There’s been a lot going on in the midwifery scene in the UK. 

The Nursing and Midwifery Council (NMC) is the regulatory body that registers midwives. All midwives in the UK, whether private, independent, or NHS, must be “on the register” in order to practice as and call themselves a midwife.

In January 2017, the NMC suddenly and immediately withdrew the ability of independent midwives, who I am apprenticing with, to attend births. They could continue to provide antenatal and postnatal care (“postnatal” commencing the moment the placenta is birthed) but as soon as someone was “in labour,” an independent midwife could not be anywhere near or provide even verbal support. Independent midwives could not even plan to transfer their clients to hospital care and accompany them as doulas.  All this was over a baseless complaint (made by a private midwifery company, a “business competitor”) about the suitability of the indemnity insurance carried by all independent midwives. This insurance was designed especially for independent midwives in the wake of a 2014 EU law requiring midwives to be insured; prior to this, IMs did not carry insurance. That decision had also threatened the future of independent midwifery without any precedent of catastrophic claims or dangerous practice, so here we are again in territory that is familiar to independent midwives worldwide.

As you can imagine, this was a crushing and dangerous acute development for all of my midwives’ clients and for at least 80 other independent midwives and hundreds of families, with knock-on effects for affected NHS hospital trusts and then all the midwives employed there, as the NMC’s backtracking clarifications of what a “midwife” could and could not legally do began to also restrict NHS midwives (technically unable to attend their families’, friends’ and co-workers’ births, for example.)  The UK is in the middle of a critical midwife shortage proven to be causing poor outcomes as it is; losing even one safely-practicing midwife now is a step backward and leaves mothers and babies at risk rather than “protecting the public” as the NMC claims.

Some local NHS trusts have graciously lent a hand to the Independent Midwives working in their areas to offer contract arrangements that would insure the IMs while allowing them to fully support their own clients as IMs out of hospital; we are lucky that Airedale NHS Foundation Trust has picked up the Yorkshire Storks, for example.  The majority of Trusts have not provided any support, and this is by no means an ideal, permanent, or sustainable solution. Independent Midwives are still in the middle of a huge crisis; but there is light!

A few Independent Midwives hoisted up their trousers and brought a case against the NMC, which was recently granted a full trial!  But this is expensive!

There is a GoFundMe to help pay for the costs associated with what is likely to be a long judicial process, which was halfway funded within a month!

https://www.gofundme.com/Independent-Midwifery-Fighting-Fund

As a birth photographer, I love when the first weight is done as a ceremony with the family looking on as a care provider weighs the baby with a hanging scale.  As a needleworker, I especially love when the scale is aesthetically pleasing!

That’s why I decided to do my part to support the midwives who have supported me for the past two years by making weighing slings to fundraise for the IM/NMC trial. As I will be leaving the UK very soon I will not be here to celebrate with the IMs when they are restored to justice and full independent practice, but I will be thinking of them with every stitch!  Each sling is $50/£35 which is a bargain!  I have test washed my prototypes and so far, so good.

Order yours now!

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I have chosen these two images to submit forward to the International Association of Professional Birth Photographers annual photo competition. The theme of my entries is ‘DIY Birth.’

The first image is submitted under the “Details” category and is of a cord burning ceremony. This image is special to me because it was the first cord burning I have ever photographed, and I was able to use a beautiful piece of pottery hand-thrown just for the purpose of cord burning, which I won from my placenta encapsulation certifying body, APPA.

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The moment itself was also special, because for the first time, I missed the birth of this child by 30 minutes after having been called out just 1 hour before- when I entered the home, my client was still sitting on the blanket she birthed on in the middle of her front room, placenta still in situ, and the midwife wasn’t there yet either. The baby’s father had laid the blanket down just in the nick of time and made the catch, and then answered the door. Legend!

Cord burning is a way to honor the separation of mother and child in a mindful way. It takes about ten minutes, and is done by holding two candles up to the cord while twisting and pulling, with a bowl or box or plate to catch the wax and shield the baby from the heat. In this way the cord is cauterized and needs no clamping or tying.

The second image is right in-your-face, no pun intended. In the “Birth” category obviously.

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That is my hand there you see in the corner, poised to make the catch. When I arrived to the house, a little curl of this baby’s white hair was already visible, and the mother was laboring just so comfortably that she had no idea she was about to birth. We decided on keeping the last moments of the birth calm and sacred rather than panicking and fumbling with a phone to get a midwife or the ambulance to come out, so it was decided that I’d preside over the birth. At the last minute, she changed positions and the father was able to receive the baby into his hands, which is what I had been hoping would happen for this family all along. Everything happened as it was supposed to. I was just proud of myself that I thought to take a picture in that moment!

There is lots more to write about each of these births, but now thousands, maybe millions, of people get just a peek into these births too.

I didn’t submit to this competition last year and regretted it; even though there are around 600 entries from all the industry leaders to compete with, just knowing that the following people will lay eyes on two of my images made during some of my unforgettable moments of 2016 is thrilling enough:

Ricki Lake, Actress, Producer & Emmy Award winning Host.
Abby Epstein, Producer and Director of The Business of Being Born
Catherine Pearson, Women & Parents Senior Reporter, The Huffington Post
Penny Simkin, Birth Educator, Counselor and Author.  Co-founder of DONA International and PATTCh
Jan Tritten, founder and editor-in-chief of Midwifery Today Magazine
Peggy Vincent, Midwife and Author of author Baby Catcher, Midwife: A Calling and Midwife: A Journey
Stuart Fischbein, OBGYN, Author and Birth Activist specializing in breech, twin and VBAC births
Lena Hyde, Photographer, Creator Design Aglow
Kristen Lewis, Photojournalist & Mentor
Darren Mattock, Founder of Becoming Dad
Dawn Thompson, Founder and President of Improving Birth, an advocacy organization
Molly Flanagan, Photographer and Founder of The Define School for photographers
Peggy O’Mara, Editor and Publisher of peggyomara.com and former owner of Mothering Magazine
Jenna Shouldice, Photographer specializing in women’s issues
Rebecca Dekker, Founder Evidence Based Birth
Twyla Jones, Photographer
Heather Dessinger, founder of Mommypotamus.com
Michele Anderson, Photographer
Jill Krause, Founder of Baby Rabies
Christina Beckett, Photographer
Marijke Thoen, Photographer and 2016 grand prize winner in the IAPBP photo contest
Lyndsay Stradtner, founder of the IAPBP, Mentor and Birth Photographer

During this past Winter Solstice week (2016) I was able to take my family on a huge bucket-list trip of mine- to the Arctic Circle to go aurora hunting. I chose Kiruna in the Swedish Lapland as our base and could not have been happier. It doesn’t look like much on paper but it was such a beautiful and tidy little town with tons to do, and each house decorated humbly and cozily with a paper advent star hanging in each window. I invited a fellow photographer along who is a whiz at landscapes, as my husband and child could not care less about aurora, especially as it involves sitting in the cold and dark and just waiting.  It was great to have some company out there in the snow! Check him out: Shots by Shinobi

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Aurora photography and birth photography have a lot in common: the unpredictability, being completely at the whim of nature, the patience required to be “on call” and expectant at night, driving somewhere fast, operating a camera in the dark, at extreme settings and mounted in awkward positions, and the sudden emotion and excitement when it is finally happening, and to be able to fully experience it while having to move and change settings quickly to photograph the activity around you.  Aurora photography is actually extremely challenging!  I was in my element!  And I am addicted!

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For example, I had no idea how fast auroras move or how bright they can get. I thought the typical videos of aurora you see are sped-up time lapses of long exposures, and that in reality they are dim and imperceptibly moving, so when the sky (figuratively, but literally) suddenly exploded before us after we’d spent many hours lolling around in sub-zero wind, I was physically and mentally frozen in place and just left my settings as they were for the dark, so I actually had to reduce the exposure on some of my images!  Active aurora really is bright as the moon and shimmers quickly like reflections on water. It was actually pretty alarming the first time it started to happen. I am not sure why the videos I took look choppy- I had to cut the audio off the first clip as I was shrieking too much!

We were told by our dogsled guide the next day that it was the best aurora of the season.  We were so lucky to get active aurora every night of the trip and I am still on my high! It was the most beautiful thing I have ever seen in my life. Birth still is the most amazing thing…but stereotypically “beautiful” might be arguable! Furthermore, as it was during the Winter Solstice, the sun never rises at that time but produces a pink glow for a few hours, kaamos, that was just as beautiful as the aurora. It became a habit just to look at the sky for hours. It may be dark in the Arctic Circle, but the auroras and hygge of the holiday season are so rewarding that the darkness and cold is worth it!

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Hello dear readers!  Yes, I am still here, in England, loving my experiences as a doula and student midwife and being kept so busy that I don’t have time to blog!  I’ve also been trying a different social media platform (Instagram), which you can see in the feed above my blog posts. I like it for its speed and immediacy, but I prefer collecting birth stories all in one place and discussing the aspects of birth that I learned about during that particular experience, as there’s always something new to learn. My New Year’s Resolution, as it seems to be every year, is to blog more!  (Ha ha.)  I have a huge backlog of beautiful births to tell you about.

But first!  Back in 2012 I posted a blog about the German hospitals that I would be working in, and the various unique aspects that made them theoretically more pleasant to birth in.  I got a lot of feedback about some of the gadgets in the photos, namely the ceiling-mounted sling and the gymnastic rack mounted on the wall, on which a laboring person can hang, step, or tie a sling onto for leverage.

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One inquiry in particular was from a woman who was in the process of establishing and designing a new birth center in Pasadena, California. She was intrigued by the wooden wall rack, and wrote to ask me what they are called and what are the design specifications. I knew that the Turnhalle (gymnastics hall) that my daughter attended also had big versions of these mounted to their walls for the kids to climb and hang on, so I asked around at the hospital and at gymnastics for the particulars of these racks.  They are called “wall bars” or “stall bars” or Sprossenwand and you can use them for anything.  I inspected how big they were and how they were mounted to the wall and then reported back to the birth center designer.  We found out that these simple wooden racks are quite expensive!

Fast forward to a few months ago, and I received a message that the Del Mar Birth Center had been completed and opened, and hey, they got a set of wall bars installed!  I was absolutely blown away by the beauty of this birth center and completely envious of the families who get to birth there. What a job well done to Ms. Delia Camp and crew on making this a reality, especially knowing how huge of a task starting a birth center is.   Check out the photo tour and see if you can spot the wall bars:

Photo Tour of Del Mar Birth Center

And now whenever I wonder if anyone reads this blog of mine or when I’m wobbling after a tough experience that makes the status quo seem too big to go up against, I can rest assured that I’ve helped make a difference somewhere 🙂

 

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  • Anonymous -  The stall ladder was in demand this Christmas Eve for yet another special delivery! Thanks so much for helping us to make this happen 😊 We would never have known about this useful option without your blogpost. Even the site visitors from the Commission for the Accreditation of Birth Centers had never seen a stall ladder in use here in the USA prior to our site visit back in 2014. ReplyCancel

These past few months have been busy in terms of my midwifery learning and growing. The UK has a very active, very busy birth community.  Midwives are common..they are in every delivery ward in the UK as they take the place of our labor & delivery nurses like they did in Germany- they fully conduct the normal births. The birth culture here is a little more progressive than ours in the USA; midwives are normal, mainstream, integral and ingrained in the system (though still manage to be underpaid, overworked and marginalized??), the guidelines for births are more evidence-based and reasonable-and are still more thought of as GUIDELINES rather than LAWS of nature- and maternal choice and informed consent is a stronger construct, though it still has far to go in the UK too.

NHS midwifery is in a weird state here. They absolutely rely on midwives for birth: hospital midwives, community midwives (these are the ones who go out to home births and do home visits), supervisors of midwives, on and on. There are approximately 60,000 of them but they acknowledge that they need thousands more in order to “fix” the system they’ve stuck themselves with due to budget cuts and shortfalls.

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There are extremely limited places in the midwifery programs at universities like York, Leeds and Bradford. The places are competitive and won by interview; some extremely motivated prospective midwifery students apply and apply and apply again until they finally get in after many years of waiting and doing odd birth-related jobs and study to make themselves more appealing.  The programs themselves are only three years long and plunge the student midwives directly into clinical care and working long shifts alongside their studies.  They also must complete placements in different areas of midwifery such as community or independent midwifery.  It’s an amazing system that I often find myself envious of, but when talking to midwifery students here, they are equally amazed by and envious of the process I am going through. All are amazed that homebirth midwifery is outright illegal or impossible in nearly half of my nation, and many realize how little they actually know about homebirth or birth in general when I explain the long process of apprenticeship in qualifying to practice alone as a CPM. I’ve been at this for three years now; still haven’t actually caught a baby, still haven’t charted, haven’t even performed a vaginal exam. Due to the laws and insurance regulations in the UK, I am not allowed to do any of those things under supervision. But I’m okay with that, because that’s the easy science part of midwifery. The learning I am interested in is the art of midwifery:  the day-to-day management of clients, time, and self.  Developing intuition. Doing as little as possible while being as safe as possible. With these midwives, I’ve learned that you routinely have to do nothing at a birth.  But the amount of mental and emotional work they put in antenatally is incredible- and that’s what I need to know.
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In a talk about independent midwifery that I presented with one of my preceptors at Teesside University a few months ago, I asked the third-year midwifery students we were speaking to, who were ready to graduate and work as registered midwives, if any of them had ever seen a physiological birth that didn’t involve even an IV cannula.  One or two out of about 20 raised their hands. I asked if any of them had ever observed a home birth. The same two raised their hands, one being a young man who asked great questions. (I told him he’d be the next Mark Harris.) The rest looked wide-eyed and incredulous, as I explained how I had been studying as long as they had and had never performed any internal exam, and my preceptor, a practicing independent midwife, added that she couldn’t remember the last time she’d performed one on a client. It was just never necessary. I explained how the last home birth (a VBAC) I attended only involved: a Doppler, two or three “inco pads” (chux), two cord clamps and a pair of scissors, two or three pairs of gloves, and a syringe for drawing a sample of cord blood for blood typing. That was it. The students couldn’t imagine it.  I’ve been told that “unlearning” all the unnecessary stuff and letting go of fear  has been the biggest challenge for any NHS-trained midwife when they go independent.

So this is the state of midwifery education in the UK: medicalized, institutionalized, cranked out specifically to perform in the overburdened, increasingly risk-averse NHS system. There are only about 100 independent midwives in the UK- these are midwives, all university-trained in the same three-year system, who have stepped out of the NHS system and are performing a midwifery that is homebirth- and family-oriented and much closer to the homebirth midwifery that Americans are used to. They perform great midwifery— they are even more hands-off compared to the things I’ve been taught in a CPM program.

A lot of this is enabled by the fact that they are legal- they need only carry indemnity insurance for each client- and are somewhat integrated into the system. If they need stuff like blood tubes and blood spot forms, they go to their local “trust” (hospital system) and get it.  They freely obtain and carry crucial oxytocic drugs and even Entonox (inhaled nitrous oxide + oxygen for pain relief). Their clients can step easily in and out of the NHS system to get what they need and avoid what they don’t-for free. Transfers to hospital are seamless and easily facilitated. There is less fear, less defensive practice. The only drawback is that it is private midwifery- so the clients bear the burden of paying the midwifery fees of around 4000 pounds, which is still not really enough to be sustainable for an independent midwife unless she has a partner or other income. Independent clients and midwives both will tell you it’s totally worth it.

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So I’ve been taking advantage of the active midwifery culture here by going to lots of study days and birth circles and independent midwifery meetings- while I’m not busy as a birth doula or photographer right now, I’m filling my time learning from experts about men at birth, waterbirth, perinatal mental health, bereavement, and more. I even conducted a placenta printing workshop in an arts space that was incredible- I showed moms (and their children!) how easy it is to create beauty from their births themselves.

I feel absolutely spoiled and indulged and that I am not missing out on what I could be doing in the USA at all.

placentaworkshopOne of the Yorkshire Storks midwives, Claire Harbottle, is also an artist, naturally with a focus on motherhood experiences. She ran a great little “maternity hub” in an arts space that focused on bringing mothers and all kinds of birth professionals and birth-interested together to explore and share knowledge surrounding the childbearing year in an art-focused way. It’s a departure from the facebook groups, polite playgroups and sterile waiting rooms where we tend to share motherhood experiences now- participating in art gets us “juicy” and more open about things, I think.  Claire asked me to demonstrate placenta printing for a group of moms who happened to still have their placentas in their freezer- maybe they were still pretty new, maybe the mother wanted to do something meaningful with it for years but couldn’t bear to say goodbye.

Not that I’m a placenta print expert, but I do love to demonstrate, and I also like to push boundaries.  Because the placentas were not going to be consumed, I felt free to expand my printing mediums to thick acrylics, watercolors in tubes, and metallics.  I was even supplied with a beautiful “demo placenta” to show the techniques on, so everyone could jump in and do it themselves. I was so excited about the metallic paint results that I’ve bought food safe metallic cake paint to do prints with for my encapsulation clients!

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I must mention another very special printing participant- an 8-year-old whose mum, a midwife, kept her (and her older brother’s) placenta all these years waiting for that special moment, which turned out to be this workshop. She jumped right in and slayed placenta art on her very first try:

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How cool is that?

Although I had never considered doing show-and-tell on placenta printing, as it isn’t really “my knowledge” to impart, being able to bring moms in all different stages of motherhood together to marvel at their placentas without any negativity or squeamishness was even better than the printing part, if I’m honest!  I wish all mothers were given a better chance to really look at this underappreciated organ that protected them and their babies. After all, when the placenta doesn’t work as it should, even on a microscopic level, it’s dangerous and sometimes fatal, and only then do we pay attention to it and give it any importance.  That doesn’t seem right to me!

Here’s the results of the workshop:

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I so enjoy being invited back into a doula family’s life to photograph them again.  Remember his birth? He was such a tiny guy, a little less than 6 pounds!  Check him out a few months later!

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This baby is well-loved by his bigger brother and sisters! He fits right in and the kids fought over who would hold him or be closest to him during our quick shoot. I miss running into him around post! bedheadbirth_0337

No sooner had we moved into our residence in Harrogate did I get an email from a friend of a new friend, looking for a doula at 38 weeks. Don’t mind if I do! I had to dig deep in the mountains of packing paper to find my doula bag, and improvise on my contracts since the husband was still puzzling on how to get wi-fi to reach the third floor of a Victorian home made of solid sandstone. But we connected, I went on call, and I was excited to get a hands-on education on the NHS birth care system.

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Firstly, this mom hadn’t planned for a homebirth during her pregnancy, but at 37 weeks she asked a NHS midwife during an appointment if she could do a homebirth, since she had been low-risk until that point. The midwives shrugged and said, “Why not?”  The next day, a midwife from the Harrogate NHS homebirth team brought over a small box with basic supplies, and a tank of Entonox (oxygen and nitrous oxide, or “gas and air”, inhaled during a contraction for pain relief) to keep at the home until needed. I had been loosely planning to invest in a birth pool kit for my clients to use, since birth pools are much more commonly used yet more expensive here, so thank you to my clients for lighting a fire under me to buy that birth pool kit ASAP!

Everything was in place, and 39, 40, 41 weeks came and went. The NHS midwives were now getting a little fussier about the homebirth possibility due to being 10 days over, and they encouraged my client to come in for monitoring, membrane sweep, something, anything to do every day to make everyone at peace. I delivered some clary sage oil and instructions for foot and belly massage. We were no longer sure whether the homebirth could happen. It seemed cruel to get her prepared for a free homebirth then take it away all so arbitrarily.

In fact, even though you have been “booked in” for a homebirth, you may not get one, since when you go into labor you call to find out if there are any homebirth team midwives available, and if not, you have to go into hospital anyway. Or call their bluff and stay home until someone with a clue shows up, which could be well after the birth- called a “Birth Before Arrival” or BBA, this happens often enough for it to have its own acronym! (Currently there is a huge midwife shortage throughout the UK- this is what is blamed for the phenomenon of not enough midwives to go to all the homebirths, as well as some of the recent poor outcomes in hospitals.) What a crusher of hopes and dreams! I suppose if you haven’t put your whole 40 weeks of heart and soul into fighting for and preparing for homebirth, as women in America have to do, it’s not such a big deal.

FINALLY! at 42 weeks I got called over. Was it the clary sage or the stretch & sweep? Did I mention I live about five blocks from the client’s home? After five years of driving an average of 30 miles one way to births, this was an unbelievable luxury! As I was skipping up the road with my big pink bag at 3 AM (with the sunrise- beautiful!), a tiny car whizzed up to the “kerb” and out popped two upbeat midwives. In crisp blue-stripe NHS uniforms. With the starched collars, fob watches and everything.  They each carried a small black leather bag and we made cheery introductions on the walk up to the house.

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I thought I was hallucinating

I found my client in her front room made dark, warm and cavelike. She was doing FINE so I helped assemble the birth pool. The midwives made themselves comfortable in the dining room and watched my client a little while….got some heart tones and vitals, listened to make sure she was coping, and otherwise left her alone! Her husband and I were still a little foggy from sleep so our conversation about how best to fill the pool and how to connect the hose was comically slow and confused, but we got it going. The classic tableau of stockpots boiling on the stove in rotation.  7cm. A intense need to make a trip up the stairs and into the restroom.

You know I’m watching her go up the stairs and rest on the loo with glee…there’s nothing better than these two movements to move a baby down.

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Pool water level and temperature finally optimized and my client dove into the pool.  With the next contraction, that familiar guttural sound. The midwives were still chilling in the next room with my client’s excited and emotional mom who had flown from the USA to be here. Water breaking, I summon the midwives, they come in, heart tones, hands off, silence.

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10 lbs 12 oz. white-blonde “corker” of a child.  Irresistible rolls. Little brother to a 2-year-old who had to be delivered with forceps at only 7 lbs. It is amazing how important fetal positioning, a natural labor, and the labor environment is to the process of birth!  I cannot underemphasize it.

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These particular NHS midwives did the absolute minimum fiddling and poking of mother and child. I blinked and missed their newborn exam! All families are treated to frequent home visits from midwives for the next 4-6 weeks, and then their care is transitioned to “home visitors” who are a little sketchier in quality of advice- pressure for early weaning being a major problem.

I believe this is the #1 thing that USA maternity care is lacking that contributes to our lower rates of infant and maternal wellbeing…home postpartum visits daily and weekly.

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Many thanks to this lovely family who trusted me in a new town! I definitely learned more from them than they had learned from me.

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First meeting at a few hours old – I almost never get to witness this!

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This gal is one of my biggest supporters and so it pained me to not be able to be there for her birth…though some tips given late at night from 3000 miles away via FB Messenger helped!

I don’t have any studio gear, so I have to use what families have.  Literally all I have is a sheepskin from Ikea. If they have a big, sunny window, that’s good enough for me! I enjoy the challenge of uncontrolled lighting and background.

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I promote herbal baths for postpartum healing and connection with baby. When I was finally able to meet the baby responsible for such a photogenic bump, I ordered them into the bath. So much beauty in an Army standard-issue housing bathtub.

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Check out this little guy now at 6 months! Rolls overlapping rolls all thanks to mother’s milk.

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