Stages of Labor

Pregnancy A-Z Series

Teaching the Stages of Labor is one of my favorite things to do in my Comfort Measures for Childbirth Class. Read on to learn about the 3 Stages!

First Stage: This begins with the onset of contractions and ends with the cervix being fully dilated (open) and effaced (thinned out). Within this stage, however, there are also three phases. The early phase, the active phase, and transition or transformation. A lot happens during the first stage! Many of the comfort measures, pain relief techniques, breathing exercises that we think of for coping with labor are used during this stage and of course many people choose to get an epidural.

Also in this stage you will learn about the Station of the baby’s head. What is the Station? An indication of how far the presenting part of the baby (usually the head) has progressed through the pelvis. A baby who has just begun to descend may be at -4 or -5 station. A fully engaged baby (one whose head has reached the bony landmarks of the pelvis) is said to be at “zero station”. As the head continues to descend through the pelvis, it is considered +1 or +2 station until it crowns at the vaginal opening at +5 station. When I work with birth doula clients I want to know where the station of the baby is so we can use positions to help encourage baby to descend through the pelvis.

Stage Two is pushing and when the baby is born! First, however there will some amount of pushing – maybe a little, maybe a lot. And this is where the station of the baby also comes in. Where was baby when pushing began? What pushing positions can help baby be born?

Stage Three is the delivery of the placenta. Once baby is here you may not notice that your uterus is continuing to contract to expel the placenta but it is! Usually the placenta comes fairly quickly -15 to 30 min, sometimes even sooner. If the placenta does not seem to be detaching on its own your provider may give you some medication such as pitocin to encourage the placenta to come out.

Taking a childbirth class can help you better understand the different stages and phases as well as different coping methods, effective pushing techniques (even with an epidural!), different options available to you — and you know I am going to highlight the advantages of having a birth guide, a doula, with you to navigate labor and birth. Sending warm wishes for your labor!

<a href="http://<a href="https://www.freepik.com/vectors/pregnant-mother">Pregnant mother vector created by freepik – http://www.freepik.comhttp://<a href=”https://www.freepik.com/vectors/pregnant-mother”>Pregnant mother vector created by freepik – http://www.freepik.com</a&gt;

Kimberly Sebeck, CLD, CCCE, HCHD, Knoxville Doula, All Rights Reserved 2022

Recovery After Cesarean Tips

Pregnancy A-Z Series

Some tips for cesarean recovery healing once you get home. You will stay in the hospital for 2-4 days, typically, after a cesarean birth unless there are complications where you may stay longer in that case. Once you are home things may feel more difficult as you navigate healing and regular life with a newborn (and possibly older siblings as well).

• Rest whenever possible. A cesarean birth is major abdominal surgery and your body needs time to heal. This may mean asking your family and friends for help with meals, cleaning, laundry, sibling care – or having a postpartum doula available to aid in these tasks so you can focus on your newborn and rest.
• Set up your home/resting area for ease – especially in the first two weeks. Stairs can be very difficult to navigate after a cesarean so if your bedroom is upstairs consider moving to the main floor or have everything you might need brought up to you. Keep food, drinks, diapers – everything you need close by. Do not lift anything heavier than the baby and if someone is available to do diaper changes and burping, let them. While you should rest as much as possible it is important to have some gentle walks/movement throughout the day to prevent blood clots. This can also help with gas pain and constipation.
• Follow your pain management plan. Your doctor will have given you a pain management plan that may include prescribed and/or over the counter medications for pain management as well as possibly stool softeners. It is important to follow this plan. You can also use a heating pad for pain relief and a pillow held against your incision when moving/sneezing/coughing. Ask for a cesarean postpartum recovery belt/band. Talk to your doctor if your pain seems out of the ordinary.
• Get good nutrition and fluids. Your body is trying to heal and if you are nursing baby you will need extra calories and fluids. Extra fluids will also prevent or help constipation.
• Remember you will still experience postpartum changes with a cesarean birth. You will still experience vaginal bleeding, hormonal changes, after pain, night sweats, etc. Take care of yourself and again ask for help as much as you need and treat each postpartum symptom as they come.
• Be patient. Cesarean recovery can take up to 8 weeks or longer. While some seem to rebound quickly if you take longer remember you are unique, everyone is different, and you will heal in your own time.
• Stay in touch with your doctor and go to your postpartum visits. While it is normal to be sore and tired after a cesarean, call your doctor if you have heavy vaginal bleeding/a fever/difficulty breathing/chest pain/redness, swelling, pus at incision site/redness or swelling in leg/bad smelling discharge from vagina/severe depression — this is not an exhaustive list so be sure you obtain, keep, and follow your specific doctor and hospital discharge instructions of when to call. And if in doubt – call.

Many people find it helpful after they have healed through the initial 6-8 weeks to go to pelvic floor therapy for further assessment and healing with trained professionals. Many also find it helpful to attend to their emotional needs surrounding a cesarean as they may have feelings of disappointment, sadness, even trauma if they were not expecting to have a surgical birth. Your feelings are as important as your body when it comes to healing. It is possible to be thankful for an often lifesaving surgery and still want or need to emotionally process the event.

Kimberly Sebeck, CLD, CCCE, HCHD, 2022, All Rights Reserved
Knoxville Doula

Quickening in Pregnancy

Pregnancy A-Z Series

What is quickening in pregnancy? The medical definition is: the first motion of a fetus in the uterus felt by the mother usually somewhat before the middle of the period of gestation.

In more exciting terms, it’s usually when you can first feel baby move! But wait! You might not be certain it is baby moving! It could feel like gas, bubbles, flutters, even your clothing “moving”. Soon you will know it is your baby moving.

When does it happen? The timing can vary. First time mothers may feel it later than those who have been pregnant before. Some may feel movements as early as 13-16 weeks from the start of their last period while others may not feel movement until 18-20 weeks. There is a wide variation of normal. The position/placement of the placenta can impact how soon and strongly you feel those early flutters as well. If the placenta is in the front (anterior) it might be a longer time before you feel movement. This is still normal. It will also usually still be some time before baby’s movements can be felt externally by someone else, especially if you feel the flutters early on.

Around week 28 you will want to begin counting your baby’s movements every day, at the same time of day. Please go to Count the Kicks for more information and handy charts and an app!

In the beginning, however, relish those early flutters! If you have felt the quickening, what did it feel like to you?

Kimberly Sebeck, CLD, CCCE, HCHD, All Rights Reserved 2022 Knoxville Doula

Expectations – A-Z Series

Expectations — we have many months to build up in our heads the “perfect” birth scenario, the “perfect” baby, the “perfect” postpartum experience. Some of us try to conceive for some time, too, and imagine/long for a “perfect” pregnancy as well. And really there is a benefit to visualizing things going in a positive way. Imagining worst case scenarios isn’t the best way to spend our time or energy while growing our babies and preparing to add to our family.

So how do we balance optimistic expectations with reality?

• Education — whether that be by experience, classes, reading books or online material, etc. Seek reputable sources.
• Set yourself up for success for your desires — if you are wanting a natural unmedicated birth, for instance, seek out a provider and birthing facility in line with that goal. Consider hiring a doula. Take a natural childbirth class. Practice any techniques you learn and are taught.
• Realize that pregnancy, birth, and postpartum are times of great changes and can be unpredictable. Some flexibility may be required. A change in your plans does not equate to failure. Take the time to acknowledge there may be some disappointment at the change without attaching judgment. *
• All babies are good babies. Some are low key and some are more needing of attention. Some come out with perfect scores and take to feeding immediately and others have multiple doctor visits and require more of a learning curve in their transition to the outside world. All of this falls into a spectrum and you will get the swing of things very soon!
• Having a new baby, juggling your own healing, lack of sleep, hormonal changes, a different body, can all make us feel like a different person.  This is ok! This is a period of adjustment. Perhaps you aren’t feeling the rush of love for This is othe baby you thought you were or you are just really tired. Again, all of this is new to your new family and give yourself some time and grace.
• Having flexibility, a plan for some help after baby comes, giving yourself grace/being non judgmental, and injecting some humor when possible are all ways to balance those first few weeks. You’re a new parent! That’s amazing! You’re doing hard work– pat yourself on the back, give yourself some time — oh and take a nap if you can.

 

*If you find yourself traumatized by an experience, please reach out to someone to talk to, such as an experienced counselor or physician, or even a friend if you are unable to speak to a professional in a timely manner.

 

Kimberly Sebeck, Knoxville Doula 2020
All Rights Reserved

 

 

 

Due “Date” A-Z Series

Continuing in the A-Z Pregnancy Blog Series we come to the letter D. I bet you thought I was going to write about doulas, didn’t you? Well, I have written previously quite a lot about doulas. Here a few links if you want to read about:

https://knoxvilledoula.wordpress.com/2015/06/12/reasons-to-hire-a-doula-for-cesarean-birth/  Reasons to hire a doula for a Cesarean Birth

https://knoxvilledoula.wordpress.com/2012/01/17/doula-musings-today/ What I can and cannot do as a doula

https://knoxvilledoula.wordpress.com/2010/02/09/hiring-a-postpartum-doula/  Hiring a postpartum doula

So for D I thought I would write about the “due date” or EDD, estimated due date. It is an estimate and some feel it should be more of an estimated due month rather than a date. After you see how it is calculated perhaps you will also feel the same.

In order to calculate your due date, add 7 days to the date of your last period and then add nine months, with the assumption of a 28 day cycle.  But remember that babies don’t know anything about this estimated calendar date and a full term pregnancy is considered anywhere from 37 to 42 weeks.

Due dates are usually calculated on your last period instead of the date of conception because of a number of reasons.

• Although the average woman ovulates (releases an egg) approximately 2 weeks after her period, the exact time is not always known.
• Once an egg has been released, it can remain fertile for up to 24 hours.
• Sperm can last for up to 7 days after intercourse to fertilise an egg.

Nowadays an ultrasound is frequently used for dating but the date can be off by a week or more. Depending on which study/evidence is cited, approximately only 5% of women give birth on their estimated due date. But it’s fun when it happens! Only 35% of women go into labor the week of their EDD.

Keep your due date in mind, absolutely, but don’t panic if baby ends up surprising you. Parenthood is all about surprises! You will soon be holding your baby in your arms.

All Rights Reserved, 2019
Kimberly Sebeck, CLD, CCCE, HCHD
Knoxville Doula

Cravings in Pregnancy

Yes, they’re real. Sometimes they can be fairly tame, like extra pickles on a sandwich or very odd like pickles mixed with ice cream. Yes, some women really do mix some weird combinations. I myself craved artichokes early in my pregnancy in an almost indescribable way. I’ve always wondered if it was because of the vitamin C content. Most of the time, however, women find themselves craving “comfort food” or foods that are a combination of salty and sweet and/or with a higher fat content.

The one caveat would be when someone craves non food items like dirt or clay. This is called pica and is a medical condition and needs to be addressed with your medical provider.  Also an extreme craving for ice could be a sign of anemia so mention that to your medical provider, although they usually check your bloodwork for signs of anemia.

Why do cravings happen? No one is 100% certain of the answer although it seems to be related to hormones. One solid theory is that as hormones shift, dopamine levels can lower which can lead to cravings. Another theory or one that may also work in tandem is that our body is craving certain nutrients. Now ice cream wouldn’t be what anyone would consider a nutrient, however, craving dairy could mean someone is needing more calcium. Salt could mean a need for more magnesium, fatty foods could mean a need for more essential fatty acids, and so the theory goes. Yet another theory is that the baby itself is putting on fat and needs fat to shape and grow its brain.

When you think about food as a source for growing your baby it can help you to think of healthier ways to satiate those cravings. Having smaller meals broken up during the day  can help digestion.  Occasional ice cream or french fries (maybe mixed!) isn’t going to hurt you but having them all the time isn’t the best nutritional choice. Maybe having food with a higher calcium content and magnesium content most of the time followed by a little bit of ice cream sometimes would be better. But I’ve been pregnant, too, and I know Baskin Robbins saw more of me during the last couple months of my pregnancy than they have seen me since!

So yes pregnancy cravings are real. Moderation is the key. And one day you can tell your child how you dipped bananas in ketchup or ordered a salad with triple amounts of artichokes or put hot sauce on absolutely everything.

All Rights Reserved, 2019
Kimberly Sebeck, Knoxville Doula
This is for informational purposes only and is not intended as medical advice

 

Body Changes in Pregnancy & How to Love It

I know, I know. You were promised a “glow”. Instead you can barely roll over in bed, coffee makes you nauseated, it’s been days since you pooped, and what is going on with your skin?!

This blog isn’t going to minimize the fact that some aspects of pregnancy are really really hard. Hopefully some of the suggestions will give you a deep breath and a reminder that the hard time won’t last forever.

1. The first and most obvious change is you are growing another human! Whoa! That’s almost mind boggling. Another person (or persons) are taking up residence inside your body. Of course there will be some uncomfortable changes! Yet you are entrusted with this life giving task. Your body was made for it. It’s up to the challenge. You have a mission to grow this other being.
2. Feel all that stretching? Stretching of the skin, stretching of your breasts, stretching of maybe some inner organs you never thought about before? You are expansive, and in a monumentally good way. You can use this time to think about and practice these stretching sensations as how you will stretch as a mother. Your body, mind, and heart are stretching in ways they didn’t before you were pregnant and the pay off is oh so sweet.
3. Speaking of your mind and heart, this is a great time to really get deeply in touch with what your body needs. Many jokes are made about cravings but go deeply into what your body is telling you. Are you bone weary today? Your body is telling you to carve out some rest. Are you having trouble settling down to sleep? Is your body telling you to meditate before bed? Cut back on caffeine? Are you feeling anxious? Do you need to reach out to your partner for some cuddles or more help around the house? Begin tuning in to what your body is telling you and make adjustments accordingly.
4. Constantly peeing. Like.. constantly. Being hungry but only being able to eat a tiny bit. Pregnant bodies do that because the bladder has pressure on it but because your kidney volume can increase by 60%. Your colon is also compressed and your GI system is retaining more water and the whole system is slowed down. That’s the bad news of it but the good news is it’s supposed to work that way. These processes allow for room for your growing baby and uterus, as well as prepare for increased blood volume and retaining nutrients, etc. This allows us to trust that our bodies are doing what they are supposed to be doing. Trust that your body is housing and growing your baby.
5. While we are talking about nutrients, take this time to nourish yourself! You’ll need some extra calories each day when pregnant — make those delicious, healthy, and nutritious calories! Eat a rainbow of colors, plate your food in an appealing manner, pour yourself a non alcoholic mocktail. You are nourishing and nurturing yourself and your baby, enjoy it! Banish society’s obsession with thin from your mind. Your mission right now is to house, nourish, and nurture yourself and your baby and it can be glamorous, beautiful, creative, anything you want it to be.
6. Pamper yourself if and when possible. Get a pedicure, get a prenatal massage. Buy some whipped lotion and have your partner rub your feet at night. Have a girlfriend style your hair.  Use a facial scrub. Wear silky robes or sarongs if you love them. Really the options are endless.
7. Remember to exercise! It is great for you, your body, your mind. Always check with your doctor first but walking is almost always a safe outlet for pregnancy as well as water aerobics. Sometimes feeling how strong and capable our bodies are can make us appreciate and love it more.
8. Intimacy can be tricky. Sometimes during pregnancy your hormones can make you feel more intimate and sometimes it can make intimacy seem far far away. Talk to your partner about it. Maybe cuddling and massages with each other will fill the space for now. Either way, having an honest conversation and reassuring each other of your love and affection will help your relationship. Your body is going through a lot of changes after all. The changes will be temporary but you want your relationship to last.
9. As a doula I think pregnant bodies are gorgeous but I do remember having fleeting moments when I myself was pregnant. Worrying if I would lose all the weight or if I was still attractive. It seems so superficial now and yet those are very real concerns for most of us! Try this mantra: My body’s purpose is twofold now – to care for my own health and well-being and to grow and nurture my baby. 

All Rights Reserved, 2019
Kimberly Sebeck, Knoxville Doula

Advocacy and Doulas

 

Advocate is a big buzz word in the birth world. There is no wonder there is some confusion when it comes to the role a doula has concerning advocacy regarding clients and at a birth.

The definition of advocacy as a noun is “someone who publicly supports or recommends a particular cause or policy”. Merriam Webster defines it further as someone who “pleads the cause of another”, often specifically before a tribunal or judicial court.

A court case isn’t something we would expect or hope a doula would need to be involved in at all. In fact, doulas do not speak for a client because doulas do not have a legal right to make medical decisions for clients. So what do most people mean when they use the word advocate when speaking about the role of a doula?

Most of the time when a client is interested in having a doula present they are interested in having their voice and preferences be heard. This is why hiring a doula well before birth and working with one prenatally is so important. Professional doulas who stay within their scope of practice are well versed and trained in helping their clients learn how to advocate for themselves! Prenatal meetings to go over different options, childbirth preparation, birth option plans, ways to discuss important topics with providers, and navigate twists and turns as they come up during pregnancy is vital to empowering pregnant people to speak up and be heard. Preparing your partner to answer questions and ask for time to make informed decisions is part of the process as well. As a doula I am not going to make a decision concerning the welfare of your baby and yourself. I will give you unbiased information and remind you to ask informed consent questions, just like we have practiced in prenatal sessions. I can reference your written birth plan as well. Most of this work is done prior to labor so it is familiar and second nature.

Doulas are often advocates for evidenced based birth practices as a whole, in society. We form support groups and are members of national organizations. But if it seems like you are gearing up for a fight for evidence based birth practices with your birth provider, we would encourage you to look up ACOG’s recommendations and see if those recommendations are being followed. Honest communication between yourself and your provider is extremely important — expecting anyone — a doula, your partner, a sister to “protect” you from your provider may signal that this is not a good working relationship with this particular provider or perhaps there needs to be an open communication about the disagreement in care and expectation.

So while it can be a little confusing to answer outright if a doula is an “advocate” (in some ways we are and in some ways we are not), the main answer is we teach our clients to advocate for themselves and we are there to remind them how if necessary.

All Rights Reserved, 2019
Kimberly Sebeck, Knoxville Doula

Julie’s Hypnobabies Experience (Birth Story)

 

This summer I’ve had the occasion to have a nursing student, Kait, getting some service hours with me. She has helped me stuff goody bags, re-typed my Comfort Measures Class handout, and helped update important local lactation consultants lists and childbirth class offerings. One thing we also did was interview one of my previous Hypnobabies doula clients. Even though I was present at the birth, it was fascinating to hear Julie retell her story. I am paraphrasing many of her words as I didn’t tape record her but certain images are burned into my memory from her description.

Julie’s story:

Julie had previously taken Bradley method of childbirth education with her previous pregnancy. She was very committed to going naturally and unmedicated but when she was induced for postdates and the labor went very long she opted for an epidural.  The pushing phase had lasted for over 4 hours. She did not have a doula with her first baby. The second time around she hired me and she chose to do Hypnobabies.

She said Hypnobabies really appealed to her and the more she progressed into it she realized the vast difference between it and Bradley. She said she found her birth plan from the first pregnancy and noticed how it came from a place of almost fear and things she didn’t want. She didn’t want to be induced. She didn’t want to have pitocin. She didn’t want an epidural. Yet, it didn’t address any of the things she did want. With Hypnobabies she was learning to manifest what she did want. She felt confident with her practice of Hypnobabies and my support as her doula that this birth would be different.

Fast forward to the very end of pregnancy and the mention of induction came up again as she was beyond her estimated due date. I do remember this well. She had an appointment with her provider and they discussed some options and what would happen if she hadn’t gone into labor within a certain time frame. She called me crying. I suggested she meet me at my office immediately.  She came over and I rubbed her feet and pressure points and we talked. I suggested she employ her practice and training of Hypnobabies and really believe and envision she would go into labor on her own. She began having pressure waves (contractions) in my office. We didn’t know if they would continue but it was a lovely and positive sign and she left leaving much more relaxed and at peace.

The pressure waves did continue, gently. She told us that she went home and made it like a cave. She told her husband to stay out, had her mother pick up her child and envisioned herself like a mama bear in her cave, warm and comfortable. This went on for some time until she called to let me know she would like for me to come over. It has been a couple of years so I don’t recall the exact time she called me but when I got there she was in the tub/shower, sitting on a birth ball, looking very peaceful. Waves were coming strong and regularly. I timed some to assess where we were at and we were shortly on our way to the hospital. She said she had absolutely no pain. As we were leaving she vomited in the driveway — another good and normal sign.

I followed them to the hospital in my car and called the student doula who was shadowing me to join us. Julie had been very gracious to allow Emily, a newer doula, to come to the birth not only to learn but also to assist Julie’s husband, who was new to the Hypnobabies idea of birth. As we pulled in to the hospital parking area, Julie was sick to her stomach again, another good sign things were progressing. I was able to park quickly and help Julie out of her car while Emily helped Julie’s husband park the car and get their things.

Once in the room, Julie was admitted and we all answered as many questions for the staff as we could so she could stay in her Hypnobabies hypnoanesthesia. We turned the lights off, kept the door shut.  The tub was filled, she remained comfortable.  Emily and her husband chatted and we all took turns getting her ice and bringing cool cloths. I kneeled by the tub and sponged her off.  Eventually it was suggested by the midwife for her to get out and go to the bathroom. This was not something she was very excited about, she related to us as she related the story.  After using the restroom she got into the bed. What I remember at this point was how dark and quiet and calm the room was. Her waves were coming very strong and beautifully at this point. The midwife had not seen many Hypnobabies births at this point and her eyes widened at seeing the strong contractions on the monitor and yet Julie remaining completely calm and at ease with them. Julie tells us that at this point in her birthing time, “ I still had no pain. I felt blue mountains erupting from my abdomen. It was so spiritual and magical.”

Soon after it became time to push and because of her extended pushing experience before, I suggested turning and leaning over the head of the bed to be in a semi hands and knees position but supported so she could remain in hypno-anesthesia. Julie says, “I turned into a mountain lion. A fierce and powerful mountain lion.” Julie pushed her second daughter out in around thirty minutes.

She uses words such as “magical” “awesome” “spiritual” “empowering” . She says the combination of having a doula and using Hypnobabies was “pure magic”. It “makes her want to have 12 more Hypnobabies just to experience it again– but I won’t”. Julie tears up, and so do we. She says she manifested this birth and we believe her.

Julie wants women to know that using Hypnobabies and a doula is a magical combination. I also agree with her that many childbirth education discusses things women do not want versus what they do want. It is possible to change the language and fear surrounding birth! Kait, the nursing student plans to use Hypnobabies in the future when she herself begins a family.

Thank you for sharing your story, Julie!

All Rights Reserved, Kimberly Sebeck, HCHD, CCCE, 2018 Knoxville Doula

Repeat Clients — Or Not?

Oh, doulas love repeat clients! There is just something so rewarding about working with a family for a second or third time — or even more! Often a doula is the first one to know that another pregnancy has happened. We get a text with a positive pregnancy test photo attached or a question of, “Hey are you available for a (fill in the blank) due date?”.

But sometimes, especially with flourishing social media, we find out a family hasn’t rehired us. It has absolutely happened to me. And I am writing this not only for people interested in doulas/have used doulas but also newer doulas. What is the etiquette regarding this?

First, I’d like to acknowledge there are very real reasons to not be rehired! Just off the top of my head:

• Funds may be an issue, especially as a family grows
• Perhaps the client went natural last time and is choosing not to this time and feels a doula isn’t necessary
• Maybe they learned so many techniques in their other birth(s) they feel they can handle this on their own (I believe in them!)
• Maybe they have become close to another doula and want to try her out (yes, I 100% support that!)
• Possibly they had a traumatic birth experience and having the same birth professionals feels like a trigger (yes, a traumatic birth can happen even with a doula present)
• It could be they hired a midwifery team that provides extra support like birth assistants or even doulas
• A new medical condition has changed their perspective of birth (same for pregnancy loss(es)
• They may be trying a different type of pain management like hypnobirthing or hypnobabies and planning to use medical grade hypnosis
• Another local doula has skills they feel more drawn to or simply feels more connected to them
• Or… It is none of your business

Yes, I have had some of those scenarios play out for not getting rehired and I am here to say it is totally fine! It doesn’t hurt my feelings one bit. While I hope if it’s over funds that I could connect them with a lower fee or sliding scale doula, I also understand a budget is sometimes set in stone and cannot be stretched. Additionally it can be awkward for some people to say they are low on funds for something. It can be awkward if you run into your doula and feel you have to explain why you aren’t/can’t/don’t want to rehire her.

Please let me reassure you that there is no reason to feel awkward. While I would love to support your family again I also trust you know what you need. I still want to hear how your pregnancy is going. I still want to hear how your birth went, watch your birth video or see your photos. I still want to be your friend on social media if that is your comfort level. Any good doula will feel this way. It’s not about us, it’s about you. If you feel like sharing the reason, feel free, and if not, that’s ok, too.  Doulas empower women and families. You do you and we will cheer you on.

All Rights Reserved, 2018
Kimberly Sebeck, Knoxville Doula