Everything You Need To Know About Postpartum Bleeding And Periods After Childbirth

by Dr. Kymberlee Lake

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Most women know that there may be some bleeding after giving birth but often women are surprised by how much and how long and they aren’t aware of the difference between postpartum bleeding and discharge and menstruation. The first bleeding after you give birth is called lochia.

What exactly is lochia? 

Lochia is the discharge consists of blood from the area on the uterine wall to which the placenta was attached during pregnancy, the sloughed off endometrium (uterine lining which makes a bed for the fetus) which gets considerably thickened during pregnancy, blood and mucus from the healing cervix,  and dead (necrotic) tissue. Your blood volume increases by approximately 50% in pregnancy, all that extra blood also has to go somewhere after birth. Most women will experience blood and lochia discharge for 3- 6 weeks though that time span can very from pregnancy to pregnancy and can be directly influenced by a healing mother’s activity level.

Why do we have lochia and where does it come from?

The blood in the lochia comes mainly from the large raw area left in the uterine wall after the placenta detaches from it. While bleeding from this area is controlled by contraction of the uterine muscles immediately after delivery, it takes on the average about two weeks for this area to heal. It is important to remember that this is a wound and it is possible to do too much before it has healed and reopen the wound, causing fresh bleeding. You will experience this bleeding for around four to six weeks postpartum.
Stages of lochia postpartum bleeding lunapads reusable menstrual pads
For the first few days it will be a heavy flow (kind of like a heavy period) and will be  colored dark red, with some clotting.  About the end of the first week the flow should start to taper off, becoming lighter in saturation and color; as time passes, it will fade to a brown, yellowish or even almost-white discharge. 

One thing to remember is that the placental area as well as the sites of sloughing endometrium are raw and open during this time and bacteria can easily spread from the vagina. So, the use of tampons should be avoided – sanitary pads are the best options to be used during this time. 

What is normal and when should I be concerned?

You might notice a ‘gush’ of blood with clotting when you stand up – this is very normal. Also, if you’re breastfeeding, you might notice that you lose more blood after feeding baby; this is caused by your hormones doing their work to help shrink your uterus back to it’s pre pregnancy size. The lochia is sterile for the first 2-3 days but then becomes colonised by bacteria giving off a typical distinct lochial smell which is normal and should not be confused with the bad odor from lochia in postpartum infection.

If the discharge smells foul, you’re still noticing a lot of blood loss after the first four weeks, or the blood is bright red, these are signs of infection and you should speak to your health care provider as soon as you can. This is especially true if you also have a fever (no matter how slight)  or are generally feel ill. Likewise, if your blood loss is so heavy that you’re going through more than a pad an hour, you should get medical help immediately – this can be a sign of a hemorrhage. If in question and something feels “off” it is worth a call to your health care provider for advice.

Types of Lochia

Depending on the color and consistency, lochia can be of three types:

  • Lochia Rubra: Lochia rubra occurs in the first 3-4 days after delivery. It is reddish in color – hence the term ‘rubra’. It is made up of mainly blood, bits of fetal membranes, decidua, meconium, and cervical discharge.
  • Lochia Serosa: The lochia rubra gradually changes color to brown and then yellow over a period of about a week. It is called lochia serosa at this stage. The lochia serosa contains less red blood cells but more white blood cells, wound discharge from the placental and other sites, and mucus from the cervix.
  • Lochia Alba: The lochia alba is a whitish, turbid fluid which drains from the vagina for about another 1 – 2 weeks. It mainly consists of decidual cells, mucus, white blood cells, and epithelial cells.

Do women who give birth by c-section still have lochia?

Many women believe that the flow of lochia is less after a cesarean section since the uterine cavity is cleaned out after the birth of the baby. This is not true. The flow of lochia is not dependent on the type of delivery –  The amount and duration is the same in both cases.

Return of Menses

There’s no hard rule as to when your period will return post-baby – it can vary from woman to woman, and pregnancy to pregnancy. Here are some general guidelines:

  • Women who bottle-feed can see their menstrual cycle return within six weeks of birth – and most will have menses back by ten to twelve weeks.
  • Women who exclusively breastfeed may not get their period back for some time. When you breastfeed, you body releases the milk-producing hormone prolactin, which, in turn, keeps our levels of progesterone and estrogen low. Progesterone and estrogen are the hormones responsible for signaling ovulation and menstruation. Night nursing directly effects these levels, a decrease in breastfeeding at night may lead to a return of menses.

Cloth pad for postpartum bleeding
Once your period returns, it can take even longer for it to get into a regular cycle. If you are bottle feeding it can take around six months, while exclusively breastfeeding your baby can take 12-18 months. But keep in mind that this does vary from mom to mom and pregnancy to pregnancy. Even with exclusive breastfeeding on demand and no artificial nipples, there are women who see a return of their menses as early as 6 weeks while others may not breastfeed and still experience a considerable delay. Each woman is different. Some women experience lighter flows and/or less cramping with their menses after having a baby, others experience the same, and still others may experience an increase. The range of normal variations is considerable but very heavy bleeding, soaking a full size pad in 1-2 hours, may indicate a problem and should be addressed with your health care provider. There are a variety of factors that contribute to possible changes with the return of your period but keep in mind that diet, physical activity, and your menstrual products can all contribute to cramps and duration.

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Please be aware that your first egg (ovulation) will be released two weeks before your period starts, so if you have unprotected sex without realizing that you are ovulating, you could get pregnant before you have even began menses again. It’s a good idea to speak to your healthcare provider about contraception even before you start thinking about sex again, so you can be confident in your choice ahead of time.

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cloth pads for periods and postpartum bleeding
Kymberlee Lake- headshot

Kymberlee is a Physician/midwife, Therapeutic foster/adoptive parent with 6 kids ranging in age from 31 to 3 and three grandchildren. She is living life to the full with MS in the Pacific NorthWET.  As an international travel enthusiast and fan of teleportation you can find her under the name “Dr_Kymberlee” live streaming and on social media, or on her often neglected blog, TheMamaMidwife.com
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12 Surprising Possible Realities Of Your First Postpartum Periods

by Jessica Martin-Weber

Sorry for the Buzzfeed style title. It’s that time of the month and there wasn’t enough chocolate to get me through writing this and coming up with a clear yet titillating title too.

The last 5 days we’ve been bleeding our hearts out on The Leaky Boob, Beyond Moi, A Girl With A View, and a little bit with What Love Tastes Like, opening up and sharing all about periods. Free bleeding information and experiences, debunking myths and being honest. In that time we’ve learned a lot. Like a girl having her first period (called menarche), there were a few things that surprised us and at times we found ourselves overly-grumpy. But mostly we felt like we were in good company and that commiserating was cathartic.

Also chocolate. Or bacon. Sometimes chips. And wine.

As we all shared the activities of our uteruses together, we started noticing a pattern. Not completely regular but consistent enough to chart and make a prediction:

Most women will be surprised by their first postpartum periods.

Not all and the surprises weren’t always unpleasant in nature but many women had no idea what they experienced was possible. Like, at all. And they thought they were the only one in the world to experience it.

Since we’ve already aired all our period panties to the world, it’s time to shed some of the mystery like a uterine lining. Here it is, our list of surprising possible realities of your first postpartum periods.

  1. No matter how long your postpartum bleeding lasts (lochia, which is not a period and you can read more about here), it isn’t an indicator of what your postpartum periods will be like.period week is coming
  2. It could take months for Aunt Flo to visit after you have had a baby, even over a year and for some it could be two years. Breastfeeding exclusively makes it more likely your favorite auntie won’t be around for a while.
  3. But it is no guarantee. Because we’re talking hormones and Aunt Flo, there’s only so much you can predict. Don’t be unprepared because you could be one of those that gets it back at 6 weeks postpartum and is like clockwork every month after. Even if you’re breastfeeding and your child never sees another nipple but yours. Yes, even if you’re breastfeeding twins.postpartum period surprise meme
  4. It could take a while to really get going, there could be brown spotting for a few days a month for several months while your body is indecisive. Get your period undies ready.
  5. OR it could come back with a vengeance with a gush that will feel like a scene from Game Of Thrones playing at the most inopportune moment. You may want to have supplies with you at all times just in case.brace-yourselves-cramps
  6. Essentially, there’s no guarantee when you’re going to start riding the crimson tide again after you have a baby.
  7. There’s also no guarantee that it will be the same as what you had before you had your baby. It could be lighter, shorter, and less uncomfortable. It could be heavier, longer and more painful.* Or any combination. Or different every time.
  8. The products you used before may still be your favorites. But you may suddenly hate them. Many women find they want to try something new and don’t be surprised if you see disposables as stinky, uncomfortable, and gradually building a mountain of waste that will be around when your children are having children. Which is a disgusting thought, your period supplies slowly rotting in a landfill when your grandkids are being born. And since you’re more comfortable with the weird things your body does (childbirth can do that to a person), the idea of washing cloth pads or to put a cup in it doesn’t seem so crazy any more. Diva-Cup-Evangelist
  9. If you’re breastfeeding, shark week may mean that your nipples protest someone latching on. Nipple sensitivity AND cramps? So not fair but often so real. Thankfully it usually doesn’t last long and chocolate can help.
  10. Even more annoying, periods and/or ovulation can cause a dip in milk supply if you are breastfeeding. So not only are you annoyed, your hungry baby is too. Most of the time this indicates a magnesium deficiency and supplements may fix this problem (see more here) but only after the most emotional and sensitive time when you have a hungry kid frustrated at your boob. You know what has magnesium? Chocolate. period week chocolate
  11. Just like a girl may experience irregular periods for about a year, postpartum women may find that it takes their cycles a good year to establish a regular pattern. The upside to this is that it is completely reasonable to always eat chocolate since you never really know.
  12. Health care providers may not have a clue what’s going on either. They should and many will but some don’t. You may have to educate them.

Be prepared for anything. Postpartum menses seem to like surprises.

Keep calm and menstruate on

*It is important to note that severe or debilitating pain or extremely heavy bleeding is a sign that something is wrong and may need more than chocolate and wine to address. It is well documented that women are more easily dismissed by health care providers about their pain and discomfort when it comes to health concerns. If your concerns are repeatedly brushed off as being normal but you feel something is wrong or your normal life is disrupted, please speak to your health care provider or find another one. Be persistent until you find one that will take your concern seriously. Menstruation is a normal biological part of life for most healthy child-bearing age women, it isn’t a pathology that women just have to deal with on a monthly basis and if it is interrupting your normal activity and lowering your quality of life, something more serious may be going on.

 

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Have you survived mastitis? How did you get through?

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Jessica Martin-Weber Drawing from a diverse background in the performing arts and midwifery, Jessica Martin-Weber supports women and families, creating spaces for open dialogue. Writer and speaker, Jessica is the creator of TheLeakyBoob.com, co-creator of BeyondMoi.com, and creator and author of the children’s book and community of What Love Tastes Like, supporter of A Girl With A View, and co-founder of Milk: An Infant Feeding Conference. She co-parents her 6 daughters with her husband of 19 years and is currently writing her first creative non-fiction book.
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Keep Calm and Menstruate on with chocolate and more giveaway!

This Week’s edition is proudly sponsored by our friends at:

Ergobaby

This week in our edition of The Leaky Book Newsletter we are focusing on periods. And no, we aren’t talking punctuation! We are talking about menstruation, “that time of the month”, your ladies days, the Menzies! We are excited to focus on a topic that’s so important to women’s health and yet widely misunderstood. We also have a featured expert with some great information on the stages of Lochia. This week also, we are excited to have Lavinia Martin-Weber from A Girl With A View to join us for Period Week. Check out her video on YouTube and make sure you subscribe. Lastly, we have a great Period Week Care Package giveaway one special Leaky is sure you’d enjoy. Have a great weeks friend, and stay warm!
-TLB Team

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Menstruation. Period. That time of the month. On the rag. Aunt Flo. Menzies. The Dot. Crimson tide. Shark week. (That one is new to me.)

Whatever you call it, menses are a normal biological part of life for healthy women of child-bearing age. And yet there is a lot of shame associated with it. Girls both look forward to it and dread it, women groan when it shows up, and everyone is expected to hide that they ever have to deal with it.

But we do have our cycles and starting somewhere between the age of 11-14 on average, most women bleed from their uterus once a month or so.

We’re daring to talk about it. What’s normal, what’s not, our personal experiences, social experiences, attitudes, and information. Men and women of all ages are invited to the conversation. Shame is not. Read more here to help us begin normalizing and not shaming periods by joining the conversation.

– Jessica Martin-Weber
Founder, TheLeakyBoob.com

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On My Menarche, Menstruation, and Menstrual Misogyny

by Joni Edelman

I started my period when I was 13. This is just slightly behind the American average of 12.8 — I guess my uterus didn’t get the overachiever gene. I was the last of my friends, which was sad for me then, because periods = grown up. At 12, while the rest of my friends were talking about pads, I was skinny, breastless, and without menstruation. I might as well have been 5.

The morning I started my period was the same day I was supposed to sing in church choir with my best friend — who had already had her period for like two years by then. It wasn’t bright blood red, as I expected. I thought I was getting something along the lines of Game of Thrones, instead I got what sort of looked like a poop smear. Since I knew I hadn’t actually pooped my pants, the period was only logical deduction.

It was the best day of my life.

Well, until the cramps. No one told me about the cramps. I went to my mom and showed her my poop/period stain, and she said, “YEP! You’ve got your period.” And she handed me a Stayfree maxi-pad. I don’t know what exactly I was supposed to be free from. The maxi-pad of 1987 was not the thin, super-absorbent pad of today, friends.

Period Week- Joni's 1st image

Look I was in color guard, and we wore tiny bloomers and everyone, I mean EVERYONE, knew when you were on your period. Everyone.

Why? The pads of yesteryear looked more like this:

Period Week- Joni's 2nd image

I know that doesn’t look thick, but trust me, that sucker could have doubled for a whiplash neck brace.

Period Week- Joni's 3rd image

This guy is making neck brace/maxi-pads look hot. They are not hot once placed in your underwear — I assure you.

My mom had never even considered using tampons because “Where does all the stuff go?” I don’t even know what that means, but for me, it meant no one could tell me how to insert a tampon. Also, there was no Google. Also, the tampons of yesteryear weren’t unlike pads of yesteryear. Let’s just say “feminine hygiene” (whatever the hell that is) has come a long way.

Without Google or an experienced adult, I tried to just read the package insert, which featured an anatomical cross-section of the vagina and uterus. No one told me that your vagina doesn’t empty out into your uterus so I was basically terrified to put anything in there, certainly not cardboard.

Here’s what happened: I put one foot on the toilet edge (per package instruction), gritted my teeth, and just shoved it in — half-way.

P.S. A half-inserted tampon A. does not work, and B. hurts. Really a lot.

So, without anyone to tell me what to do, or that I could fix that, or that you weren’t supposed to have something hanging out of your vagina, I walked around miserably for three cycles with a tampon half inserted in my apparent endless tunnel of a vagina. After the half-inserted tampon became too much to bear, I went back to the neck brace and wrapping a sweatshirt around my waist. Obviously.

It never even occurred to me that there might be any alternative choices, or that maybe the choices I had weren’t even really made with me in mind.

I don’t remember when I finally figured out that tampons were meant to go inside your body — like, all the way. But eventually I did and I wore them for most of my adult life; not even considering where they came from or what they meant to me or why they were $7 a box.

They are more than $7 a box now.

Also, they are taxed, like they are some sort of luxurious item. Oh what’s that you say? You don’t open a package of 24 tampons and throw them in your bathtub to create a cushion of pillowy softness upon which you might bathe?

Well you are just missing out. Pillowy bleached chemical-laden softness.

And here’s another thing I bet you haven’t considered, while we should congratulate Science on making a maxi-pad that doesn’t make you looked like you crapped your pants, can we also ask why we ever wore those diaper-pads anyway? I appreciate that this is all better than a rag shoved in your underpants, as was the custom, prior to the advent of the wood-pulp pad in 1888. It probably beats sheep’s wool too (though maybe not, there are so really soft sheep).

The Feminine Protection Industry in the US consists primarily of Tampax, Playtex, Stayfree, and Kotex. Playtex and Stayfree are both owned by Edgewell, which is run by one Ward Klein. Tampax is under the household GIANT Proctor & Gamble, CEO, David S. Taylor. Kotex is a Kimberly Clark product, overseen by Thomas J. Falk.

HOLD ON.

I’m seeing a pattern here. Are you seeing a pattern here (besides the apparent need for a middle initial)? Dudes. All dudes.

Now, while I realize that dudes are often preoccupied with vaginas, I think this has gone too far. And it would be convenient to call me a fem-nazi here, but this is real.

When I was 13, I walked around with $7 worth of cardboard taxed tampons hanging out of my vagina — because no one ever challenged it. No one ever considered that other ways to deal with your period do exist. No one ever considered that the “feminine hygiene” product industry might not actually be designed to benefit women. No one said, own your period, know your vagina, capitalism is bullcrap. We were all just happy with our beltless neck brace maxi-pads and our cardboard miserable to insert tampons.

And then there is the maintenance.

Oh vagina, how do we deodorize thee? Let me count the ways: Powder, spray, wash (who would want their vulva to smell like an Island Splash), wipes, douche, and even extra fancy soap made for ladies. Vaginas actually do not need any accessorizing. They smell like a vagina, because they are a vagina. They have their own little ecosystem that doesn’t need vinegar or backing soda mucking things up. They actually don’t need anything. At all.
A bunch of super rich middle-aged dudes are basically robbing us, by way of our vaginas.

Did you know you can use a sea sponge instead of a tampon?

Not the tampon type? There are pads you can wash. And they are made by WOMEN. I know. It’s weird. Ladies, with jobs and making stuff.

And the menstrual product to rule them all: The Diva Cup. Created, owned and operated by Francine Chambers.

A lady person.

Someone who, ostensibly, also now (or at one time) has had a period.

There’s still a tax on the Diva but Francine isn’t in charge of that.

____________________

IMG_0670

I’m Joni. I’m lucky enough to have 5 amazing kids (19, 16, 15, 4 and 2), one fantastic husband, an awesome sister and a yarn addiction. When I’m not raising up people I’m a freelance writer, RN, and the momma behind mommabare. Love is my religion. I like cake and crafty crap. And yoga. In that order.
You can follow Joni on Instagram here and on Twitter here.

 

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Normal Postpartum Bleeding and Discharge and the Return of Your Period After Giving Birth

by Dr. Kymberlee Lake

Most women know that there may be some bleeding after giving birth but often women are surprised by how much and how long and they aren’t aware of the difference between postpartum bleeding and discharge and menstruation. The first bleeding after you give birth is called lochia.

What exactly is lochia? 

Lochia is the discharge consists of blood from the area on the uterine wall to which the placenta was attached during pregnancy, the sloughed off endometrium (uterine lining which makes a bed for the fetus) which gets considerably thickened during pregnancy, blood and mucus from the healing cervix,  and dead (necrotic) tissue. Your blood volume increases by approximately 50% in pregnancy, all that extra blood also has to go somewhere after birth. Most women will experience blood and lochia discharge for 3- 6 weeks though that time span can very from pregnancy to pregnancy and can be directly influenced by a healing mother’s activity level.

Why do we have lochia and where does it come from?
The blood in the lochia comes mainly from the large raw area left in the uterine wall after the placenta detaches from it. While bleeding from this area is controlled by contraction of the uterine muscles immediately after delivery, it takes on the average about two weeks for this area to heal. It is important to remember that this is a wound and it is possible to do too much before it has healed and reopen the wound, causing fresh bleeding. You will experience this bleeding for around four to six weeks postpartum.

For the first few days it will be a heavy flow (kind of like a heavy period) and will be  colored dark red, with some clotting.  About the end of the first week the flow should start to taper off, becoming lighter in saturation and color; as time passes, it will fade to a brown, yellowish or even almost-white discharge. 

One thing to remember is that the placental area as well as the sites of sloughing endometrium are raw and open during this time and bacteria can easily spread from the vagina. So, the use of tampons should be avoided – sanitary pads are the best options to be used during this time. 

What is normal and when should I be concerned?
You might notice a ‘gush’ of blood with clotting when you stand up – this is very normal. Also, if you’re breastfeeding, you might notice that you lose more blood after feeding baby; this is caused by your hormones doing their work to help shrink your uterus back to it’s pre pregnancy size. The lochia is sterile for the first 2-3 days but then becomes colonised by bacteria giving off a typical distinct lochial smell which is normal and should not be confused with the bad odor from lochia in postpartum infection. – 

If the discharge smells foul, you’re still noticing a lot of blood loss after the first four weeks, or the blood is bright red, these are signs of infection and you should speak to your health care provider as soon as you can. This is especially true if you also have a fever (no matter how slight)  or are generally feel ill. Likewise, if your blood loss is so heavy that you’re going through more than a pad an hour, you should get medical help immediately – this can be a sign of a hemorrhage. If in question and something feels “off” it is worth a call to your health care provider for advice.

Types of Lochia
Depending on the color and consistency, lochia can be of three types:

  • Lochia Rubra: Lochia rubra occurs in the first 3-4 days after delivery. It is reddish in color – hence the term ‘rubra’. It is made up of mainly blood, bits of fetal membranes, decidua, meconium, and cervical discharge.
  • Lochia Serosa: The lochia rubra gradually changes color to brown and then yellow over a period of about a week. It is called lochia serosa at this stage. The lochia serosa contains less red blood cells but more white blood cells, wound discharge from the placental and other sites, and mucus from the cervix.
  • Lochia Alba: The lochia alba is a whitish, turbid fluid which drains from the vagina for about another 1 – 2 weeks. It mainly consists of decidual cells, mucus, white blood cells, and epithelial cells.

The Stages of Lochia table image

Do women who give birth by c-section still have lochia?
Many women believe that the flow of lochia is less after a cesarean section since the uterine cavity is cleaned out after the birth of the baby. This is not true. The flow of lochia is not dependent on the type of delivery –  The amount and duration is the same in both cases.

Return of Menses
There’s no hard rule as to when your period will return post-baby – it can vary from woman to woman, and pregnancy to pregnancy. Here are some general guidelines

  • Women who bottle-feed can see their menstrual cycle return within six weeks of birth – and most will have menses back by ten to twelve weeks.
  • Women who exclusively breastfeed may not get their period back for some time. When you breastfeed, you body releases the milk-producing hormone prolactin, which, in turn, keeps our levels of progesterone and estrogen low. Progesterone and estrogen are the hormones responsible for signaling ovulation and menstruation. Night nursing directly effects these levels, a decrease in breastfeeding at night may lead to a return of menses.

Once your period returns, it can take even longer for it to get into a regular cycle. If you are bottle feeding it can take around six months, while exclusively breastfeeding your baby can take 12-18 months. But keep in mind that this does vary from mom to mom and pregnancy to pregnancy. Even with exclusive breastfeeding on demand and no artificial nipples, there are women who see a return of their menses as early as 6 weeks while others may not breastfeed and still experience a considerable delay. Each woman is different. Some women experience lighter flows and/or less cramping with their menses after having a baby, others experience the same, and still others may experience an increase. The range of normal variations is considerable but very heavy bleeding, soaking a full size pad in 1-2 hours, may indicate a problem and should be addressed with your health care provider. There are a variety of factors that contribute to possible changes with the return of your period but keep in mind that diet, physical activity, and your menstrual products can all contribute to cramps and duration.

____________________

Please be aware that your first egg (ovulation) will be released two weeks before your period starts, so if you have unprotected sex without realizing that you are ovulating, you could get pregnant before you have even began menses again. It’s a good idea to speak to your healthcare provider about contraception even before you start thinking about sex again, so you can be confident in your choice ahead of time.

____________________

Kymberlee Lake- headshot

Kymberlee is a Physician/midwife, Therapeutic foster/adoptive parent with 6 kids ranging in age from 31 to 3 and three grandchildren. She is living life to the full with MS in the Pacific NorthWET.  As an international travel enthusiast and fan of teleportation you can find her under the name “Dr_Kymberlee” live streaming and on social media, or on her often neglected blog, TheMamaMidwife.com
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