Thursday, February 7, 2013

So You're Gonna Have a C-Section

I have had two c-sections. One was an emergency, the second one was scheduled after hoping for a VBAC. After each birth I was extremely disappointed that my body wasn't "normal" and I couldn't have the vaginal birth I had always dreamed of.

Since then I've often thought about women who go through c-sections. We're often pitied upon because we either didn't get the birth we "wanted" or we didn't have a "normal" birth. I also think we're treated differently by the medical community. The joy and excitement of birth suddenly becomes just a routine surgery. But that's a whole other post for another day.

Sometimes c-sections can't be helped. There are many times when surgery is medically necessary. Thank God for modern medicine, because I imagine that if I would have lived 300 years ago my baby and I would not have survived due to my high blood pressure.

C-sections can be scary. It's major surgery. There is no getting around that. Women go into the operating room not knowing what the hell is going on and I believe that's just wrong. We have baby books and magazine articles and butt-loads of birth stories involving vaginal delivery. We know what to expect in those situations. But c-section stories? There aren't that many out there. First of all, they're kind of boring. The surgery is pretty much the same if it's planned or emergency. Secondly, a lot of women don't have an outlet to tell their story.

Even though c-sections are not ideal, the birth of a child should be celebrated, no matter how the baby came into the world.

The purpose of this blog post is to be as detailed as possible about how my two c-sections went. Of course my experience will be different than other women's. People react differently with medications. Doctors and nurses have different personalities. I was lucky enough to have two really good c-section experiences. My situation is different in that I never experienced labor or pushed. My emergency c-section was due to an induction that went on for two days and nothing was happening. My blood pressure kept climbing dangerously high and the only thing to help both Joe and I was delivery by c-section.

I don't think there was anything too out of the ordinary with my c-sections, so hopefully my experiences can prepare other women for what to expect during a c-section. I also included some tips for recovery and some things to think about in terms of c-section scar cosmetics.

BEFORE SURGERY

Emergency c-section:

I was sent to the hospital for observation because I had high blood pressure. It wasn't going down, so they admitted me to be induced. The nurses and doctor had a "wait and see" attitude. After about 48 hours of magnesium sulfate hell, bed rest, no drinking and no eating (in case I had to have surgery they didn't want me to vomit up the contents of my stomach and possibly aspirate), and no progress from Cytotec or Pitocin the doctor said it was time to have a c-section. It wasn't a "it will be later this afternoon" it was a "I'm going to go get ready right NOW." I had 20 minutes to prepare myself.

Like I said before, it wasn't like I had stalled in dilating or had no progress in pushing and then they decided to do a c-section. But I imagine the whole going into surgery in 20 short minutes feeling is the same "holy crap" feeling regardless of the situation. My "labor" had consisted of me burning up and shaking and DYING of thirst due to the magnesium sulfate.  Part of me kept wanting to keep trying the induction, but in some way I was relieved to get the whole thing over with.

While the doctor was getting ready, the nurse came in with THE DRINK. I had no clue what this little tiny plastic shot glass type cup was. She told me to drink it and it helps prevent one from throwing up during surgery. She warned me that it didn't taste good, but just try to imagine it was a margarita. I drank it down in one gulp and oh em gee... it tasted HORRIBLE! It was very tart/soury/bitter and just bleck.... The purpose of this drink is to netralize stomach acids so I wouldn't throw up during surgery and aspirate the vomit into my lungs. I put on my blue hair net thingy, settled back into my bed and was wheeled to surgery. Ryan stayed behind to put on his scrubs.

Planned c-section:

I was told not to eat or drink anything after midnight before my surgery. Same reason as before- so I wouldn't vomit during surgery and aspirate. I swear this was the hardest part of the whole thing. I'm like a freaking hobbit when I am NOT pregnant. When I'm pregnant I'm like a hobbit who is high and I want to EAT ALL THE FOOD!!! It was tough.

We had to get to the hospital at the butt-crack of dawn. I checked in the admission office then went upstairs to the birth place. Instead of it being a very laid-back "we'll see what happens" atmostphere, it was very down to the point. It was very structured and routine. I was handed a gown, was weighed and got into the bed. A nurse came to ask the same questions I swear I'd been asked 15 million times before. A lab tech came into draw some blood. Another nurse put in an IV. My blood pressure was checked. I was hooked up to a contraction and baby heart monitor. It was all very systematic. The "routine-ness" kind of overwhelmed me, but thankfully the nurses were nice and their laid back attitude calmed me down.

My husband and I hung out for awhile. My nurse sat there and chatted with us. My doctor came by and visited and told us to give the anesthesiologist's assistant grief for being Jesuit.. They brought Ryan a breakfast tray which I eyed like maniac. Then they brought the nasty drink. I drank it. I had about 20 minutes until I was going to go to the O.R. and I felt really sick. I went to the bathroom but nothing came out. I don't know if was just nerves or from the drink.

I came back to the room at the anesthesiologist was there. He asked me a bunch of questions and asked if I had any concerns. I had vomited everywhere with my first c-section (more on that later), and I told him I would like to avoid that this time, and he said they'd put some anti-nausea meds in my IV. I also told him I wanted a spinal block instead of an epidural since that is what I had with my first c-section. He left and we had just a few minutes to spare. The nurse came in and shaved a little bit of hair off my belly and bikini area for sterilization reasons.

I put on my blue hair net and walked to the O.R. This was a huge victory for me. I was on bed rest before because of my high blood pressure and had to be wheeled to the O.R. I felt so helpless and defeated. This time I walked with pride and courage.

Like my first c-section, Ryan stayed behind to put his scrubs on.

ANESTHESIA

Emergency c-section:

Being wheeled into the O.R. was kind of scary. I was by myself. The room was very bright and steel-y. There were three or four nurses there waiting, but I couldn't tell who was who because they had the surgical masks on. It was freezing cold. They had to shift me on to the operating table from my hospital bed. Made me feel like a 300 lb woman. They had me sit at the edge of the hospital bed to administer the anesthesia. I felt kind of weird having my lumpy buttcrack showing for all the world to see, but I had 5 different nurses and a doctor look at my hoo-hah during my hospital stay, so I wasn't too worried about my buttcrack.

The anesthesiologist came in and told me he was going to use a spinal block instead of an epidural because it was faster. I sat on the edge of operating table. A nurse stood in front of me and I hunched over as far as I could and she supported me while the anesthesoligst did his thing. The nurse was really nice and helped me relax. She told me to focus on relaxing my shoulders. The anesthesolist warned me that he was going to injecting me with some stuff to numb me before he actually did the spinal. He said it would feel like a bee sting, and that's what if felt like. Just a sharp prick. It hurt just for a second.

Then he started on with the spinal. I couldn't feel anything on my back as he was putting the spinal block in. It was still nerve wracking waiting. It was about 10 minutes of "OK I can still feel my legs... what's the hold up here?" That was probably the thing that scared me the most- the spinal not working. I was hunched over for what seemed like forever and I suddenly I felt a zap-zinging feeling in my crotch. The anethesiologist asked if I felt anything. I said yes, and then the zinging feeling went down my left leg, then my right, and then slowly I couldn't feel my legs. The nurse helped lay me on the table. I tried so hard to to move my toes, but it just wasn't happening. It was so weird, but kind of cool. I could still move my arms.

They put me on some light oxygen and I laid back waiting for the show to start.

Planned c-section:

I walked into the operating room with my nurse. It was freeeeeezing cold. Lots of weird equipment. I used a step stool to get on the operating table. Like my first surgery, I leaned over on my nurse and the anesthesiologist assistant came to give me the numbing shot. It stung like before, but only hurt for a second or two. I asked him if he was Benedictine trained and that just started a whole fun/joking conversation about theology. It took awhile to get the spinal block in, maybe 10 minutes. I was shaking because I was so cold and nervous. Like my first c-section, I was scared that the spinal wouldn't work, but then the coolest thing happened. It wasn't a zinging feeling like before... it felt like someone slowly laid a nice warm blanket on my legs. I stopped shaking. It was actually quite relaxing.

I had a choice this time whether to chose a spinal or an epidural. I went with a spinal because it is what I had before so I knew what to expect. Plus, it wears off faster than an epidural and I'd be able to get up and move around sooner.

The nurse helped get me settled onto the table and they put me on some oxygen and I waited. During this time they inserted a catheter. I couldn't feel it, but let me tell you, I was SO THANKFUL I couldn't. With my first c-section I was on bed rest during the induction, so they inserted a catheter a day or so before the c-section. It was the most uncomfortable thing I've probably ever experienced, and that includes having surgery. It sucked so bad.... so needless today when I asked the nurse when I was going to get my catheter and she said when I was numbed up, I almost french kissed her.

THE SURGERY

Emergency c-section:

I laid back and they placed my arms outstretched and secured them down. They placed a blue curtain up separating me from where they were going to do surgery. I don't know if this was normal, or if I just have a very short torso, but it was all up in my face. The nurses were really good about making sure it was out of my way.

It was that time that Ryan came in and sat next to my head. Everyone was doing stuff around me, and Ryan and I were just nervously chatting. I didn't even know my doctor was there and I heard them say "We're scraping a knife against your abdomen." I could not feel a single thing. At this time they were cutting and suctioning out the amniotic fluid.  I swear what was like 2 minutes later I saw the blue sheet rustle around- they were getting Joe out. The nurse said, "You might feel some pressure" but I felt nothing at all. The nurses were all "There he is!" and "Hi peanut!" but I didn't hear him cry right away. Babies born vaginally get all the mucus and crap in their lungs and nose squeezed out of them in the birth canal, but not c-section babies. They had to use a bulb syringe and suction him out, and then I heard his little bubbly cries.


The nurses took Joe to the warmer to do their assessment. That's when I started getting the shakes. With the exit of the baby my body's hormones were all effed up. I was shaking so badly until they put a warm blanket around my arms and chest. Ryan left my side to go cut the cord and see our son.

A few minutes after he was born they brought him to me. I couldn't hold him, but the nurse put him right up to my face. It was the weirest thing. Here was this baby I had been carrying within me for 9 months and there he was in person! I was still in shock from everything... being induced 2 weeks early, a failed induction and an emergency c-section. It was all very surreal.


They took Joe out of the O.R. to get weighed and Ryan went with him. I felt no pain, but was starting to get woozy. Suddenly, I had to barf. It just hit me like a ton of bricks. The anesthesiologist got me a little tray and I upchucked in it. Not sure if it was from the spinal, or hormones or what it was, but I had felt fine one second and the next it was like a scene from The Exorcist.

I felt better after that and I just waited around for them to stitch me up. I felt nothing. I started feeling loopy. My memories of being wheeled out are kind of fuzzy. I remember talking about the Kansas City Chiefs. I also remember them wheeling me out and there was a thing that contained all the bloody rags from the surgery. I asked "Are those my guts?" Yeah, I was majorly out of it.

Planned c-section:

Everything was pretty much the same as my first c-section. They didn't strap my arms down. They put the blue curtain up and my husband came in and we all just chatted. I was kind of weirded out by the anethsisa. I couldn't feel anything, but it almost felt like that weird prickly feeling when your arm falls asleep... like you can ALMOST feel it. I was a little worried about that but pushed it out of my head. I was wondering what the hell the hold up was, and asked if my doctor was there yet. "Yeah, I'm here! We got you open now!" I guess the anethsisa was working well, because again, I felt absolutely nothing!

The doctor, anethsiologist's assistant and I were joking about Benedictines vs. Jesuits while everyone else was probably wondering what the hell these Catholic weirdos were talking about. One of the other doctors assisting my OB said I'd feel pressure. Again, I felt nothing, just saw a lot of rustling of my blue sheet shield. Lots of "Yays!" and "Awwwws!" and I heard Sam's very loud gurgly cries. They lifted him up enough for Ryan to see. I was expecting Sam to go right away to the warmer, but my doctor brought him to see me, upside down and all gooey from birth!




My doctor took Sam to the warmer where they did their assement. Again, Ryan went over there, but this time didn't cut the cord. Then they brought him to me. Since my arm wasn't strapped down I was able to touch him, but I didn't feel comfortable holding him.


Ryan went with Sam to the nursery where the nurses continued their assessment. I laid there and got the shakes and they placed a warm blanket over me. I didn't feel sick at all. In fact I felt totally and completely relaxed. It was such a chill, zen feeling. The anthestiologist got a slightly cool rag and wiped my forehead. He said, "We're going to treat you like you're at a spa. Just close your eyes and relax." I never fell asleep, but I just felt sooooo good. Not over woozy or out of it. Just very peaceful. It was freaking awesome. Now that I'm writing this I wish I could go back and get that feeling again.... sign me up, yo!

I understand that some women won't have the same relaxing experience while getting stitched back up. Some babies are rushed to the NICU or to surgery and I cannot imagine how scary that must be. I was laying there knowing my babies were in good hands and were healthy. I guess the only thing I can say is if your baby is rushed to the NICU, just try to be calm. Trust the medical professionals around you. Focus on this one part of getting sewn up and then focus on the details when they are finished with you. 

They transferred me to a hospital bed and wheeled me out. Things are kind of fuzzy when they were wheeling me out.

POST SURGERY

Emergency c-section:

The hospital where I had Joe did all their assements of newborns in the mother's rooms. They had a portable warmer, so when they wheeled me back to my room Joe was already waiting for me. I didn't have to wait at all, soon they placed him in my arms and I got to work breastfeeding.

After about 30 minutes or so they brought me some food and water. Remember I hadn't eaten or drank anything in 48 hours so I devoured the broth and orange popsicle. Aaaaaaaaand it all came back up, all over me. Not sure if it was the drugs I was on, or the hormones or I ate too fast, but it was nasty. I've heard of other c-section mams throwing up after delivery, so be wary!

You still can't feel your legs for quite awhile after surgery. I think it was maybe 4 or 5 hours before I got feeling back in my legs. During that time they put these things that wrap around your legs. They inflate and deflate. The purpose of these is so you don't get blood clots in your legs. At first they feel pretty awesome, like a massage. But I had to wear mine longer than normal because I was still on bed rest because my blood pressure never went down. They started to itch like crazy.

The nurses came in and periodically checked my incision. They said everything looked great. It was not until later that night of my surgery with Joe that I started to feel pain. It wasn't excrutiating, just bothersome. Pain medicatoin helped that. The nurse took off the wrapping to my incision later that night. I thought it was kind of soon, but she told me the incision heals better if it's not all trapped up in bloody bandages.

My post-birth story isn't really the same as normal c-sections because although Joe was safe and healthy, I was not. My blood pressure kept sprialing out of control. Thankfully my recovery was easy, because I had to focus on my health!

Planned c-section:

Sam's assement was done in the nursery, so when they wheeled me back to my room I had to wait about 10 minutes before Ryan brought him to me. My doctor came in to talk about how the surgery went, which was perfect. Finally they brought Sam to me and I started to nurse. They brought me food, which I ate and didn't throw up this time. It was a really great experience.

I had to wear the blood clot preventer leg thingies, but only for about 24 hours. They still drove me crazy at the end. My catheter was removed about 24 hours after my surgery. However, I was able to get up and walk about 10 hours after my surgery. I felt like an old woman, all hunched over because I was afraid to stand up straight. I got tired very easily, but tried to walk as much as I could, little by little.

Pain-wise, I was in a lot of it. But it wasn't all from the c-section- it was from breastfeeding. When you breastfeed after birth your uterus contracts. It hurts. But with each delivery the breastfeeding contractions get worse. It hurt SO SO bad for me. I didn't know what was going on and I was scared to death that my inner incision was busted open or something. I called in the nurse and she told me that it was from breastfeeding. Since it was my second delivery it was gong to hurt more than last time. No one ever told me that!

Like my first hospital stay, the nurses checked on my incision often. The dressing over the incisoin was removed later that night.

GOING HOME

Emergency c-section: 

Again, my situaton with Joe was different, because my blood pressure remained high after delivery. I believe a typical stay for after a cescarean birth is 3-4 days. I had Joe on a Thursday morning. If all went well, I could have left on Saturday. I didn't leave until Monday because I was in such bad shape. Needless to say, I was ready to get the hell out of there. They used medical glue for my incision, so there was nothing they had to do with my incision. They just gave me tons of instructions and I finally went home.

Planned c-section:

Everything went very well with my c-section. Thanks be to God I didn't have blood pressure issues. My c-section was on a Monday morning. My doctor said I could leave on Wednesday and the latest I could stay was Friday. I was like "Hell yeah, I'm going to blow this popsicle stand ASAP!" However, on Tuesday night I felt very weak and tired since I had gotten out of bed a lot. I decided to wait until Thursday. As much as I wanted to get back to my own home and to Joe, I really needed that extra day of rest at the hospital. Thankfully my nurses were AWESOME so staying wasn't that big of a deal for me.

With this c-section they used staples to close my incision. Before I left they had to take out the staples and put on steri-strips. It felt uncomfortable, but it wasn't too terribly bad. I think I had taken some pain meds about 30 minutes before that, so that probably helped.  

RECOVERY

Emergency c-section:

Despite me being so sick from my high blood pressure, my recovery went very well. They used medical glue, so I had no problems with my incision. I don't even really remember if it bled. The pain at the incision felt like a big, major cat scratch. My pain meds took care of that. Most of the time I just felt achy. Thankfully my husband helped out a lot since he had a lot of paternity leave, so my physical recovery was pretty quick and easy, maybe 4 or 5 weeks. Mentally... well... that's another story

Planned c-section:

Recovery was very tough this go around. I'm relatively sure that was due to the fact I had a 2 year old boy to take care of in addition to a newborn and my husband had to go back to work fairly soon. I just didn't get the rest my body needed. I was in a lot of pain. It was a good 6 or 7 weeks before I felt normal again.

I did have a problem with my incision. The doctor told me to leave the steri-strips on until about a week after I was discharged. He told me to call him if there was any major oozing coming from the incision. Well, it was a week later and my steri-strips were still barely hanging on. I looked in a mirror and noticed they were yellowed and when I wiped with a cloth there was what looked like yellow pus. Plus, it smelled awful down there. I was sure I had an infection. I called the doctor and went in early the next morning. He took a look at my incision and said it was perfectly normal. My incision had a little bit of discharge, but that was normal. It was yellow because of the steri strips. The steri strips were also causing the gross rotten smell. He said that after awhile, the bacteria on the steri strips causes a reaction, and that's what the smell was. I was relived that everyhting was OK, but wish I had known about that so I wouldn't have freaked out. They told me to take some gauze with peroxide on it and wipe down my incision a few times a day to keep it clean.

TIPS FOR RECOVERY

*Use a hair dryer to dry your incision after a shower. A nurse told me this tip with my first c-section and I am so glad she did! I didn't feel comfortable patting down my incisoin to dry it, so I used a hair dryer. It made it nice and dry and helped with itching.

*Get as much rest as you can. Get as much help as you can. You are recovering from major surgery. Don't try to be all, "I'm a woman, I can handle this shit!" If you feel up to cleaning the kitchen, either talk your self out of it, or do about half as much as you would normally do, because you will pay for it later.

*Get everything you need and place it around you. Books, lotion, computer, water, snacks, whatever you need. That way you don't have to get up all the time and you don't have to annoy your husband by asking him to get you every little thing.

*But before you become a complete couch potato, do get some VERY light exercise. And when I mean exercise, I mean walk from one side of your house the other. The next day, walk around the outide of your house. The next day maybe walk down the street. The next day walk around the block. Start of slow, but you NEED some sort of activity or it will be harder to recover.

*Take your pain pills if you need them. You might feel like Linsday Lohan the first week or two with as many pills as you pop, but the better you feel, the more you can move around and the faster you will get better.

*If you have to cough or sneeze or laugh, press a pillow in your abdomen. It helps, trust me. 

*It's normal to feel numb around your scar. This numbness may be there for years. It's weird, but normal.

*DRINK WATER! This is so important if you are nursing, but it is also essential for overall well being. Water is awesome. I am so not even joking! DRANK!

*It's going to seem like you will be in pain/achy/tired FOREVER. You're going to think that having a c-section was probably the worst thing that could have happened to you. But remember, vaginal births have recovery time as well, just not nearly as long. Expect to be in pain and sore and shitty for 4 to 6 weeks. Each day will get better, I promise. Then in 6 months you'll be like, "Let's do this again!!!"

COSMETIC

Some women are very self-conscence of their scars. Most are barely noticeable and are low enough so if you wear a binki, it can't be seen.

But if you are fat like me and your belly looks like this: 

My boobs are much bigger

.... then you won't even see your incison because it's covered up by a nice apron of fat. Because of this I've never really worried about what my scar looks like.


There are natural remedies out there to reduce scarring, but I honestly don't know much about them.

However, there is one thing that I learned with my second c-section. My scar from my first c-section developed into a keloid. I had never heard this until I was on the operating table and my doctor said he was "cutting out the keloid". I was like "Ehhhh... what in the hell is a keloid?!" It's just excess collagen built up around the scar. That's why I always thought my c-section scar looked like a tiny earth worm across my belly. He said even though he was removing it, there was chance my second incision would develop into a keloid, which it has. Oh well.

*************************************************************************

I think that's all I have for y'all. Again, every situation is different. Complications from c-sections can happen. I don't want to sugar coat anything. But knowledge is power, and the more you know going into a c-section, the less scary it will be. For some, c-sections are no big deal. For some women, the thought of surgery scares the bejesus out of them. But just think of it this way: you're letting someone cut you open while you are still awake. That's pretty bad ass.

Focus on the positive. Focus on the new life that you brought forth. Focus on completing the end of your pregnancy journey.

Please feel free to email me if you have questions. Also, if any of you other c-section mamas have anything to add, please do so in the comments! (I'm not smart enough to host a link-up.)

I hope this helps!







13 comments:

JoAnna Wahlund said...

Why did you have magnesium sulfate during an induction? Isn't that supposed to stop contractions?

Maggie @ From the Heart said...

They gave it to me so I wouldn't stroke out because of my high blood pressure. They were hoping the Cytotek and Pitocin would be strong enough to work.

Alissa Juelich said...

I wish you had written this 7 months ago!!!

Stacy said...

Wow, this was super informative! Thank you for writing it! Question about the keloid- is it an issue or just cosmetic?

Abby said...

Thanks for sharing this - it is totally timely because I'm scheduled for a planned c/s on Monday. My first baby (daughter) was a med free, intervention free regular ol' vaginal birth, so I never, ever thought I'd have to be *planning* for a c/s. Unfortunately, baby #2 is frank breech with no interest in flipping in the right direction. So thanks for sharing - it gives me a little bit more idea what to expect! Fortunately, I had a long rough recovery even from my vaginal delivery (lots of tearing and stitches, and separated my pelvic bones so couldn't walk or turn over in bed or anything like that well for *weeks*) so at least my recovery expectations are probably more realistic than they otherwise would be. It's emotionally hard to wrap my mind around though!

Joy said...

Wonderful overview!
I was taught by an older midwife to tell the mom at that " you may feel some pressure" moment since many women do feel it ~ You are birthing your baby now ~ because you are so right: in addition to being surgery it is also the birth of your baby.

sayin' i love you said...

Well, I haven´t had a c-section but I did have those pains you mentioned after giving birth to my daughter (she´s #3) I didn´t have those with 1 and 2. By the way, that´s how my belly looks too :)

Blair said...

Thanks for sharing this. It's hard to find c-section stories in general since many of us have had kind of traumatic experiences. I've had 4 sections and with 3 of them I labored to 10cm (the 3rd was unintentional but the first two I was trying for a vaginal birth). I still have a lot of hangups and fears related to these experiences, so it's nice to read others' accounts and advice!

Sara said...

After 4 c-sections myself, I'd just like to second most everything you said. Nice over view. And congratulations. I will note that at my hospitals (3 different ones) all the assessments were done away from me. I got wheeled to a recovery / observation area and my kids were sent . . . ? For all four, my husband stayed with the babies when I was out of it. This turned out to be a special time for him, being Daddy and watching over our new little ones for their first couple of hours while my spinals were wearing off.

As far as nausea, I badly sick after my third, but only after that one.

Gigi said...

Thank you! Thank you! Thank you! I am due in three weeks but started having BP issues two weeks ago. At this point, it's controlled by bed rest, but they are prepping me for inducement and a possible c-section. I am still hoping for a natural birth, but I am being realistic. I spent months reading and prepping for a birth with no meds and now, trying to prepare for what may happen c-section-wise has been difficult. You have been an answer to my prayers. God Bless!

Rebecca said...

I am 41 and will be having my 7th c-section in 5 days. I so enjoyed your article It was as if I was reading my own experience. A great laugh. I especially could relate to your last picture! I laughed my butt off. Thanks so much for sharing.

C-section incision said...

All the information are really nice this is very valuable information for all. Thanks for sharing such amazing post.

Anonymous said...

I am shocked to hear that they trapped your arms down. I am in the UK and they don't do this here. Indeed I was told they are not allowed to do this in UK hospitals. So don't know why they do it there in the US. I hope you made a complaint to that hospital about this.
Jenny.

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