western country with a hospital just down the road isn't safe, the chances of anything dreadful happening are tiny wherever you choose to give birth, so yes it is very safe, but I get a bit sick of hearing that birth is "easy and natural" if only you aren't afraid. I'm sure for some people fear is an issue, but so is luck and anatomy!


In an attempt to get back on topic, I'd agree that more midwife led units in hospitals should be the way to go, I'd support the theory of choosing home births, where an informed decision is made but I wonder how much these cost compared to midwives in hospital? Given the state of the NHS finances I'd rather see spending on midwife units and better continuity of care to benefit everyone than on the giving a lucky few a "wonderful birth experience"

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newfakename (love your style with that by the way), I completely see where you're coming from. Trust me, I don't think birth is easy and I agree luck plays a huge part - even though my birth experiences were very positive and easy relatively speaking, I never ever want to go through it ever again - the pain was excruciating and I just count my lucky stars I got away with it (not entirely scott free - I have some scars!) and have two lovely children. But.... the point I was making is that we have to give whatever is our best case scenario for birth a proper crack, just as you did. I have no doubt you needed your c-section and I really hope you feel better about everything (your NCT teacher sounds bloody annoying). I agree with your comment that the mainstream 'standard' care needs to be made much better. It does seem that a lot of the time (and I am guilty of this) we focus too much on the extremes - elective c sections/ intervention heavy births vs 'natural' home births, when the reality is most women end up with a reasonably normal birth, with good and bad aspects.
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Back to this point around cost. I'm always hearing about the lack of bed spaces in hospitals and the cost of bed spaces, bed blockers, etc. etc. So surely, if a woman has her baby at home, the cost of having two midwife's there is offset by the fact she isn't using up a bedspace (i.e. staying overnight and all the attendent costs of having a patient in hospital) in hospital? I know many people have had really horrible experiences of giving birth (both in hospital and at home) My experience was that I did have a home birth, there were no complications, 6 hours in labour, two midwives. While I was pregnant, I did look into 'home from home' type environments - there is a private, midwife led place in Streatham which appealed but I didn't have the income to afford it.
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I've been following this thread with interest. My own experience of NCT left me unprepared for the reality of the birth experience and inclined to be sceptical about the claims of the 'natural birth' lobby, admittedly on basis of my experience of one rather flakey NCT teacher and a number of unsatisfactory midwives. Anyway, I am convinced that my daughter and I owed our good outcomes to being in hospital, so that we moved in a matter of minutes from a midwife-led unit to obstetrician-led care when things started to get grim. And because the transfer took place in good time, we avoided the need for a caesarean.


I don't think that I could add to sbryan's post but I have been struck by a couple of things said by other posters


"a lifetime of negative images we see of labouring women in movies and TV"?

really, is that all? not so long ago, these negative images were the lived experience of many women, and death in childbirth was a real possibility. Actually it looks like what's happening with birth preferences is a classic case of risk homeostasis, whereby a reduction in the risk associated with one factor (childbirth) is compensated for by an increase in risk-seeking behaviour (opting for a homebirth).


the other thing is the claims about natural birth and animals. Frankly, a load of old cod.

My dog was born by caesarean section, as were all his relatives and many of his friends. Any vet will tell you that maternal and foetal distress in labour is common in animals. Caesarean sections are routine among many domestic animals, especially those judged to be valuable.

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Interesting point about risk seeking behaviour - I would argue that practices like epidural are another example of potential risk seeking behaviour - I would no more accuse a woman opting for a homebirth of risk seeking behaviour than someone who chooses intervention such as epidural which interferes with the normal progression of labour and can significantly increase the chance of further complication. Choosing to have your baby in Kings, where for my first baby, I shared a blood spattered post natal toilet with 5 other woman and had virtually no assistance from anyone in the 8 hours after my birth could also be described as 'risk seeking'.


Death in childbirth is a real possibility still - I am not sure if you are trying to suggest that people with my sort of perspective on birth think it is some sort of jolly. We don't. I spent my whole life being terrified by the thought of birth based on what my mother and many of my friends and relatives went through (and TV - where every woman I ever saw in labour was totally fearing for her life and had to be rescued by heroic doctors!) and it was only when I educated myself (a process that is ongoing), I managed to gain what I hope is a more balanced perspective.


PS thanks belle and mrs f and about the clarification on the French

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Going to hospital is not "risk seeking" behaviour. Due to the chaos on the post natal ward at King's and the complete lack of empathy or desire to help from the midwives, it does expose you to risks that one should not reasonably expect in a hospital. We must not accept this state of play. I wish I had written a letter of complaint to King's in the months after my daughter was born but I was simply too tired.
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thanks Monkey


personally I wouldn't take TV as my source of information on life, not even the heroic David Attenborough


I spent a large part of my early life in developing countries and am only too aware of what a risk childbirth presents to both mother and baby (and therfore to the wider family as well). Many women have no option but to use midwives or family members to help them and therfeore maternal mortality statistics are unvarnished and extremely sobering.

In this country, as in many other Western countires, there is a risk (that word again!) that people end up throwing the baby out with the bathwater by opting for what is perceived as 'natural' but is anything but. Maternal mortality and poor labour experience has been hugely reduced as a result of advances not by midwives or doulas or the NCT, but as a result of medically led improvemnts - Michel Odent, for example, was not a midwife but an obstetrician.


I also made a point about the natural lobby quoting the way that animals give birth. Obviously we would have no way of knowing if animals in the wild manage birth safely (but we do know that intervention rates for domestic animals are not negligible.) Without intervention, natural selection would quickly weed out those who couldn't give birth unaided, because their pelvises were too small, or the baby's head was too big, or whatever. However, we humans are lucky enough not to have to worry about natural selection weeding out those who can't give birth 'naturally' - that is what forceps and ventouses and caesarean sections and indeed medical intervention is for.


So it is ill-informed - and more than mischievous - of anyone to say that all women can do it for themselves and to imply that if they can't, then it is their fault. If one has bought into that message and is then racked with a sense of failure and guilt, unfortunately the only other people who can be blamed are the people who peddle that kind of fake reassurance.


Having said all of the above, and said it rather vehemently, can I also clarify that I am in no way supporting the 'doctor/midwife knows best' attitude that seems to be rife in King's and other places, from what other posters have to say. I was lucky enough to have sensitive treatment from the obstetricians and anaesthetists at St Thomas's (although most of the midwives and the ward facilities were rubbish - littleedf, you struck a chord there with your description of the Kings' facilities) but appreciate that not everyone might have been so lucky.

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A couple of points raised; dogs and other domesticated animals are no longer the result of natural selection, hence the need for c-sections and high maternal mortality in many breeds like bulldogs which have been selected for large skulls. My mongrel gave birth easily, twice, to six and seven pups respectively, with a bit of toast between contractions to keep up her strength.


However I take your point that by standing on our hind legs and developing big brains human beings are not very good at childbirth. However I still feel that it is better to go into labour believing that it IS possible to give birth naturally. After all, if it was impossible, we wouldn't be here. I also grew up in developing countries and would say one thing in their favour is that the people are generally fitter and stronger and giving birth for the first time in their teens/early twenties, as nature intended. I on the other hand was what is kindly known as an elderly primagravida... Physical labour of any kind is unknown to me. I sit at a desk all day. But I still wanted to give it my best shot, and I do believe that had conditions been optimal I could still have managed a home birth.

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hi all - i just wanted to post in support of newfakename - (i've changed my logon too as I know what this place can be like!) to say I had very similar NCT teacher and very similar birth experience and post birth depression because of my experience. The c section was fine - it was the guilt and upset that I hadn't had a natural birth that did it for me - and this is from someone that before the NCT classes had always wanted a planned c section . Our teacher even said - why not take a toaster in, (hardly ) and also - if you don't like your midwife ask for another one (!!!!!). Also my daughter may not be here now if I had listened to the NCT all the way and not my friends - I was advised to have an induction when my daughter was a week late , I ummed and ahhed - and then all my friends said - do what the doctors say - so I did and in the end my daughter had been in some distress so who knows what would have happened.

my experience of birth and breastfeeding completely ruined my first 6 months. and I entirely blame the childbirth classes I went to.


very very glad the government has changed the guidelines as it gives the right message to all those mothers to be out there - do what is right for you - or more importantly your baby, nothing else matters.

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