This birth took place in Bergen County and my Northern NJ Birth photographer photos and Tanja's story were featured on Orgasmic Birth.
"My Dream Team" Backstory by the Mother, Tanja
At the beginning of February 2016th, we found out that I am pregnant. Thrilled with the news, I visited my obstetrician, but my appointment did not go how I expected. I did not feel informed enough about my pregnancy process and different testing that kept being required and never explained; my questions were at times answered in a tone “not a big deal” or “you should know that”; and I was slightly ridiculed when I mentioned that my job (teacher for 2 to 6 year old children) is getting a bit demanding for me in my new condition. It took me few months to admit to myself that I deserve better than that and to start the research for new care-provider, preferably midwife this time. My husband suggested to call each hospital affiliated with midwifes and ask them for their names and phone numbers. First on my list was Hackensack UMC Pascack Valley in Westwood, NJ. They gave me quite a few names so I called each and every one of them. My husband, who was helping with the research, said: “Check this one out, I think you will like her, Donna Tabas.” I did as he said and felt that she is THE ONE! And that is how I started forming my DREAM TEAM.
Now I will tell you more about each and every team member.
First and most important one is MY HUSBAND, of course. The one I took longest time choosing, only little bit over thirty years! And even that was not my choice, I believe, it was God’s preordained plan for us and I am so thankful for him in my life – the most loving, caring, kind, and gentle person that I know of. And he only confirmed all that through my pregnancy and birthing journey. He was by my side when I was doing the pregnancy test – we cheered in amazement together to my pregnancy and our parenthood that was starting; he was researching and letting me know each week what is happening with our baby and what parts of its body is developing at the moment; he supported me when I needed to stop working unexpectedly at three months of my pregnancy due to challenging requirements of my teaching job; he was by my side when I was changing from obstetrician to midwife and did research with me and helped me find the right person for us; he read the books that were teaching him how to help me during the pregnancy and birthing, he coped as a champ to my occasional emotional outbursts of tears and such; he loved me through each and every pregnancy or just womanly tantrum; he was there to not let me give into my sugar cravings at times; he was by my side at the ultrasound exams watching in wonder with me our son growing in my belly; he supported me when choosing the doula; he worked hard after work on our baby’s room fixing the walls with contractor, painting, putting the trim; he was kissing our son each and every morning and night for both of us with such joy and gentleness. He is the love of my life, my rock and my stronghold. I hope that most of the ladies reading this have such support, and that the men will be inspired to be such a support.
The most important medical support that thought me so much about everything that I ever needed to know about my pregnancy and birthing was DONNA TABAS, CNM. I still remember our first meeting and her gentle and calm, yet strong and confident demeanor that won my adoration. Even before we decided to work with her, my husband and I learned so much from her. “SHE IS THE ONE!” we agreed and our real pregnancy journey began. First thing that Donna did was give me the booklet of about two hundred pages that she created that covers all possible questions that a pregnant woman will ever think of asking: from dietary requirements and how much weight I should gain to all the changes my body and mind can possibly experience during this process, and more. She also explained to us what is the difference between medicated and unmedicated birthing and why the first one ends up with C-section in 40% of the cases when the real emergencies are actually only 10%. As I mentioned before, Donna is very gentle but very open and persistent as well - she will do everything in her power to help you birth in the most natural way without distressing you or the baby and only in the real emergencies go for other alternatives. In order to do so, her goal is to keep mother as healthy as possible. In my case that meant – stay away from sweets and watch your weight because it was high to begin with. When Donna faced me with that in her direct but kind way, I was a bit hurt deep down inside. “Well, I was not that much overweight anyways! I am doing my best. I am not even eating the whole chocolate bar a day!” deceiving justifications went on and on in my mind until all of a sudden I realized: “Donna is not my enemy nor will she gain one ounce of anything if I do listen to her or not. The only advantage from her advices will come to me and my child. So, what am I fussing about?!?! Donna is trying to help me and it is up to me if I am going to listen to her and now help myself! And I AM!” So, I took all the paperwork about food that Donna gave me and worked diligently on following the food chart and food intake that was suggested. Whenever I had sugar craving I followed Donna’s advice and took some protein (nuts, egg, piece of whole-wheat something) instead. Little by little my sugar-cravings eased of. Thanks to Donna I concord the reality and the myth of my cravings.
Donna also kept saying: “If you want to have natural vaginal birth you have to have doula, have to have doula, have to have!” Oh man! Coming from a country where that did not even exist yet and where just few decades ago my grandmothers gave birth wherever they happened to be around the house at the moment due to a lifestyle in the countryside, I thought that Donna is surely overreacting about doula. Nonetheless, I decided to find out for myself what that doula really is. After the research, I concluded: “Doula means having a private masseuse at the birthing, and this strong Serbian girl does not need that for sure!” And if Donna did not gently persist, I would live to learn how wrong I was. To find out more about Donna and her wonderful work, please visit her website www.northjerseymidwiferycare.com.
My husband and I decided to research still more the doulas in our area. Once we gathered all the information needed, I started contacting different doulas and I must say that I came across many nice ones. However, some were not available, some were over our budget, some were having clients at the same time as our due date… I managed to interview few still and things just did not feel right with them, until I met HOLLY GRAFF! She came ready in each and every way – she was present, very sensitive to my nature and needs, surprisingly knowledgeable not only about basics but about all different approaches, techniques, and exercises that I was interested in and she was able to do it with me on the spot. WOW! Thank you, God! I really liked her and felt comfortable having her in our birthing room, so I asked her to come again and meet my husband. She won my husband’s heart in a beat also with easy going conversation, but even more so with gentle instructions about his role before, during, and after the birthing process. It was very important that two of them bonded and had good communication, because they would work as a team in helping me go through my highs and lows at birthing. As a person of excellence, which Holly Graff certainly is, she came again to visit us and teach us how to properly do certain exercises that our midwife asked us to do during the last weeks of my pregnancy. Thank you, Holly! If interested in contacting Holly, please send email to email@example.com.
RACHEL CONNOLLY KWOCK is professional doula and photographer. She came unexpectedly into our lives, again through our midwife, Donna Tabas, and at the last minute almost, but we are so grateful that she did! I fell in love with her writing while browsing her adorable website. She shared her deepest self in many of the stories which I consider very brave and admired her before we even met. When we did meet, her calm and soothing demeanor, none intrusive but gliding curiosity, and gentleness in manner won both me and my husband and we agreed to have her on board of what is to become my dream team. During my birthing, I was ever grateful for that decision, because she was not only completely invisible and quite so I did not even notice that she was photographing me, but she was also invaluable part of the team contributing with the ideas for new positions during my waves, reminding the team that they need to eat to keep the strength, and keeping positive vibe. Thank you, Rachel! If you want to see more of her mastery, please visit her website and enjoy yourself!
It was such an honor to be doula to Matt, Megan, and Baby Atticus. It was humbling to see a husband and wife so dedicated to one another and to their baby. The endurance and struggle Megan went thru, to try and provide her baby the birth she felt was best, was immense. It was inspiring to be witness to her coping - to see her roaring her way thru labor humming and moaning, rocking and swaying side-to-side, back-n-forth on the bed, in the tub, in the shower- allowing herself to surrender to the power of birth. I will never forget the heartbreaking look on Megan's face when she was told she will need to have surgery. I know the end result is a million miles away from where they thought and hoped it would be, but personally I will never forget being amongst a circle of women in the presence of an incredibly powerful lioness who thundered her way thru every surge, and her devoted husband who provided incredible support, focus, assuring words, gentle touches, and constant devotion and attention. Megan, thank you for sharing your experience of challenge, healing, and love.
"Whatever birth you end up with or choose, becoming a mother is a strong and brave act – it’s the beginning of the selfless gift of unconditional love you give to your baby. " - Megan
By Megan Stark
I’ve been a doula since 2012, trained in both birth and postpartum support and I am obsessed with birth.
But let me start at the very beginning.
When I was born, I was diagnosed with pulmonic stenosis, which for me was a condition that required immediate emergency surgery. I was whisked away to NYC to have open chest surgery, which as a new mom, I can’t even wrap my head around how incredibly terrifying this must have been for my parents. I healed well, and became an avid rock climber in my teens. After college I completed an internship in Boston, and while there I suffered from a TIA (stroke). This alerted my cardiologist that perhaps something else was going on with my heart. She discovered a hole in my heart – which is a far more common condition than my pulmonic stenosis. After my internship I moved to the New River Gorge in WV with my future husband. I wanted to learn more about the hole in my heart and how it might affect future pregnancies, but the health insurance laws prevented me from obtaining health insurance for some time (pre-existing condition clause). Once I did obtain insurance, I had to wait a whole year to be seen by a specialist for my heart (again the pre-existing condition clause which has now been ruled illegal by the new health insurance laws). Finally – in 2010, I was able to learn more details about the hole in my heart and what it might mean to pregnancy and birth. I was told that the hole was of such a size that pregnancy would be dangerous – and so began my journey toward providing a provider that could close the hole without another open chest surgery.
My husband and I moved back to my home state of NJ, and in 2011 I had the ¾ in. hole in my heart closed via a cardiac catheter procedure. The most amazing thing happened after my procedure – I no longer felt like I was suffocating when I exercised! I had never quite realized I felt his way, since I never knew any differently.
In the summer of 2012 I finally got pregnant, we were excited and elated, and shared our news with my family in one of those adorable Pinterest worthy ways. At seven weeks we lost that pregnancy, and I was devastated. Miscarriage is a cruel and sad event, and one so many people experience but it is so commonly written off, ignored and covered up. If you have experienced a miscarriage (nearly 30% of all pregnancies end in miscarriage), please know that you are not alone, and if you are struggling with this loss seek support from your friends, family or a professional. It is a true and profound loss, and you are absolutely allowed to mourn that loss.
As I said, I was devastated. So I decided to re-focus my attention, and began my doula training in 2013. Training to become a doula was this incredibly intense and powerful experience – just like birth! I loved attending births, and was feeling positive and excited about becoming pregnant again. In the summer of 2013 I achieved that goal, and gun shy this time, told our family in the quietest way possible. This time, I was sick – soooo sick. I was bloated and hormonal, and miserable and scared. I was terrified we would lose this pregnancy, and wanted to keep it as quiet as possible. At 12 weeks we went for our ultrasound.
There was no baby.
Our pregnancy was a “complete molar pregnancy” and my sickness was related to my out of control pregnancy hormones. I lost my mind. As a doula, I knew about these types of pregnancies, but they are rare, and having made it to 12 weeks, I was so hopeful that this pregnancy would stick. A molar pregnancy is dangerous, so a D&C is necessary and follow up blood tests are required. Women who have suffered from a molar pregnancy must also hold off on trying to get pregnant again for some time. This is to be sure that if the pregnancy hormones go up again, that Doctors can be sure it is not from pregnancy and instead from the molar pregnancy. (While rare, molar pregnancies can turn into a form of cancer, so the blood tests monitor that the hormones are going down and not up.) Here's the link for support group I found: FB.com/groups/mymolarpregnancy/
Another year passed and we finally decided to try again, one last time.
And this time it worked. We were due in April 2015, and I had one of the most amazing pregnancies. I wasn’t sick, I felt great and I was so hopeful! I also began working from my doula trainer, Debra Pascali-Bonaro, and was greatly immersed in all things birth and babies. It was such an amazing time! I was one of the most over prepared mamas-to-be you could imagine. I hired my doula co-worker and friend Rachel Connolly-Kwock as my doula, prepped my husband with too much information, took Debra’s new childbirth class, “Pain to Power”, and found an awesome midwifery group “The Midwives of New Jersey” which have an incredible water birth record. I wanted providers that I knew I could trust. As a birth doula, I had heard and saw so many women who felt coerced or disrespected in their births, and I wanted to avoid questioning my providers motivations, after everything I’d been through, I needed to know that they too wanted to avoid a cesarean as much as possible.
I planned a natural, intervention free water birth and wanted to labor as home as long as possible with my doula and husband. When I went into labor early Saturday morning, I was sleeping on the couch (at 41 weeks, while still quite comfortable, I was having some trouble sleeping). I worked through the surges on my own for a couple of hours, but was suffering from (what I later realized was) really intense back labor, decided to wake my husband for more support. At 9am things were progressing so quickly, we decided to call our doula. Let me say, that when your doula shows up, there is an incredible feeling of relief knowing you now have the professional, knowledgeable, kind and understanding support of a trained doula by your side to support you and your birth partner. We labored at home until after noon that day, and then made a plan to meet up with my lovely midwife Chrisy at their office. The office was closed that day, so it was particularly peaceful to labor with my support team. I was encouraged by my midwife to hydrate, take some honey, and eat as we knew labor could still be quite a while. We decided to check my dilation and I was just about 6cm. After a couple of hours we decided to move to the hospital, as I was desperate to get into the tub!
I labored in the shower and the tub for hours, but I was not progressing. My contractions were not coming at a steady clip, my back was killing me, and I was becoming discouraged. My doula, husband, 2 midwives and midwife assistant were incredibly encouraging and supportive. We agreed that breaking my waters might help my contractions to become steadier, assisting me in progressing. At this point I was still only 6cm, nothing had changed.
Hours later, I was done. I mean done. I asked for an epidural, something I swore I would never do. My lovely midwives distracted me, suggesting we instead try a very tiny amount of Pitocin, to see if we could get things going. I did not want this, but was feeling exhausted beyond anything I had ever felt before. I knew if my midwives were suggesting it, they felt it was likely needed. The goal was a vaginal birth above all else, and I knew that I would not be able to go on like this forever. Along with the Pitocin, I agreed to another drug that would allow me to rest between contractions. A couple of hours later, I roared awake during an intense surge. I was DONE- and this time I meant it! We decided to check my dilation again, and I was fully dilated. After some time, the midwife asked if I wanted to push. I had absolutely no urge to do so, which I thought was odd. But, ready for baby to arrive, I got to it! I pushed in every position you could think of. On my bed legs up, legs down, on all fours, standing, squatting, up, down and practically inside out! I was falling asleep between surges, completely worn out – my strong and amazing husband was literally holding my sleeping body up. Two hours later there was no progress, the baby’s heart rate was decelerating, there was meconium present and I was making no progress. The backup OBGYN was called in, and I was told that a cesarean was now on the table. My wonderful midwives knew how much I did not want this. They gave me the time and space to consider my options. I knew when my midwife Cindy told me that it would be safe to try a little longer, but that she really felt that nothing was going to change, that she meant it from her heart.
Sometimes births take a turn from what we anticipated. When a woman has a cesarean, she often feels she has failed herself and her support team. This is so sad but the reality is that we end up needing to ask for self-forgiveness. For a mother, who dreams of natural birth, to be told that your dreams have been dashed is heartbreaking on so many levels... You wanted the experience for you and your baby, you wanted to know that experience other women speak of- of birthing your baby and holding them skin-to-skin, a moment when all time stands still. You are scared and don't want surgery. You are aware of the benefits of natural birth from reading studies that show the hormones released during the birthing phase may be critical to emotional development, the shaping and molding of the cranium can ignite cranial-sacral balance, the baby being exposed to microbiomes can provide a lifetime of strong gut health and improved immune system. It is not to say some of the health benefits of natural birth can not be nurtured over time in a surgically born baby, but when you are told you are going to have a cesarean these are just some of the thoughts that flood your mind.... and it is devastating. Most prominent and most upsetting is the sudden lack of control - you were in control of your body (sort of, right - as much as we can be birthing a baby) and you were looking forward to responding to your body and baby's needs as the birth process progressed, but then all of a sudden your body, your baby, your birth, became my body, my baby, their birth.
Defeated and exhausted, I apologized to my husband for not being able to do it, and agreed to the cesarean section. My husband of course thought that was silly, he was so proud of me for what I had accomplished - but at the time I felt like a lemon. My dream of my intervention free water birth had been lost earlier that evening, and now my vaginal birth was gone too. As I was rolled into the OR, I was mentally numb. The surgery is quick, bright, intense and bizarre. All around you are strangers, your partner isn’t allowed in the room for the prep, your doula isn’t allowed in at all, and after all those hours of intensity, your body is numb. I feel so lucky that my midwife Chrisy was in the room during the prep, which for me was the scariest part. She held my hand, talked to me, and kept me company as I prepared for the birth of my baby. Finally, my husband was ushered in, and what felt like seconds later, my baby was born. A quick flash of the baby over the curtain, screaming and purple and my husband was rushed over to the baby. He was able to bring the baby to me for a quick kiss before the two of them were taken to the nursery. Another dream, of immediate skin to skin time and delayed cord clamping was taken away.
Birth via cesarean in an amazingly quick process, but the closing up is tedious and lengthy. Without my baby or husband there, it was sad and lonely. Again my midwife’s presence was so comforting. She continued to hold my hand, chat when I needed to, and let me know what was happening when I asked. Everyone in the OR is concerned about your body, but my midwife was there for my emotional support, and I am so grateful for that, in a way I will never be able to express fully with words.
Finally, finally, I was rolled to recovery, and sometime thereafter reunited with my husband. This time when I saw my baby I was able to hold him and kiss him. He nursed immediately, was so tiny, beautiful and perfectly healthy. So much love was in the room as I was surrounded by my doula Rachel, midwives Cindy and Chrisy, and midwife assistant, Ashley. Everyone was exhausted, and the outcome was not what anyone had wanted or predicted. The OBGYN confirmed that the baby was OP, which confirmed what all had suspected and explained my back labor, lack of progress, and the fact that I never felt an urge to push. OP babies can be born vaginally, but Gail Tully of Spinning Babies explains that OP babies are unpredictable – some can be born vaginally “sunny side up”, some turn during labor and some get stuck and need to be born by cesarean.
So now, I heal. I forgive myself for not having a vaginal birth. I come to terms with my cesarean scar. I trust that my providers did all they could for my “dream birth.” I learn to not obsess about the health implications for a cesarean baby. I talk about my birth and my disappointment. And I nurse, like crazy, because I need a victory, I need to know that my body isn’t lemon, because it isn’t. Birth is unpredictable, cesareans can be necessary, and moms are strong. Whatever birth you end up with or choose, becoming a mother is a strong and brave act – it’s the beginning of the selfless gift of unconditional love you give to your baby.
I want to thank my midwives:
Cindy – for her wisdom and experience and because I knew I could trust that she had the same goals for my birth as me.
Chrisy – for her kindness, warmth, and comfort when I needed it most.
Ashley – the midwife assistant, for her beautiful photography and the way she told me I was strong when I needed to hear it most.
Rachel – my doula, for always knowing what I needed when I needed it, for supporting my birth wishes, my husband, and for taking care of me, even now as I heal.
To Matt – my rock, my strength. For literally and figuratively holding me up when I needed it most.
Photo Credits: Midwives of NJ & Matt & Megan Stark
Courtney's story was so amazing because she had no expectations or desire for a waterbirth but when her midwife acted quickly to fill the tub yet and Courtney's veins responded slowly to iv fluids, she arrived somewhere she did not think she would be. Thank you Courtney for sharing your story....
I was due May 1st. This is my birth story: My contractions started at 5:30pm the evening before and they were very intense and strong but were not consistent or close together. 18 minutes apart, half hour apart, 12 minutes, 11 minutes apart. They never got closer together than 11 min apart so I called the midwife on call at 2 am (Lisa Milstein at Avalon Midwives) who said to call back when there 5 to 7 minutes apart. I called her again at 9 AM with the same news no updates and she suggested to set up an appointment for me to go to the office to get checked. She said we will just take it from there. I started using my TENS machine to deal with my contractions. Joanne Cunha was going to try to be available to deliver my baby but she was working in the office that day so she met with me at the office to check me. I told her that I lost my mucous plug yesterday and that my contractions are really intense. She said since the contractions are so far apart that this could be false labor and contractions can last for a few days like this. She wanted to do an internal check but basically suggested that we go home and wait until the contractions are closer together. I was so disappointed I really wanted to have my baby on May 1st- I love that date.
Joanne said before you leave let's just do an internal check, she said wow!!! you are 6 cm dilated right now!! She said you are going to have his baby today! She said if she breaks my water right now the contractions will be closer together and everything will start progressing normally. I was so afraid for her to break my water I was afraid it would hurt. She told me I wouldn't feel it, so she broke my water with a little pin prick on the end of a rubber glove. It didn't hurt at all but I started gushing water immediately and she put a giant chuck pad folded up in my pants lol so we can drive to the hospital without getting water everywhere. She said she wouldn't be available to deliver my baby today but Kim Kirby will be there and she is great. I love Kim I was so happy to hear that she was on call!! As soon as we left Avalon and walked out to the elevator the contractions started and they were five minutes apart the way they are supposed to be. My TENS machine really helped. We got to the hospital at 11am and I had to pee so bad. When I came out of the bathroom Rachel my Doula was in the waiting area with Rob! I was so happy to see her! I started telling her what happened at Avalon just when a big strong contraction came, she said don't worry about telling me the story let's just get through this contraction. Then I saw Kim with her iced coffee (which she never got to finish ) she gave me a kiss on the cheek and we were so happy to see each other. She said let's get you into a room! Do you want a tub? I said yes.
We were in the room that we saw during the tour. They sat me down on a yoga ball which was so relaxing and took away all the pressure. They were trying to put the belt on monitor on my belly but could not get it in the right position. Rachel was rubbing my back softly and using aromatherapy- citrus smelled so nice ! I told her I wanted an epidural and Kim said that they have to first flush me with Iv fluids for half hour and then they have to request the epidural. That takes a lot of time and Kim couldn't find my vein to get the IV fluids going I have black and blues all over my arms. She asked me if I wanted to get into the tub to get through the contractions more easily. I told Rob that they are tricking me I don't think I will be able to get the epidural. I wasn't panicking I don't think it really clicked in my mind what that would mean. Once I got in the tub I wouldn't be able to get an epidural quickly. Rachel looked at me and said think about the opportunity that you have right now you can do this! When I got into the tub it was so relaxing and warm it's unbelievable how wonderful it felt. The temperature was absolutely perfect. During contractions I would press the whirlpool button. Before I got into the tub I kept yelling that I feel pressure! I feel pressure! Kim said what kind of pressure ? I kept yelling I don't know I don't know I don't know I think it's the head.
Kim told me that she felt the head and that it was right there! She said there's no point in getting out of the tub the head is right there! She told me I could start pushing. I kept yelling I don't know I don't know I don't know I don't know how do I know when to push? I felt a contraction and I pushed and she said we see the head!! She said keep pushing I pushed again and I yelled I feel the ring of fire I feel the ring of fire! As I was pushing the head I felt my whole crotch stretch and burn. By that time the entire head was out I heard the nurse say okay shoulders are next. She told me to give a big push she said do it harder that's not hard enough! I pushed again and she said one shoulder was out I felt like my entire insides, my pelvic bones were separating as I felt the baby move through. I was yelling beastly sounds and started screaming get it out ! get it out! Why aren't you getting it out ?!! I don't know understand why you cant get it out!! I gave a long push, the push was so long I couldn't believe that the push lasting that long and the rest of the baby came out.
I went from intense horrific pain to complete bliss with no pain at all. The moment the baby came out there was absolutely no pain. Rob was crying because he said the birth was so beautiful just like on TV. He said the water was completely clear no blood, no poop! When the placenta came out that's when the tub turned red. She was born and they put her right on my chest in the warm water. She was beautiful 8 lbs. 13 oz. 20 3/4 inches. Rob cut the cord. We got to the hospital at 11 and I delivered at 1:06. I was really frustrated with how much pain is involved with the pushing the midwife said I only pushed for six minutes. She said stop complaining and can you just be proud of yourself? Look what you just did! You just had an unmedicated water birth- do you know how many people want to do that?! You are so strong and had so much control. You did an amazing thing today and you're still intact, no tearing! That's amazing!
Thank you for sharing your story Courtney.... It is so interesting the details of what we remember - for Courtney it was the words and the pain and the bliss :). Bring more bliss! I remember Courtney saying at our postpartum visit that she was so amazed how, with water birth, baby just went from being inside you to being on your belly - without interruption. Also, there were a few funny details... Courtney said thank goodness their wasn't a tour or something going on outside her door and I told her, there was- it all happened so quickly that the midwife needed to remind the nurse to close the door right as the maternity tour was walking by. It was also funny when Courtney said "This is orgasmic!' when they put the ice pack on her crotch or right after the birth when Courtney said "I feel so powerful, I feel like I could punch someone in the face!" I said okay Courtney - if that is how you want to use your power! May all postpartum mothers feel so powerful to want to punch someone in the face. Courtney tells me shops closed after baby #2 but I am secretly hoping to attend more of their births. To read Courtney's Tips & Tricks on early motherhood, visit her blog Angelic Treasure https://angelictreasure.wordpress.com/
Thank you Courtney (& Rob & Lucas & Rosa Lia!) for sharing your story! I of course wish for all women and, personally, all my clients to have such easy and uncomplicated beautiful births and if presented with more challenging births - I wish for safe and healthy motherbabies. May we all be happy and healthy at the end of the day(s).