The lead up to Saiges Birth - A breech baby battle
travellingseiz
What a crazy adventure we have had with this wise wee soul. Where to start?

As most of you will know this pregnancy came after a loss at 9 weeks due to a missed miscarriage so our precious wee babe is what we call a 'Rainbow' baby - The beauty that shines through after a horrible storm. Here is the adventure of the arrival of Saige - Just a heads up it will be graphic and possibly triggery for some. On with our adventure....

22nd April 2016 confirmed we were expecting. We were both delighted and more so when we realised our baby was due around New Years. Our first scan went well with a great heart beat but there were concerns over the unusually large yolk sac which can be an indication of genetic abnormalities such as trisomy and statistically scans with large yolk sacs miscarry in approximate 70% of all cases. Not the news I was hoping for. It was a very tense wait for the next scan - and of course for our anatomy scan, to try and put our minds at ease.

Our 8 week scan was perfect and our 12 week scan showed a lil bean wriggling away - Happy as could be. Our anatomy scan came back great with only a 1 in 8,800 chance of any trisomy disorders so that was a relief. We didn't have any additional scans organised and waited out the rest of our pregnancy. Our due date according to our 6 week scan was 31st December 2016 - What an awesome due date!

We choose not to find out the gender of our baby - We loved the awesome surprise we had with Phoenix. Tane and I felt like we were having a girl but we certainly weren't convinced of babies gender the way we had been with Phoenix. As we neared the end of our pregnancy the world and it's mysterious ways certainly indicated a girl but I was still only 60% convinced haha

The pregnancy was a hard one. I had morning sickness right the way through as I had with Phoenix. Suspected HG until about 26 weeks - I managed this with both Metaclopromide and Odansetron though it didn't stop the vomiting or nausea, just reduced it from hourly to maybe 3 times a day. After 26 weeks the vomiting subsided - Maybe once a day until about 32 weeks then dropped off to occasionally until I gave birth but the nausea still plagued me most days. On top of the morning sickness I had awful pelvic pain from 8 weeks on-wards. It worsened as I got bigger.

At the start of our pregnancy we were house hunting every weekend with a toddler in tow. When I was about 18 weeks; And after losing 8 auctions and 2 PBN and searching for over 11 months; we finally purchased our house in Warkworth. By this stage we'd moved out to flat with Ange and had put 90% of our belongings in storage. We finally moved into our home in August. I was about 5 months pregnant when we moved and it was exhausting for me but we got there in the end.

I'd planned to birth at home, had organised everything (pool, califont, towels and blankets along with everything else I needed) and set it all up at 37 weeks.

My 38 week appt brought an absolute shock - Baby has turned breech and I wouldn't be able to birth at home unless we could get bub turned back. I would need to birth at North Shore Hospital and a C-Section was the 'Standard' recommendation for a breech baby. I was heart broken and cried for days.

The day after bub was found to be Breech I went to Whangarei hospital to have an ECV done in the hope baby could be turned. There were a number of risks associated with an ECV including the possibility of needing an emergency c-section if the placenta came away. Tane was working so Hazel came along for the journey. There was no way I was ready to meet my baby just yet so I hoped nothing would happen to need an emergency c-section and I was begging for the ECV to be successful.

The ECV involved injecting my thigh with a medicine to relax my uterus. The Ob then checked babies position and using their hands (and an unbelievable amount of force) the OB and her assistant tried to manually turn baby through my belly. To say it was painful is an understatement. To have two women's hand's cm's deep in my belly and pelvis trying to lift and spin baby was excruciating. To top it all off baby didn't budge - Not one inch. After 15 or so minutes they gave up.

When the hospital midwife asked what I planned to do now I said 'Birth baby breech' and here started my battle of wills between those medically minded and myself - aiming for as natural as possible. This was my first taste of the battles to come and how very important it was for me to be informed and to know my rights. The hospital midwife said to me 'Oh well you'll have to be continuously monitored then when you're in labour' Meaning the CTG machines would need to be attached from the outset. Now I found these very restricting and psychologically limiting and I knew in labour I would want to move about freely. When I mentioned to the hospital midwife that 'No - I wouldn't be continuously monitored but that a doppler could be used as and when needed' she seemed quite taken aback, I'm not sure most of the people I encountered on my journey were ready to meet someone who wasn't going to follow the rest of the sheep who have c-sections for breech babies 'Just because they're breech'. I went home disappointed and concerned about the 'Battle' I saw before me.

This whole time I had been asking baby to stay put until at least it's EDD - Now I was wishing bub had decided to come at 37 weeks so I could still have had my homebirth. It was such a crushing time. I knew this would be our last baby and I had so wanted to birth at home - On my terms, in my environment and my way and now all I could see was all of those hopes being flushed down the drain just because my baby was breech and worse yet a c-section which has to be the polar opposite of my homebirth - How had this happened?

I came home and started researching - vowing I would arm myself with as much information, knowledge, statistics, advice and real world outcomes as I possibly could. I also set about finding every possible avenue to try and turn a breech baby. So began hours and hours and hours of trying everything possible to turn bub - Inversions, accupunture, osteopaths, chiro's, moxibustions, hypnotherapy, hot and cold, music and light - you name it and I'm pretty bloody sure I tried it. It cost me hundreds of dollars and literally took up all my spare time. It was exhausting - Not the way I planned to spend my last weeks of pregnancy.

I had a number of growth scans along the way tracking babies position and size. We were well placed position wise with baby being frank breech (feet up by it's face) and bum presenting well in my pelvis however the growth scans indicated bub was a big baby (9lbs 7oz at 39 weeks then 10lb 7oz at 41 weeks) and big babies are not high on the 'recommendation list' for a vaginal breech birth (Known as a VBB).

A little bit of history on Breech Births. Breech was considered a 'Variation of normal' for hundreds of years until a trial study called the 'Term Breech Trial' was conducted - This study aimed to figure out the outcome of breech births. The information is considered by medical professionals as the 'Go to' in breech cases and was quoted more times than I care to consider during the course of my care BUT this study has since been considered bias and unreliable due to the way the study was conducted - with no consistent approach and information being presented in a bias way - for example when discussing mortality (Death) in breech births the term breech trial (TBT) study gives figures that include ALL deaths in breech presentations - It doesn't itemise out those deaths that were almost a given due to genetic disorders or very premature births. Breech presentation at full term has a higher rate of genetic abnormalities - some suggest this might be due to the baby not having the ability (Muscle tone or otherwise) to get into the optimal birthing position. Breech births are also more common with preterm babies (As most babies like to get into optimal position as spaces becomes limited and birthing day draws near) and premmies have a higher likelihood of adverse outcomes vs a full term bub.

Anyways -Before this study breech births were generally delivered vaginally. No reason not to when it's just a variation of normal right? Well the statistics from the TBT showed a higher risk to baby in both mortality and morbidity and so it became common practice to send those with breech babies straight to theater for a c-section - After all it was the 'safer' options right? Well yes and no. C-Sections are major surgery and with that comes major risks but these risks lie with the mother generally. Common risks included infection, hemorrhaging, uterus adhesion to other internal organs (Potentially requiring additional surgery later on to correct this), a stay in HDU for complications, reduce rates of successful breast feeding, complications from the anesthetic administered... I could go on and on and on. I'm not saying there aren't risks with Breech - There are. These risks lie with baby and include such horror scenarios as head entrapment (Where the head gets stuck in the pelvis) which can lead to death of baby or serious brain damage but the risks in a VBB are few but serious as opposed to a c-section where the risks are more but generally with a lesser severity.

So why does this matter? Well over the course of decades those skilled in VBB such as midwifes and OB's has dwindled. VBB is something every midwife and OB has to review in a teaching/ classroom scenario but those who have actually witness and been hands on with VBB's are few and far between. This means there is little support for mums wanting to VBB and a serious lack of skilled VBB care providers. There is a change in the tides as more momentum comes about to normalise breech presentations again and to up-skill the care providers so VBBs can be an option. Even as I went through all I did with this pregnancy the 'Hospital policy on Breech Birth' was updated (Ironically in January 2017) to better support VBB's as opposed to becoming an automatic recommendation for a c-section. Still it angered me that I would be battling to birth vaginally simply because the antenatal sector had forgotten how to birth VBB's. Why should I be subjected to major surgery just because of a study that really isn't all that credible? And because skills have been lost over generations because of this flawed study?

At almost 40 weeks I met with the hospital OB consult (The big cheese so to speak). I went in with my battle suit on, Hazel by my side for support and weapons ready to be drawn. I was expecting a war. Instead I was met with a very matter of fact lady called Jye. She was my kind of talker. Statistics, evidence based information, Options but above all else she was ready to HEAR me. We spent 1.5 hours going over everything - All the scenarios and options and possible outcomes. She needed to know I was making an informed decision to cover her arse and I respected that. I felt Jye understood my position and as much as she said she needed to recommend a c-section because that is; in her mind; the safest option - she could accept that I wanted to attempt a VBB and she would facilitate that wish though there was some negotiations to be made on my birth plan to cover the hospitals arse once again. It's ok, I can compromise and did so willingly on some factors; not so much on others - but come the end of our meeting we were both happy with where things were sitting. VBB with a c-section as back up if there were any indications of baby distress or I was in trouble. However there was to be no induction methods to be used - Not even a stretch and sweep (Which was fine by me) as any inductions of a breech messes with the natural process both baby and body needed to go through to get bub here safely. Breech birth is a hands off affair. No one touches baby until it's been delivered to the nape of it's neck so this made sense and I mentioned in passing that if I got to 42 weeks we'd look at a c-section (Never thinking I'd actually get there!)

More bloods, more attempts to turn baby, more money and time spent in vain. Finally around 41 weeks I stopped trying everything and accepted my baby was breech and that was the way it would be.Baby might turn during labour but I didn't feel confident so I made my peace with a breech baby and a breech birth. I mapped out both VBB and C-Sections plans and discussed at length with everyone I encountered on my journey about my preferences and why. I was mostly supported.

Meanwhile my Midwife and I searched for a VBB experience midwife to take the lead carer role come delivery time but we couldn't find anyone. Kudos to my Midwife - She was out of her depth but still supporting me in my decisions. It must have been pretty scary for her.

Next meeting was around 41 weeks with another OB at the hospital for post dates and to discuss c-section details. I was by myself but more relaxed this time given how positive my initial meeting with Jye had been. Unfortunately this one didn't go so well AT ALL. The meeting started with her sitting down next to me, putting her arm around me and saying 'I'm going to be blunt here. I think you need to have a c-section. I estimate you baby has a 1 in 5 chance of serious brain damage if you deliver vaginally' - This approach, especially coupled with being in my personal space while delivering it, left me so disarmed I didn't actually know what to say or do. I instantly donned my battle suit and drew my weapons. Who was this woman to speak to me like this and where the hell are her figures coming from. There is nothing in all the research I've done to support this ridiculous statistic... All I saw was a woman trying to terrify me into doing what she wanted. After all I was overdue now with a suspected (I say suspected as growth scans are notoriously unreliable) big baby so I was a 'Ticking time bomb' on the hospital books. When I said I wouldn't be having a C-Section and I chose to attempt a VBB she moved from the bed side to her desk and her mannerism changed from all caring to stoney. 'Well there are things we'll want you to do like have an IV inserted and an epidural inserted 'Just in case' on arrival'....
No way, Back up. Why the hell would I choose to have an epidural inserted 'Just in case'? Are you serious? Take on a host of potential risks and complications 'Just in case'. Now I was angry.
I told the OB consult that I wouldn't be having either of those on arrival and if I changed my mind we would discuss that on the day. I also advised that if she didn't stop scaremongering me like this then I would leave and birth at home by myself - Which I wouldn't actually do but there was no way I was going to be spoken to like this. Funnily enough the meeting wrapped up quite quickly - Maybe 10-15 in total - and I left with a bitter taste in my mouth. My midwife later advised that the 1 in 5 chance of brain damage had been a statistic that she had made up based on her 'extensive experience in third world countries'... Bloody hell!

More time came and went. At 41 weeks (Just after the above horrendous meeting) I went for another ultrasound. Baby was measuring 10lb 7oz. Still breech. Fluids and dopplers and placenta were all perfect. By this stage I'd adopted the 'I'll have baby either when I go into labour naturally or when there is an indication that baby NEEDS to come out such as distress, low fluids, placenta degradation or me being unwell- in which case I'll have ac-section'. I was being monitored daily with ctg's and having ultrasounds twice a week. I personally was fine and believed baby and I would be fine. I had absolute faith in my body and my baby.

Not long after this Tane's mum had an accident and broke her femur. She ended up in hospital needing surgery to put her leg in place. Around 42 weeks we popped in to see her at NSH and Kathy my midwife had organised a meeting with me and the consult anesthesiologist to discuss my concerns about the c-section. His name was Ted Hughes and he was awesome. Great to talk to, informative, discussed all my concerns at length and went over everything I could expect. He spent about 1.5 hours with Tane and I and I was really grateful for his time. Of course he still recommended a c-section and sooner rather than later. Everyone was getting nervous now.

It was becoming apparent I was the talk of the hospital with comments such as 'My colleague and I were talking about your case in theater today' or 'Everyone is aware of your case and you're making them nervous' and a letter from the horrible meeting saying the case had been referred to the hospitals lawyer! Initially I was annoyed I was being so well discussed- didn't that go against patient confidentiality? but then my midwife mentioned it was a great thing that I was getting people talking about VBB, about challenging the normal and making them all think outside of their own little bubble and that made sense to me. I saw it as a positive.

The hardest day came for me when Tane said he thought I should have a c-section. I felt no one had my back any more, No one believed in me. Not a single person but me. This was a concern. I now knew I was going to walk into a birthing suite with not a single supporter. I was walking into dangerous territory - This; to me; was more dangerous than a breech baby, more dangerous that a big breech baby. This was a room full of skeptics tending to me at my most vulnerable time. Now I was starting to get nervous.

And then Thursday 19th January arrived...

Welcome Saige Wynter Lucille Goldsmith
travellingseiz
Thursday 19th January 2017... 20 days over due and feeling every ounce of pressure. I felt like I had been walking on a knife edge for weeks now. I was exhausted both physically and emotionally. I'd have good days and bad days. I felt like I was just a vessel to carry this baby - I felt like very few people saw ME as part of this equation. It was tiring.

Thursday is Phoenix's day off day care. We had fun playing around though getting on the floor and moving was becoming more and more difficult. I'd suggested to Phoenix we go and have a lie down. I was in bed relaxing. No signs of labour but my Braxton Hicks had been non stop for days now. Literally back to back but no pain so I wasn't worried. As I lay there trying to get Phoenix to rest I have a contraction - A decent one. Hello? Should I get excited? I'd had a few false starts over the weeks so I ignored it and tried to lie down and rest - hoping they'd pick up in frequency. 5 minutes later another one. Ouch. These felt different... Another one 5 minutes later. I couldn't lie down. These ones demanded I get up and move. Should I call my midwife? Nah- I'll give it an hour.... 5 minutes later another one... I started to have diarrhea too - This was looking promising! Actually - I'd better call my midwife. First contraction started at 4pm and I called my midwife around 4.20pm.

'Hi Kathy, I think I might need to change our appt tonight - I think I'm in labour'

Kathy was here within 15 minutes. She'd called an ambulance on the way (Always in our plan as we didn't want a breech baby delivered roadside if we could avoid it) and checked me out as soon as she arrived. It'd only been 30 mins since my first contraction - I was already 5cm. Holy cow!

I called mum and organised Tane to drop Phoenix off at Mum and dad's place. This was finally happening!

I climbed into the ambulance and assumed an all fours position with my arms wrapped around the head of the bed and I used two buckles to brace myself with through each rolling surge. They were certainly picking up in intensity.

Tane was following behind the ambulance. I had just finished joking with the ambo guy Phil that 'I hear labouring women are your worse nightmare and I know you guys hate it when our waters go so I'll do my best to hold on til we get to the hospital' only to have a huge contraction 5 minutes later followed by a pop and a massive gush as my waters went everywhere! Oooops! Sorry Phil.

I called Tane, Change of plans. Meet mum at the mobil oteha and get to hospital ASAP - He asked me if I could see them behind the ambulance I couldn't stop laughing. I was way too focused on riding the waves of labour.

When we got to Albany there was traffic so the ambulance went lights and sirens and got on to the bus lanes to get me to the hospital. Kathy was keeping an eye on bubs heartbeat which was perfect. There was Meconium in my waters but that's to be expected with a breech bub. my contractions were getting closer, longer and harder but still manageable. I kept my breathing deep and low. Lots of moaning. I just really hoped Tane would make it in time for the birth.

We arrived at hospital and transferred me up to the birth unit. Kathy had everyone on stand by. My room was flooded with people quite quickly after I arrived. I went to the bathroom, had a check to find I was now 7cm dilated but babies bum was still quite high. I then assumed my all four position on the bed and proceeded to try and break the bed head (I see a similarity here to how I labored with Phoenix hahaha). Because bub was breech each contraction would squeeze the meconium out of bub and onto the bed liner they had put down for me. It was weird and I never anticipated so much meconium from one baby. On the up-shot though - One less Meconium nappy to change right?

Tane arrived a short while later; as did my mum and Phoenix. They'd decided it really was better for mum to meet Tane at the hospital. I said hello to mum and Phoenix. Told Phoenix how much I loved him and how soon he would be a big brother then he left with mum. It was almost a little sad to know it was the last time Phoenix would be with us as a family of three but I was so excited for him to be a big brother - I know he's going to be awesome.

I was set up on the ctg for continuous monitoring. My contractions were definitely getting stronger and closer. Baby seemed to be doing fine and recovering well after each contraction so I was happy.
The OB consult on call was Jye - She came in and still recommended a c-section. We went through the worse case if I went ahead with a VBB which was head entrapment with the need to split my pelvis to get baby out - This would be a long long recovery and baby might end up brain damaged or dead. It was hard to have a rational conversation with me as I was managing my waves of labour and it took all my focus to keep my breathing on track. Tane was awesome at reminding me to just breathe. Deep and slow - Breathe Sarah - Breathe.

An IV was attempted and I nearly killed the lady inserting it. The line went in my wrist and I instantly felt like acid had been poured into my vein. I started screaming for her to get it out, get it out now! She fucked around for what felt like eternity (It was probably only a minute or so) then I went to take it out myself and she final removed it. That was horrendous. Her second attempt on the back of my hand went in no trouble, no pain, no discomfort. My wrist (A week later) still bears the bruise of her handy work and still gives me pain when touched. Lets say she wasn't my favorite person this night.

More pressure for a c-section and I just couldn't think with all that my body was doing. I knew I was in a room full of people who didn't believe in me or my body or my baby. I knew I was fighting a losing battle and I was very aware any perceived 'distress' would be straight to theater. I also knew it would be harder to have anything I wanted in a c-section the closer we got to full dilation. I didn't want to labor for hours only to end up with a c-section. I told Tane to make the decision and either way he had to be happy with the consequences and he had to support me with whatever recovery there was... So c-section it was.

A cervix check before heading off to theater had me back at 5cm dilated - Maybe this was the right decision....? It was still a very bitter pill to swallow.

I was prep'd and in theater within 10 minutes of the decision being made. I was given a spinal instead of an epidural due to a back injury. The local was a tiny pinch and the actual spinal itself I barely felt - ironically this was one f my key worries about having a c-section. I felt sorry for the lady administering it as I was still contracting hard and fast and I couldn't stand anyone touching me while having a contraction so she literally had minutes to find the spot and administer the drugs. Straight away my feet felt heavy and weird so I lay down. I asked for some anti nausea knowing anesthetics make me feel sick. I had three more contractions before they disappeared due to the spinal. A catheter was put in which was uncomfortable. Next they set up the drape and all the ECG leads, BP cuff and what not. During this time they had started pinching my belly to see if I had feeling. I was fine on my left and middle section but I could feel the pinching on my right hand side. Like a pin being pushed into my skin. The anesthetist didn't look too happy and said my only other option was a general (They couldn't give me another spinal) - She said 'lets go with it and see how you feel' -And feel I did. Tane tried to distract me with music. It was a good distraction too but nothing would prepare me for the pain to come.

The cutting open wasn't too bad. Like a sharp knife blade being gently pressed into my belly and the whole delivery part was very quick - maybe 10 minutes. Lots of pushing and pulling. Jye asked me to 'Push baby out Sarah- Come on. Big push down into your belly' which I didn't expect and in a way helped me feel like I had 'Delivered' my baby. Once bub was out we were blessed with 3 minutes delayed cord clamping then our baby was presented to us face first, dripping wet. My gosh what a spitting image of Phoenix. Next, and some what unexpectedly, we got a bum view with Jye asking 'And what sex is baby?' and I was shocked and overwhelmed to see a girls bits staring me in the face. We had a daughter! I cried. Royal by Lorde was playing at the time our daughter was brought Earthside - I wonder if it's a sign of things to come hahaha. Four days later we would notice a small graze on Saige's bottom. Looks like the scalpel nicked her during the delivery. I wonder if it will eave a life long scar? A story to tell that's for sure.

There was a change to the atmosphere of the OR shortly after Saige was born. I couldn't put my finger on it and they handled the situation well but something was amiss. I would later find out my uterus has torn and I was hemorrhaging. I lost 1.2L of blood - boarder-line needing a transfusion or so I'm told.

The 'Put me back together' was HORRENDOUS. I kept vomiting and kept being given anti-nausea meds but they just didn't seem to be cutting it for me. I couldn't stop shaking (Common I know) and the pain was excruciating on my right side. I almost passed out twice and had to ask them to stop on one occasion just so I could breathe and compose myself. The repair work took longer than expected and I was in so much agony I struggled to do skin to skin or breast feed Saige while in the OR. Thankfully Tane was able to do the skin to skin right there in the theater until such time as I could. I tell you I have never felt relief like it when they said they were all finished. In hind sight maybe the general would have been a better option.

Once I was in the recovery room I was able to breast feed and skin to skin cuddle with Saige. She was weighed. She was chubby - I knew that just by looking at her! She checked in earth side at 7.24pm on Thursday 19th January- Weighing an impressive 10lb 5oz. She is 54cm long and her head was 37.5cm round. She is perfection.

I spent the night unable to move my legs due to the spinal. My right side 'un-numbed' much faster than my left side which was such a weird sensation. Saige and I spent the entire first night skin to skin and I didn't sleep a wink despite being exhuasted. I spent the night vomiting - We suspect from the morphine. The next morning I was up and moving as soon as I could. I wanted the pain pump out and the catheter too. By 3pm in the afternoon we were cleared to head up to Warkworth birthing unit where I stayed for 4 night.

Recovery has been 'Easier' than I expected. Pain management is key. I came off the morphine within 24 hours and have been managing well with panadol and Ibrufen. I still struggle to get out of bed and my incision is tight and achy and still numb. My torso feels really bruised which in all fairness it probably is - I feel like I've done 10 rounds with Mike Tyson focusing on my stomach. Gas has been a major problem. Coughing and sneezing suck so does underwear in general as the bands just sit at the wrong height for my incision. I can't bend down yet but hope to some time soon.
Breast Feeding has had different challenges with the incision making it hard to put much weight on my belly but Saige and I are managing well.

I'm finding the limitations with regards to driving, lifting and generally getting around very frustrating. It's been such a different recovery to the one I had with Phoenix.

The up shot of a c-section? My bleeding has been minimal - 5 days pp and it's almost gone. Hey there's got to be at least one positive right?

Now Saiges name - What does it mean?
Saige - Is a wise person or a herb with healing properties
Wynter - comes from a character in a trilogy I read who was brave, bold, strong, admirable and capable. Everything I could hope my daughter would aspire to be.The trilogy is the Moorehawk series.
Lucille - Is my middle name handed down from my mother and named after a family friend called Lucy who passed away just before I was born. She would often visit me in spirit form when I was a child. She was apparently an amazing woman.

How'd our family react?

Yvonne was delighted to have her first grand-daughter after 5 grand sons. I'm sure this girl will be spoilt for choice in the knitting department!

My Parents we thrilled at add another grand baby to the clan.

Bill was delighted about his grand daughters arrival too.

Phoenix was amazing. oh my heart. When he first saw Saige he just wanted to cuddle and kiss her to within an inch of her life. He proudly shows her off to anyone and everyone saying 'This is my sister Saige, come say hello'. My heart just about explodes with the beauty of it. He's such and incredible big brother - Saige is a lucky girl.

So, despite this birth turning to shit and me having to mange the sudden change so late in my pregnancy- I am beyond happy Saige is here safe and well. Would I ever have a C-Section again - In all honest not if I had a choice. If I NEEDED one I'd be asking for a general because I couldn't face going through that again. I cant see us having any more children so I doubt this will be a problem in the future. We happy with our 'Matching set' - our 'Salt and Pepper' - our Saige and Phoenix.

EDIT TO ADD:
- My incision has a numbness around it - a band about 5-6cm wide and running the length of my incision. From the sounds of it this is likely to be permanent. Another added bonus of a c-section right?

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