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Archive for August, 2008

Who is she?

I’ve spent the last couple of days trying to have a reasoned discussion with Dr Amy on her Homebirth Debate blog, as usual it has been unsuccessful. It’s like having a conversation with our Amy, she’s 3, you try and be reasonable, patiently explaining everything, suggesting a compromise and then realise that she is incapable of seeing the world from any other perspective than her own.

As a result of my utter frustration with this blinkered, dominatrix I decided to blog about her exultation of medicalised childbirth and started with a Google search for images of mad doctors, fighting surgeons then, realising this was especially purile, Dr Tuteur herself. I was disappointed as what came up was the image she shows on her blog so clicked ‘search the web’ instead, and up came some odd results like ‘Did you check amy tuteur’s weblogs linked under her name? All she does is rail against doctors…don’t feel too protective of her. …’  this comes from Kevin, MD  in 2006. So I clicked on his link and found a comment on a entry from Dr A, ‘The C-section rate is rapidly approaching 30%. That’s at least twice what it ought to be, and last I heard babies have not doubled in size and fetal distress has not doubled in incidence. If that’s not defensive medicine, I don’t know what is. I followed her back and discovered her alternative site Treat Me With Respect, a site on which there have been no entries since 2006 and is far more more general than Homebirth Debate and in which, when responding to commentators she is, interestingly bearing in mind the title of the blog, far more amenable.

So, on the one hand there is an MD who believes that Amy rants against Doctors in Treat Me With Respect and on the other we have a midwife (me) who knows that Amy dismisses my profession as uneducated and dangerous liars. Then we have her comment which appears to blame the rising section rate obstetrician’s fears of litigaton, that in 2006, but then just 4 days ago in an entry entitled The impact of c-section on women who are not part of the NCB culture she states ‘Clearly “natural” childbirth is beneficial for the natural childbirth industry. It’s difficult to see, though, how it is beneficial for women’  have her opinions changed or is Dr Tuteur perhaps an amalgam of different personae?

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Oh wow, I have dreamed about it, winged about the endless repetition of paperwork and now Liverpool have finally realised how time-saving a computer could be and are providing 75 laptops to their community midwives.  Do I think that my Trust will be this foresighted, absolutely no way. We would have to have a manager prepared to fight for the best options for her staff and, as we have an absolutely ineffective, blinkered, wet-weekend ‘leading’ us, who can’t even ensure that there are enough midwives, then believing that we could be bought into the computer age is just a pipe-dream.

I know, I’m sounding bitter, well I am. For a year now we have been functioning (that’s a joke) one and a half midwives down, there should be 7.5 of us, there are 5. This has all sorts of ramifications, obviously everyone’s workload is increased, we are all having to cover extra clinics, this means that our travelling times and costs are higher and it means we each have more on-call commitments. Due to the increased work we are all doing extra hours, but we don’t get paid for it, we are supposed to claim time-owing, how ridiculous is that, we are working extra because there are not enough midwives to cover the work, how do we take the time back? 

Whilst I’m being a ‘grumpy old woman’ I shall muse upon the G.P’s I work with total inability to read, or act upon, any communication I have with them. This time they are also displaying a total ignorance of the NICE guidelines on Antenatal Care, despite the fact that they receive them from The National Institute, I’ve personally given each of them a laminated copy and I’ve sent them E-Mails about them. Usually I just grin and bear it but this week their disregard has meant that 4 women have been added to end of my clinic list, that means at least an extra hour, probably more like and hour and a half. The guidelines recommend the timings of antenatal visits, ‘my’ G.P’s only see their pregnant women at 25 weeks and 38 weeks and often not even at these times, all the other visits are with either the consultant or myself, they are hardly swamped by providing care in pregnancy. Two of my ‘extras’ this week are 39 weeks, they saw the G.P last week, I caught up with one of the Docs and asked what his concerns were about the women, he hasn’t got any, he just thought that they should be seeing a midwife every week. I have now given him another copy of the schedule of visits.

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This was in The Daily Mail today and I reproduce it in full. It is a terrible indictment on how our maternity services are being failed by those who hold the purse strings and make the decisions about how the public’s money is spent.

Anyone who reads my blog will recognise many of the concerns I repeatedly rant about. The delerate low-staffing, the midwives having to complete paperwork which could easily be one by more appropriate persons, leaving the midwives free to do the job they have trained for. The lack of support for newly qualified midwives and the expectation that staff will work longer hours, not have meal breaks and then still have to suffer abuse from patients and their relatives.

What did I find especially sad, but something that I have heard myself say? “Would I recommend midwifery as a career? I’m really not sure.”

Frantic mothers without pain relief, sick babies in unqualified care: The disturbing diary of a modern midwife

By Adele Waters

Earlier this month, the Royal College of Midwives warned the Government that problems in Britain’s delivery wards were reaching a crisis point as staffing levels were not keeping pace with our increasing birth rate.

Here, newly-qualified midwife Sarah Cameron, 35, who works in a busy London maternity unit, shares her work diary with ADELE WATERS.

SHIFT 1

Several staff have rung in sick so there are just three of us on duty – another midwife, a support worker and me. I end up with 15 women to look after – as a new girl it should only be four or five and even when I’m up to speed it should only be eight or ten.

Breastfeeding support is given a fairly low priority – there just isn’t the time. It’s all I can do to keep up with answering the buzzers.

I realise even pain relief gets missed out sometimes and women buzz their bedside alarms saying that they’re in pain and should have had painkillers over an hour ago.

First-time mums ask if they can have a baby bath demonstration and I explain that I don’t have time but I’ll ask the healthcareassistant if she can do it later. I know it’s very unlikely she’ll be able to. Mums often go home without being shown how to bath their babies or how to make a bottle up. In fact during my three-year training, I’ve never seen anyone shown how to make a bottle up.

I also have some ‘extra care’ babies to look after – those that aren’t ill enough to be on the special care unit but who still require more regular monitoring than others. I’m not qualified to do this so spend a lot of the time asking the other midwife for advice.

One of the main duties of looking after extra care babies is to calculate the feed requirements. If you get this wrong it can be serious – too much milk will wear a weak baby out, too little milk and they won’t gain weight.

I was worried that I’d make the wrong choice. The other midwife is very helpful but I feel sorry for her as she has 18 women to look after, two of whom are in early labour.

There is no way that good care can be given to women when you’re looking after that many.

SHIFT 2

Today I was asked to work an extra shift on the labour ward – normally I’m looking after pre and post natal women. I was feeling very nervous. I thought back to when I was a first year student – just three years ago – when I was left to support a woman in labour on my own.

The senior midwife overseeing me had another woman to look after and she came running into the room just as I was catching the baby.

I had been terrified but calm and the new mum told me I’d make a great midwife. I’d come into midwifery late – I was married, in my 30s and had given up my job as an administrator to retrain – so comments like that helped confirm I’d made the right decision.

I am looking after a lady who is in labour – my first time as a qualified midwife. I spend the rest of the shift in a room with her and her husband, encouraging and supporting her. I’m lucky – the other midwives have all got two women each.

Research shows that the more one-to-one care a woman receives in labour, the greater her chances of a normal birth. If you keep having to run out of the room to care for someone else, the woman is less likely to cope and more likely want an epidural.

This increases the chance of a forceps delivery or even a Caesarean section.

But my lady hasn’t needed any intervention or drugs. She’s coped with emotional support, back rubs and a warm bath. She wasn’t overemotional, just got on with it. I do think that having me there helped.

SHIFT 3

Back to my ward for a 7am start to find it full – 40 women, about 20 babies and five midwives, including me. We’re told to get as many women discharged as possible to free up beds. However we won’t shove people out if we don’t think they’re ready.

If we can’t free up any beds, it means that the women who are booked to be coming in for inductions of labour this afternoon won’t be able to.

One of the antenatal ladies that I’m looking after needs an important ultrasound scan to check how her placenta is functioning. Even at 9am the scan room can’t offer me a space. The lady decides to go home without the scan and gives me verbal abuse.

I know it’s frustrating for her, but I struggle to understand why someone won’t wait to find out whether their baby is well or not. She has very high blood pressure and her baby is not moving as much as normal, so the baby might need delivering early.

I explain this and attempt to get her to stay, but even though this is a much wanted IVF pregnancy, she leaves anyway.

Dealing with aggression is part of this job. I’ve seen women being verbally aggressive to other midwives in situations like this.

I’m worried. I constantly feel, ‘this isn’t right, women deserve better’. Sometimes, this just feels like a production line, and I wouldn’t want to give birth where I work.

I am married and have a son of my own, now aged nine – if I have another baby I know it’ll be lucky that one of my midwife friends will come in with me and deliver the baby.

It seems horrific that the only way to guarantee you get good care is to have a friend who’s a midwife.

SHIFT 4

This is the worst shift so far. There are three midwives for 40 women. I have nine women to care for; one has been quite poorly. She lost a lot of blood after a Cesarean section and ended up in the high dependency unit. She still needs a lot of regular – and time-consuming – observations.

My other postnatal women are given pain relief then I abandon them for the rest of the morning as I need to look after my poorly lady and those yet to give birth.

It’s lunchtime before I get back to see them: they’re not happy – I wouldn’t be, either. I quickly start doing postnatal checks so I can start some discharges – which includes 30 minutes’ worth of paperwork per person.

Nothing at college prepares you for the fact that you will be run ragged. I get home at 4pm exhausted.

I realise that I haven’t had anything to eat or drink or been to the loo since 6.30am – that’s 91/2 hours without stopping; I sometimes feel like a marathon runner without the training or the glory.

When asked about the vital qualities of a midwife, I always say you have to care genuinely about the women you’re working with, have good communication skills and you must to be able to cope well under pressure. But perhaps the key thing is strong bladder control!

SHIFT 5

One of my women really needs to go to the labour ward – but it’s full. I struggle to give this lady the support she needs as I’ve got four other women to look after.

There’s nothing I can do apart from give her paracetamol (commonly used in early labour) and advise her to have a bath to relax and ease the pain.

Too busy to even stay and help, I leave her partner supporting her and see the anxiety in their faces. We’ve all heard the horror stories about women delivering on an antenatal ward without a midwife there and, when the staffing levels are so low, I can see just how this happens.

I just don’t understand why – when the units are so short staffed – they just don’t employ more midwives.

I’ve been told that the hospital can’t afford to cover all the shifts with the permanently employed midwives, and relies on temporary staff like me to make up the shortfall. This is fine if people agree to come in, but it does go wrong.

I had several calls over the weekend when I was off from the unit desperately begging me to come into work as they were very short staffed. However I had my son to look after. And why don’t they employ me on a permanent contract instead of once a week, and then last-minute shifts? It’s very frustrating for me – and means a poor service for the women.

I think about how much I – and all my family – have sacrificed for me to become a midwife and yet I can’t even get a permanent job, even though my skills are clearly needed.

During those three years of studying I’ve missed out on things with my son such as school sports days, because I couldn’t miss lectures.

It’s also been a huge financial sacrifice. I went from earning £25,000 a year as an administrator to living off my husband’s wage.

We had no holidays, bought no clothes. We had to pay £200 a month for child care. I didn’t get a bursary because it’s means tested and my husband earns £35,000 a year – deemed too high. So all our savings are gone.

Today I discovered that during the first quarter of 2008, there were over 80 ‘Near Miss Incidents’ reported at my hospital, citing staff shortages as the reason. That’s over three times as many as the year before.

Near miss incidents don’t necessarily mean that anyone was harmed, but that they could have been. These figures are purely for the maternity department; that’s nearly one a day!

SHIFT 6

Today the shortage of beds means we have a bed block situation at the hospital.

There are no empty beds so inductions are being cancelled. Women get very worried; they’ve normally been told by their midwife or even by the consultant that the baby needs delivering.

Some women are getting induced for medical reasons (such as the baby is not moving or growing sufficiently) and have been told it would be safer to have the baby early.

Other women are getting induced as they’re now ten days overdue, and will have been told that at ten days over the placenta starts to deteriorate and it’s safer to have baby delivered.

I worry that one day by the time we get round to inducing a woman we won’t find a foetal heartbeat as the baby will have died.

SHIFT 7

MY first actual delivery! I’m on the labour ward and there are six midwives including myself and we all get allocated one woman. We are well staffed because the ward is unusually quiet today, with only half the rooms full.

The lady I’ve been allocated hasn’t arrived yet but is en route in an ambulance. She’s 38 weeks’ pregnant and woke up with severe abdominal pains. As she arrives, the paramedic gives me a hand-over.

Suddenly the woman gives a big grunt and I peep under the sheet to see a baby’s head between the woman’s legs – rapidly followed by the rest of the baby!

I don’t know who in the room is the most shocked – it’s certainly a memorable first delivery.

SHIFT 8

Back on the labour ward. There are seven women in labour all requiring a lot of support – they either have epidurals in place or want them. But there are just five midwives, including the shift co-ordinator.

Women with an epidural require one-to-one support from a midwife, because they are more at risk of their blood pressure falling, fainting or of having a reaction to the drugs.

The baby can also react to the drugs so its heart needs to be continuously monitored.

There is no way these women are going to get that – which means four are going to have to go without an epidural. The thought of having to look after a woman in labour wanting pain relief and having to tell her she can’t have it fills me with dread.

I get allocated a woman to care for and go and introduce myself – she’s screaming for an epidural. Luckily it’s been decided that she’s the last woman who can have one so I get this arranged for her as soon as possible.

Later, there’s a newborn baby that’s not breathing. I run to the room to find someone else is resuscitating the baby and, happily, they do so successfully. It’s an incredible relief. I’ve seen a neonatal death after an unsuccessful resuscitation and it’s horrific.

By the end of the shift I’m a nervous wreck and leave vowing never to work another shift on the labour ward. Unbelievably, I’m more stressed now than I was when I was a student.

The problem with only working the odd shift is that I’m not getting the experience I need to consolidate my skills and become competent.

It may suit the hospitals to have lots of part-time staff as then they have more cover for sickness and holidays, but I don’t think the managers have considered how hard it is to gain your confidence when you’re getting so little experience.

Equally, after a year I’ll go up a pay band which means I’ll be in a more senior role but I’ll only have done about 48 shifts before getting there – which is like getting a promotion after only nine weeks of full time work – it’s madness.

SHIFT 9

Two of the large bays are being ‘deep cleaned’. I’m not 100 per cent sure what a deep clean involves but there’s a lot of people in overalls and some strange, loud hissing, sucking noises coming from the bays for the rest of the shift.

Overall I think that the wards on maternity are kept very clean and cleanliness is never really an issue that people complain about.

Sometimes women come in with their own cleaning products because they’ve been warned about the dirt, but I never see anyone using them.

I’m at the midwives’ station reading through some notes when a man approaches me – he’s the husband of a woman who wants to go home. He very aggressively asks me when I’ll have completed the paperwork for his wife.

I tell him it should be around 20 minutes as long as none of my other women require me for anything in the meantime.

He’s not happy. He says: ‘It needs to be quicker than that, we’ve got an appointment to get to and need to leave now.’

Sometimes I feel people treat me like a servant. I think people are so used to living in a consumer orientated, fast service environment that they expect to get that in hospital as well – that they can click their fingers and get something.

Later on when I’m discharging another lady it’s a different story. She’s in her 30s. It’s her first baby and she and her husband seem overwhelmed at the thought of going home with their baby so I spend ten minutes chatting to them.

They seem more positive when they leave. The thing that makes them stand out for me is they way they couldn’t thank me enough as they left.

But sadly they are not the majority. Of course women deserve the best care when they give birth – that’s what we have been trained to provide – but due to staffing levels this is often not possible.

When I started this job I knew it was the right thing to do – I knew I was going to love being a midwife. But now, would I recommend midwifery as a career? I’m really not sure.

  • We have changed Sarah’s name to protect her identity.

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32 weeks

When writing up my diary I forgot all about my next Grandchild, Tinkerbell. How terrible is that? All that I can offer in a defense is that it is very different when it is a daughter-in law who is pregnant, or it is for me, as my involvement as been far less. Yes we do have the check-ups and the worried phone calls but I feel that I have to keep more of a distance, not ‘interfere’ as much. DIL is 32 weeks now and her bump has really expanded, she is still petite but now it looks as if she has a football hidden under her T-shirt. She is at that stage where most pregnant womem are still feeling quite well. She is just starting to have problems sleeping, and is finding that she has less room for large meals but her plan is to carr on working until she oes into labour!  I have been assuming that I am not invited to be at the birth, I haven’t asked as I don’t want them to feel pressurised, I feet sad but it is their time, I’m just anticipating driving the staff on labour ward mad by constantly checking on how things are going. Today though they asked me if I was going to bury the placenta in my garden. I was surprised, especially as it came out of the blue, but I answered that if they didn’t want to keep it then I would if it was okay with them but that they would have to remember to save it for me. Their response has me in a quandary, they said they wouldn’t have to remember about it as I could just take it with me. Does this mean that I will be in the room when the placenta is delivered, this would imply that I were there at the birth, or does it suggest that they expect me to come in as soon as baby is born? I dare not ask, it could be putting them in an awkward position. Oh well, another 8 weeks or so and I should know.

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Diary entry

This is going to be an honest, therefore rather boring diary entry. I’ve taken this week off work for a basic, selfish reason, daughter has gone back to work so I am now looking after the boys, Louis and Jamie, 2 days a week, 10 hours a day. I was anticipating that I may find it ‘difficult’ but I do have to admit that it was, on the whole, easier than I thought but when it’s bad it’s really bad, they are lovely, happy babies but there are two of them, two crawling bundles of mischief. Try ‘nipping’ to the loo and it turns into some sort of Krypton Factor 3D, spatial awareness test.  Going to the bathroom involves opening and closing a stair gate before the boys get there so it’s a case of sneaking off and then problems arise when undertaking the return journey as by then they are hanging off the gate, screaming. The quandary is how to get through the gate without making them fall off the step they are standing or giving one of them the opportunity to race up the stairs as soon as the gate is open whilst you are occupied dealing with the other one, I need another pair of arms. Then there’s the getting out of the house test, I now have to use a pushchair to get them to the car, it is just so stressful otherwise. Last night a friend suggested putting one in the highchair whilst I take the other one out to put him in his car seat. There are benefits, wouldn’t have to shut the front door, I would know that he was safe but it is a pain, getting a highchair out, strapping him in, plus I would have to give him something to nibble on as they are not stupid and do make the connection between highchair and food. I have now had to put locks on all the kitchen cupboards, the TV cabinet and the dresser, one baby I can police effectively, two are virtually impossible.

I have had another traumatic experience with a lawnmower. A few weeks ago my ‘favourite’ lawnmower fell to pieces, the chassis was totally rusted away, and this week my ‘difficult’ to start, rip your arm out of it’s socket, mower, refused to respond to my appeals, so I told it, and golfing Hubby via text message, what I thought of it and went to my local DIY store and bought an electric one. The thought of being able to just plug it in and mow, no checking oil levels, filling with petrol, crying with frustration when it fails to respond to pulling of the starter cord, I was so excited. Of course, I had to assemble it but no probs, 20 minutes later there sat my new, bright green lawnmower. I plugged it in, tilted it, pressed the safety button and, nothing except a hum. No blade rotating, just the very quiet whirr of a motor but it was obviously not powering the drive for the blade. I tried, and tried again, no joy, definitely no joy just utter frustration. I texted Hubby who responded in a most unfortunate fashion ” Long grass can look good”. That pushed me over the edge, I flew wildly at my arm torturing machine. It was shaken, kicked, lifted and dropped and then I pulled at the starter cord, it roared into action. Forget garden machinery specialists, a temper tantrum is free, and does the job! Hubby and I returned the electric mower to the store and got a refund.

Amy, Jamie and Louis have been attending nursery for short periods as a prelude to when they start in 2 weeks. On Friday I went with them so I would know where it was if I ever had to pick them up, the staff seem lovely, Amy loves the rabbit and guinea pig and the sandpit was a hit with the boys. We had to leave them for 2 hours so daughter and I filled the time with a supermarket dash for all the requirements for the twins birthday party.

The birthday party was a success, due in no small measure to the fact that the weather remained fine, even slightly sunny so everyone, especially the multitude of small people, were able to be out in the garden. I had gone round to daughter’s house a couple of hours before the party to help her set-up and even as I got out of the car I could hear a baby screaming. I walked into the garden to find a scene of chaos, and sitting in the middle of it were my Mother and step-father. Louis was sitting in his highchair covered in the remains of his lunch, Amy was running around with just her pajama top on and a tearful daughter was holding a wailing Jamie. Son-in law had done a disappearing act, can’t blame him for escaping the Grandmother-in law from hell but unfair to leave daughter trying to cope with the bedlam and attempting to prepare for the twin’s party. I decided that the most helpful thing I could do would be to relieve her of the boys so I took them upstairs and dumped them in the bath, which worked the trick with old misery Jamie and amused Louis and Amy. Mum and step-father left, son in-law returned and so once I had dried and dressed the boys I put them in their pushchair and went for a long walk. By the time I returned the twins were both asleep, the garden and house were ready for the party and daughter was a happy bunny (I think the Pimms helped).

Jack starts school next week, I can’t believe that my little man is that old, it only seems a couple of years since he was born, mind you he is young to be going into full-time education as he is only 4 years and 4 months. I shall miss having him around as much, I hope he and I remain as close.

Amy is a bossy, bright little madam. Talk about over-active imagination, she still has her invisible animal friends, life for her is magical. She remains unpredictable where her brothers are concerned, one minute an entertaining big sister, the next a sly individual pinching and hitting when she thinks no one can see.

Izzy is an appealing little girl, blonde curls, huge blue eyes and long, dark eyelashes. Her joint hypermobility means that she is still bow-legged but it a strange way it adds to her cuteness. Her language development is slow, the twins, especially Louis have nearly caught up with her. It is obvious that she understands everything so I’m not concerned about her intelligence but she does become quite frustrated by her inability to communicate her wants. For a tiny person she eats an amazing amount, and is quite indiscriminate about what she will eat, hence the phonecall from her Mummy a couple of days ago . Apparently Izzy had eaten a berry from the garden, what should they do? What berry was it? Daughter doesn’t share my love of gardening so was unable to identify the shrub it came from. After a 20 questions session I decided that it was nothing dangerous but did advise watchfulness and an immediate eradication of all berries in the garden.

Nearly there now. Jamie; 5 teeth, both boys still wearing amber necklaces; crawling, supported standing, cruising. Clapping, kissing, waving, ‘dada, mum-mum’, babbling, wicked laugh. Louis; 6 teeth, mobility and development the same as Jamie plus ‘mama, grandad, uh-oh, ta’, and hi-fiving.

That’s it, up to date.

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Celebration

This time last year we were all anticipating the birth of the twins, Jamie and Louis, tomorrow we will be celebrating their first birthdays. They have given us a few scares healthwise, especially Louis but here we are now reminising about the day they were born and being delighted about what healthy, handsome lads they are a year later. Their Mummy and Daddy have both set their alarms for 11.46am and are going to pick Louis up and give him a huge hug  as they couldn’t do that when he was born.

This week has been super-tiring, hence my minimal expeditions into the blogshere. I am eagerly anticipating a quiet, relaxed Sunday and Monday when  shall share the ‘secret of how to make a lawnmower work’.

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Too many ‘heroes’?

What does a hero/heroine mean to you? My perception has always been that this referred to someone who is exceptionally brave, someone who puts their life on the line in some way for another being or cause. For me Gandi, Mandela, they were heroes. A person who dives into a raging river to free people from a submerged car, mountain rescue teams who turn out in blizzard conditions to rescue missing persons, they are heroes, their acts are selfless.

I turn to Beijing, our Olympic competitors are performing magnificently, they are winning the UK a record haul of medals. They have trained hard, dedicated themselves to becoming top-class athletes, are they heroes though, that’s what the media are calling them? I’m not trying to denigrate their achievements, in their fields they are outstanding but I feel that to hail them as heroes is to take an accolade away from individuals who have performed ‘feats of courage or nobility of purpose, especially one who has risked or sacrificed his or her life’. Yes, they do have extraordinary prowess, ‘nobility of purpose’ though, no as athletes are not altruistic and I feel that this is the root of heroism.

Salute our Olympians, yes but please reserve the accolade of heroine for a person who truly deserves it.

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