Orgasmic Birth: Our Review

This movie, Orgasmic Birth, focuses on the women giving birth, and that’s something the public has been waiting for a long time!! Every woman you’ve ever shared birth with is in this film. There is the mother who believes you trust doctors for everything and she ends up with an induction, epidural and baby finally born after two vacuum attempts … and she believes the doc saved her. You see the mom who also believes the same, is induced, and has a cesarean. However, the movie starts and ends with the mothers who have believed in the birth process, their bodies and that how they birth matters to their babies. You hear from fathers who love that their babies were born surrounded by their home and loved ones…their natural environment to begin life in.

Instead of the black/white contrast of The Business of Being Born, you have a sophisticated segue in the sense that the commentator’s information is presented around the story told so the dots are connected fully because these women tell their own story and the commentator fills in the ‘real’ story. It’s not told fear based, it’s told from a know natural birth perspective. No rant. It just is.

We believe that it is also the intent to interview everyone in a home or home-like atmosphere, with the exception of hospital footage for those two moms with routine medicalized birth … and that’s a smooth, thinking contrast. Every person is speaking softly even when venting on medical birth. Love the moment that Dr. Northrup tells us with medical intervention we “screw it up” — “it” being normal birth.

It is also one of the first films presented to the public to show a wonderful birth class outside of the hospital. We don’t know if it is the producer’s intent but perhaps the film is trying to turn Lamaze around and portray Lamaze in the Institute for Normal Birth light. We say this because the producers limited themselves to Lamaze. They did also keep footage of someone mentioning a Lamaze in-hospital class that they didn’t like.

We wish more had been done to represent other independent birth ed options as independent childbirth educators are among the most deeply anchored normal birth supporters in America and have always known that hospital preferred birth classes are a disservice to women, hindering their access to unbiased information and, many argue, used only for props to keep women birthing in hospitals. Around the world, normal birth education may not be done in the traditional setting that we in America are accustomed to but it is still independent of medical fear and bias, with knowledge transfer occurring rather as a woman to woman knowledge share with midwives as the informational conduit.

We do wish the film included reflection on mothers who are second or even third generation homebirthers as well. These women kept normal birth in America from completely fading away. There really needs to be a film as a tribute to these women pioneers. In other words, it is important that nations, especially America, fully recognize that home birth, normal birth is not something new; that women have believed in and enjoyed their normal births before 2008.

The births shown are wonderful. One of the best births is the mom who talks about childbirth as a mother’s sacrifice. You might cringe because you start thinking here we go… “Birth is painful. Birth is a sacrifice. Birth is about a medal.” However, to our delight, this mother delivers within a pretty normal window for active labor, 26 hours, she’s birthing at home and the midwife says outright in a hospital she would have been given pitocin and c-sectioned by now. The great thing is the mom talking afterwards about enjoying that birth for its own challenge for her if not for any great spiritual or relaxing birth story.

This is a great contrast to the mom who I mentioned above with the vacuum baby who says not until closer to her due date and hiring a doula did she hear anyone talk about embracing contractions. Until then everyone talked about labor as a difficult thing. You really do get the full connection of the contrast between the two women’s births… some of the responsibility lies with women doing the work to face and/or overcome fears… some of the responsibility lies with careproviders’ attitudes about birth and their inability to provide humanized birth. It’s not only about medical vs. normal birth. It’s also about what women are told, have been told and how it’s still quite accidental for women to hear about birth as an enjoyable event in their lives.

The abuse survivor’s birth and another homebirth will make you cry. The very personalized births will leave you smiling and swaying with the moms. Very cool.

We can’t wait to share it with you and we hope to see you at our screenings!! Just check our “Birth Events Near You” page on this blog.

 

Time For A “Second Class” of Midwives?

The cause of rising malpractice insurance for obstetricians is NOT that birth is risky. It’s that the medical model for birth care, also known as managed birth, is dangerous. We are not a nation of women and babies who need saving from labor. According to ACOG’s greatest supporter, Dr. Amy’s latest responses on who deserves to decide who is licensed to be a midwife in America, she considers anything less than a medical model midwife ~ highly managed by an obstetrician ~ a “second class” of midwife.

Let’s consider this: the average American believes primitive homes with dirt floors are unsanitary places to give birth, a clean source of water is vital for our health for consumption and bathing, a nation ought to have good farmland for producing healthy foods organic or otherwise, a nation ought to have cutting edge physician care options and everyone has the right to a free public education to the high school level.

If we are a nation of women for whom the majority live in clean homes with clean drinking water, are able to purchase nutritious foods and supplement with container gardening if not a full garden, are educated to a high school level minimum then why does America’s infant mortality rate rank only 0.19% better than Croatia? The American government is spending millions on health care and technology aimed at the minority and lower income population to close the disparity in maternal outcomes. American health insurance companies spend millions reimbursing for ultrasounds, screenings and diagnostic tests for genetic counseling and detecting babies with anomalies while they are in utero.

Setting aside some of the possible causes for the disparities in the IMR (i.e. nations that allow for abortion, nations which use a different cut-off date for considering a death to fall under the Infant Mortality category, etc.) we still have what it takes to rank higher as a nation of healthy mothers and infants. If our government truly wishes to rest on its laurels for providing what our citizens need for whole, physical health then, yes, our country is poised for what Dr. Amy considers a “second class of midwives.”

Our country should be strong and proud to say we are a nation of healthy, low risk mothers and we have earned the right to be the first to recognize that non-intervention trained women may serve these mothers, and these non-intervention trained women are intelligent and can recognize through simple measures how to recognize the mother who must be transferred over to a next level of clinical care. That level of care can be the CNM who is the expert in navigating the halls of medical protocol and hospital policies in addition to the CNM having the board certification to enact ‘medicine.’ The next level then should be the medical specialist who also has surgical skills.

Our front line for our nation of healthy women preparing to give birth should be the midwife who is the expert in normal birth as well as the expert regarding her community and it’s affect on the mothers seeking her birth expertise. She can be the dialogue bridge between the medical experts who are willing and available to provide specialized services and the woman who truly needs them.

When choosing [representatives] for your committee, please include midwives who still do 70% of the births in the world and are experts not only at ‘normal’ birth but at keeping infants normal around the birthing process. ~ MacDorman and Singh, 1998

Were it not for the 1% of women in America who continue to choose homebirth with normal birth experts, the public would never have access to experiencing normal birth and using spontaneous, vaginal birth over an intact perineum as the gold standard for which to measure all birth policy.

I sometimes wonder why [we bother compiling statistics on midwives], since their statistics are so much better than everyone else’s. ~ Rebecca Watson, New Mexico Department of Health

 

A VBAC Journal: What Happened in Ten Years’ Time?

THIS ENTRY HAS BEEN EDITED TO CORRECT SOME FACTS RELATED BY “TRACY.” Yes, the stories you will be reading are true stories and experiences that occurred and are occurring.

The year is 1997. The place is Hackensack, New Jersey. A mother awakens in the early hours of the morning to go to the bathroom. She has spent the past two months with an uncomfortable ‘burn’ sensation whenever she rises from a sitting position. She is approximately 32 weeks into her pregnancy and out of habit she checks when she wipes. The paper is dark. She turns on the bathroom light and the amount of blood in the toilet alarms her. She calls her doctor’s office then 911 and then quietly awakens her husband not wanting to awaken her sleeping children. She calls a young woman who has babysat for her in the past. Her husband is trying not to panic but he runs outside waiting for the ambulance to arrive so he can direct them to the correct home.

Upon arrival at the hospital it is determined the birth is going to occur. This is her second spontaneous VBAC. The first occurred in 1995. She is advised by her obstetrician that a vaginal birth is the healthiest birth for her baby to receive every hormone he/she needs to signal to her baby that birth is imminent. Her obstetrician tells her matter of factly that she cannot be given pain medications as those drugs will depress babies’ respiratory systems.

Within hours a beautiful little boy is born. He weighs 4 pounds, 4.5 oz. He is the largest preemie in the NICU. She is pumping and bringing her breastmilk to the hospital for her son. She is there from 4am in the morning when her husband is home from work and she remains until late afternoon with him caring for their daughter until he brings her to the sitter and then comes to see his son and wife for a couple of hours before heading back to work again.

In those days while she is holding her son, singing to him, feeding him her milk and trying to coax him to breastfeed himself the nurses talk to her. It is during those days that she learns it is confirmed her son’s premature birth is due to a placenta abruptia and she learns it is common for pregnancies following cesareans. Two births earlier she had had an unnecessary c-section … they wouldn’t stop with the vaginal exams and fetal scalp blood draws …. she was in distress and her son made it clear he felt her distress.

* * * * *

The year is 2002. The place is Connecticut. A mother dreams a foretelling of an appointment with her doctor where she asks her doctor to talk to her now about cesareans and epidurals. She wants to know ahead of time so she can make choices if there is an emergency. Her next appointment is a deja vu. She asks to speak to her doctor now about cesareans and emergency situations. Her doctor brushes her off and tells her she’s fine. Nothing’s going to happen. Just a few days later her water breaks prematurely at 26 weeks. She is at the hospital and she is told if labor begins attempts will be made to stop it. If the medications do not work the birth will proceed. Nurses come in and tell her to sign this form and that form … one form being for a c-section. She says she is not consenting to a cesarean right now. The nurse states it is only in case of an emergency and she won’t have time to sign a consent form. She asks to talk about the procedure and her options first. The nurse tells her someone will come in after the doctor is finished with his observations of the labor and will talk to her then. No one ever comes.

The labor is proceeding. Within a few hours she feels her child emerging. The doctor sees the baby is a frank breech and pushes the baby back in and up the canal. Her husband sees a lot of blood. Mom is scared and no one is answering her questions. An anesthesiologist shows up and gives her directions to position for an epidural. What epidural she asks? The epidural for her c-section anesthesia. What C-Section she asks? Also, if there is going to be one she wanted general. That’s not a healthy option the doctor says. An epidural it is and it is not until after that she sees she was given a classical T incision but the doctor tells her she is triple stitched.

In the postpartum check ups that follow she has questions about what was done and why. Her doctor responds that she is being difficult and she should be happy her baby is healthy and alive. She responds that she has had miscarriages, her baby was ripped from her body and is still in the hospital away from her so please excuse her for not being easier right now. Two years later she receives her hospital records as she requested and sees no one has written why she had a cesarean or any information regarding the surgery other than she has a classical incision.

The year is 2007. She is pregnant and she is joyful in her pregnancy. She wants to refuse a vaginal ultrasound on the grounds of the previous ones coincidentally preceding miscarriages. She is again accused of being difficult and her doctor is defensive of technology and it’s use is solely to know ahead of time if something is wrong with her baby. She dismisses any connection between ultrasounds and miscarriages. NOTE: “Tracy” miscarried twice, within five months of each other, since her cesarean. Her third miscarriage occurred two days after a more invasive type of ultrasound, a transvaginal ultrasound.

She is unhappy with how she, her thoughts, her research into her options and what is healthiest are dismissed. She wants to birth a different way. With someone who will hear her and who will read the research with her and who knows what normal, spontaneous birth looks like, feels like, smells like.

So she begins her search for answers and she comes across research that lists the order for the risk of uterine rupture based on type of incision as:

low transverse 0.5% [Haq 1988] - 2.0% [Clark 1988]

low vertical 1.3% [Enkin 1989]

classical and inverted T 2.2% - 4.0% depending on the study

upright T and J-incision may be higher; data needs to be found

Frye, Anne “Holistic Midwifery Volume I

She comes across articles that foretell the difficult journey she has ahead, a fight for the right to choose her own health care for her body, for her baby.

 

We Want Freedom: Diane Goslin

It is with great pleasure that we bring you the following press release from the Midwives Alliance of Pennsylvania, whereas in the matter of Diane Goslin, Certified Practicing Midwife (it feels so good to write this) as to the charge of practicing medicine without a license.  We want freedom:

 

The Midwives Alliance of Pennsylvania has announced today that The Commonwealth Court of Pennsylvania has reversedthe September 2007 decision of the Pennsylvania Board of Medicine to order Lancaster County Certified Professional Midwife Diane Goslin to cease and desist from the practice of midwifery.           Contrary to the Board of Medicine’s prior statements, the Commonwealth Court determined on Friday that, “…practicing midwifery cannot be construed to be the same as practicing medicine 
and surgery.”  The Board had wrongly contended that Goslin was in violation of the 1985 Medical Practice Act by practicing medicine without a license. 

Additionally, The Commonwealth pointed out that the 1985 Act, “…authorizes the Board to impose penalties only upon persons who practice as a nurse midwife without a nurse midwife license.”  Goslin as a Certified Professional Midwife is certified by the National Association of Registered Midwives (NARM) and is considered trained and qualified to attend out of hospital birth. 

The Commonwealth Court’s 5-2 ruling also overturned an $11,000 civil fine that the State Board of Medicine imposed on Midwife Diane Goslin. President Judge Bonnie Brigance Leadbetter and Judge Doris A. Smith-Ribner dissented, but did not file opinions explaining their votes.  The Court further pointed out that the 1985 PA Nurse Midwifery Act, “…authorizes the Board to impose penalties only upon persons who practice as a nurse-midwife without a nurse-midwife license.”  Goslin however practices as a Certified Professional Midwife.

Diane Goslin may now legally attend births in The Commonwealth of Pennsylvania.  Goslin, 50, who lives near Strasburg in the heart of Lancaster County’s Amish community, said today her interpretation of the ruling is that it allows her to resume deliveries. The state board of medicine couldn’t immediately be reached for comment. 

 

The board took action against Goslin in early 2007, eventually fining her $11,000. The situation resulted in several occasions where hundreds of Amish men, women and children came to Harrisburg to rally in support of Goslin.  The board can appeal to the state Supreme Court, no decision has been reached at this point whether they will pursue that course of action.

The Midwives Alliance of Pennsylvania (MAP) is a professional trade organization representing midwives statewide. MAP membership includes midwives, students, and a supporting membership of other healthcare professionals and consumers. MAP affirms the unique fabric and diversity of midwifery in Pennsylvania and seeks to promote and preserve the art and craft of midwifery while serving as a self-governing and self-regulating sisterhood for participating midwives. The aim of this group is to successfully advance legislation for the recognition, regulation and licensure of Certified Professional Midwives in the Commonwealth of Pennsylvania.

 

However, we do not rest as the Pennsylvania case may follow the same route as Connecticut whereby the Witch Hunt is on and midwifery may move towards licensing and regulation.  Licensing is at issue in Kentucky and in Missouri:

 

As nice as that sounds for the majority of the American public who believes everyone needs a license, in this field the license in question is about regulation as in Nurse Midwifery.   In America licensing means we will have more midwives going through med school and being trained in the medical model.  One argument is that this means they will also be looking at birth as “risky business” and we will simply have wolves in sheep’s clothing attending our births.  Another argument is why not hold our midwives to the same accountability we hold any other service provider, licensing may provide a means to keep that scorecard and may be what brings women’s health rights full circle and whole.   

To get there, licensing midwives, we must first recognize what normal birth is.  Thomas H. Strong, MD has said it, Marsden Wagner, MD has said it, Midwifery Today will keep saying it, Ina May Gaskin shows us and we in the trenches working with the women who are birthing have said it:  birth care in America isn’t broken…it doesn’t work.  We need midwives more than ever.  Will we embrace them and support them in becoming experts in normal birth or will we prefer only shadows of truth, never to be blinded with truth?

 

 

 

Real Women Eat Real Food

Got energy?  Normal birth requires sustenance.  It is among the most physical activity ANY human will ever accomplish but it is unique to the woman’s body.  The work of labor has been compared to marathon running in terms of preparation but then some say that athletic training is for endurance and extreme activity.  That analogy is well written here at True Face of Birth.

If we say ‘labor’ is an ‘extreme’ activity then do we mean birth is to be highly managed and a medical event?  NO!  Birth is a natural, physical event our bodies were designed to do.  Even how much energy we burn…it is possible that the stores we use are very different and that is why we don’t burn calories in such a way that we lose weight just giving birth.  The calories then are very much needed for the survival of both mother and baby. 

The human body has muscles designed for short bursts of activity and some designed for long term activity.  The energy stores in our bodies are the same, some store short term energy needs and some store the long term energy needs.  Running is an activity in which some people are naturally inclined towards sprinting and some are made for distance running whereas in birth all women are designed to labor as their baby needs them to.

A marathon works out just one body that many can adapt to by training.  Males and females can prepare for a marathon.

Only women can give birth because their bodies aren’t just a skeletal plan…they are a whole design.  Take a look at the elevations of the female pelvis and notice the beautiful stretchy band that allows our pelvises to shape around our babies.  If only you could see the hormones (you can smell them though!) that we have that are unique to labor and the wonder that our glands secrete even more of these hormones the higher the intensity of our birth and possibly is why women express that they must have been in denial when they tell the story of their very fast birth.  Each mother-baby pair is unique, each birth is something a little different.  It’s that something that is why the woman’s body is designed the way it is: it can birth through an astounding number of labor and birth scenarios.  Talk to someone who knows normals birth…we’ve seen face presentations, different types of breech presentations, babies that have flipped breech/vertex, babies that remained posterior throughout, babies rotating out of posterior and back (no pun intended).  Women’s bodies have adjusted wholly…physically, mentally and emotionally to birth their babies spontaneously over intact perineums.

When you read of athletes who say their birth was a struggle don’t let it turn you off to believing you can’t birth naturally if you’re not a fitness buff.  Look at the details behind the birth announcement: it still comes down to did you labor of your own design?  We release the energy we need when we need it, naturally.  We know exercise strengthens our bodies and the female body is susceptible to osteoporosis.  It’s quite possible that giving birth with both feet on the ground will also help us in our later years.  Birth is a ‘whole woman’s health’ event.  

We draw from the energy around us and need support that is not afraid of birth.  

Take care of your body in labor and it will take care of you!  So, where’s the REAL food in YOUR birth plan?

Joni Nichols in Mexico writes this of Plenitud, the birth center in Guadalajara, Mexico:

 

Our moms are required to bring a cooler with food with them.  We’ve had everything from left over stews to freshly made tuna or salmon salad. Often they will just bring the “fixings” ham, cheese, tomatoes, avocadoes, etc  and the doula assembles the sandwiches.   All bring fruits, yoghurts and yummy favorites.  Recently the couple brought a wonderful collection of chocolate; chocolate cookies, Belgian chocolate bars, Nutella etc.  The American couples seem to lean towards peanut butter sandwiches.

 

In March a mom asked for her first vaginal check mid morning.  She was at 10cm.  Said she was hungry and ambled with her husband to the hospital’s cafeteria to have breakfast.

 

I still regret not taking the photo of her empty plates stacked in front of her when we walked over to join her at the end of the meal.  For that matter it would have been fun to have photos of the plates full too!

 

She had eggs, beans, tortillas.

 

Came back to the room and got in the tub and had a baby!

 

Three years ago a couple requested tortas…nice big thick sandwiches which the mother ate while hanging over the tub edge.  Her birth ended in the operating room…not something any of us were happy about obviously but it did “test” that old saw about not eating before surgery.

 

She said she was happy she didn’t go that route hungry since she was limited to just liquids for the first 6-8 hours afterwards. 

 

Abrazos

Joni

 

 

Orgasmic Birth Arrives in June!

View the trailer here and the film was expected to be featured Friday, May 16 2008 on 20/20.  We hope the joy of birth will be presented positively by the journalists!  Check the listings on the Birth Events page to find us hosting a screening near you!

Note:  I’ve been told this will be airing Friday, May 30, 2008.  Please check your local listings!

 

Men At Birth

Now I’m hearing that song by Men At Work just after typing this title.  And I’m thinking that actually it’s probably appropriate.  Really, while I hope that birth can be that easy going for everyone I know it isn’t.  Your baby’s birth is … how many cliche’s can I come up with?

And you want himself there somehow present, and in your world ~ the real world ~ it’s him in the back yard grilling a fabulous steak that you’re gonna be happy to dine on afterwards while your midwife and other female companions, maybe even your children are there and also give you the immediate space support you need and desire.  And maybe later he may come inside and be there for that first minute…..

Breathe.  Have a reality check.  You are you and he is he.  In the entire world there is no other relationship exactly like yours.  Find what works for you both and find the support that works for both of you.  Do the sane thing:  think it through with a grain of salt and take a look at the whole spectrum…whatever you’re thinking just make sure you’re thinking about your birth, the one that counts.

And yes, you can eat during labor and we know moms who have asked for scrambled eggs and bacon just hours before their baby reached that patiently awaited 10cm and 0+ station.  Mmmmm good!!

 

ICAN: Controversy?

Danielle Elwood of ICAN of Connecticut recently began an outreach to the birth community of our fair state.  It seems that she contacted Governor Jodi Rell to request support officially acknowledging April as a Cesarean Awareness Month:

“The reason I am writing you today is about Cesarean Awareness Month which took place in April. As the founder and leader of ICAN of Connecticut, I took it upon myself to contact Governor Rell with a request to recognize April as Cesarean Awareness Month but I was met with closed doors. After being denied I called and spoke with someone on Governor Rell’s legal team who explained to me that the Governor cannot support such a controversial cause.”

Is it any wonder that our state’s Medical Examining Board enjoys the power it wields over midwives?  Gov. Rell we encourage you to learn more about the process of normal, natural childbirth and the history of misused and abused obstetrics.  We encourage you to talk to your peers in states where midwifery is welcomed as a safe option for low risk women.  Midwives reduce the unnecessary c-section rate and that shouldn’t be controversial.

Danielle also included a short list of states that recognize April as Cesarean Awareness Month:

Governor Charlie Crist (R) Florida
Governor Kathleen Sebelius (D) Kansas
Governor Mike Beebe (D) Arkansas
Governor Chet Culver (D)  Iowa
Governor Ernie Fletcher (R)  Kentucky

If you would like to contact Governor Rell you may do so at:

Governor M. Jodi Rell
Executive Office of the Governor
State Capitol
210 Capitol Avenue
Hartford  CT 06106
Toll Free: 800-406-1527
Governor.Rell@ct.gov 

 

Cesarean Prevention: Tell Me If You’re Using Cytotec

 

You do so much to take care of yourself in pregnancy and you read about labor, try to take the most informative birth education series and choose the “right” careprovider and birth location for a healthy birth.  Most people don’t see this one coming.  We trust careproviders to first do no harm.  Harsh as it sounds, you can’t trust them all and even careproviders acknowledge some of their colleagues are doing things they would never do.

More importantly remember the best cesarean prevention is knowing your body is designed to give birth in its own time, in its own way.  If you are a first time mother it is especially important to know that birthing spontaneously and vaginally is the foundation for your next births.

 

“The two most power filled words - I can.”  - Anonymous

Every birth educator and doula needs to tell their clients this: Your careprovider must tell you if they plan to use Cytotec and must tell you about all of the risks involved before you consent to its use in your care.  You must remember that Cytotec also goes by “miso” or “misoprostol.”  Use all of these names in asking about this tiny little pill.

Throughout this blog you’ve read about the basis for informed consent as well as the disregard for informed consent when it comes to birth care.  You’ve also read about the dangers of Cytotec, how it’s used off label and it continues to be used in spite of the unpredictable rates of injury including death.  

While researching what progress we’ve made in raising awareness of the off label use of Cytotec I came across this lawsuit settlement from 2001 and now we are working to make others in the birth community aware of it as members of our Yahoo group spread the word:

“$2 million 

Failure To Obtain Consent For Off-Label Use Of Cytotec 
Case name withheld. 
Plaintiff’s Counsel: Joseph J. Wadland and James L. Ackerman, Wadland & Ackerman, Boston and Andover 
The plaintiffs were a 38-year-old woman and her husband who were expecting their first child. At about 41 weeks of gestation, the decision was made by her primary Ob/Gyn to induce her labor. A dose of 25 micrograms of Cytotec, a drug that the FDA has approved for the prevention of gastric ulcers, but not for the induction of labor or cervical ripening, reportedly was given vaginally. The care providers did not obtain the mother’s informed consent for the use of Cytotec that was being administered for an “off-label” indication in a high-risk situation. A series of complications arose, including the deceleration of the fetal heart rate and the baby was delivered via Caesarian section. The baby was lifeless and resuscitation efforts were unsuccessful. The mother also required a hysterectomy as a result of off-label use of Cytotec. When the claim settled on Aug. 7, 2001, it was the first reported settlement or verdict in Massachusetts involving the drug Cytotec. 
This settlement was first reported in the Nov. 5, 2001 issue.”

If you are in an online group that shares birth information share this one.  Please.

Then continue to read our posts on understanding informed consent and the stories of Cytotec’s unpredictability. 

Own your birth.  Demand full disclosure of all care practices.  Spread the truth about birth: You can.

 

Spring Birth Trivia: $25,000 Pyramid Redux for Birth

Watch the movie to the end. If you know the answer e-mail it to us at thepowerofbirth@independentchildbirth.com for a chance to win a free pair of BabyLegs (ship to USA only, sorry!)