Midwives and home births : the truth
A regular reader points me towards a sickeningly mawkish article in the Guardian about a midwife who specialises in home births.
She exudes a confidence that belies her relative inexperience, which perhaps goes some way to explaining why she is so suited to midwifery.Their words, not mine. But it sums it all up. Make sure there is a doctor close by when you have your baby.
Labels: home births, madwives
30 Comments:
When I was a baby surgical intern I was piddling around inside a patient, too scared to make any useful progress. My attending (consultant to you, I think) looked across the table at me and said, "Bill, you can't get into any trouble that I can't get you out of." THAT is confidence. The blithe disregard that problems can occur is purely lack of experience, naivety, and not having bad things happen to you . . . yet.
However my attending appended his statement with, "Now, don't take that as a dare." THAT is prudence.
Just found your blog - absolutely fantastic. Have liked to you.
"I'm lucky enough to have witnessed the work of Gooder and her Brierley colleagues because the woman in question is my wife and the birth was that of our second child, Jonah."
Some quality journalistic research there.
I followed your link and read the article expecting some awful obstetric emergency resulting in morbidity or mortality, but no, nothing untoward occured and all involved are happy with the birth and the care. As a result I am having difficulty understanding your insistance 'Make sure there is a doctor close by when you have your baby' as the article certainly does nothing to support this. There again though, you and I each have our own bias!
Perhaps when the results of the Birthplace study, which is funded by the NIHR Service Delivery and Organisation (SDO) Programme, and the Department of Health's Policy Research Programme, are published we will have an end to the eternal arguements regarding the safety of homebirth.
http://www.npeu.ox.ac.uk/birthplace
http://ferretfancier.blogspot.com/2008/03/bbc-sinking-and-religious-nhs-reform.html
thought you may appreciate this dr c
And doctors are always so perfect of course. Like the GP that told my newly diagnosed 7 year old daughter that people sometimes grow out of type 1 diabetes I suppose? Thanks for raising false hopes!
Or the doctor that told my husband that his frequent urination problems were just a bad habit and he needed to hold on as long as possible so his bladder would be stretched back to a normal size. Turned out he had a bladder neck obstruction and the constant holding on caused a bladder diverticulum.
Or the GP that told me that coeliac disease has nothing to do with type 1 diabetes and that relatives of people with type 1 diabetes are not at increased risk of coeliac disease?
At least the nurses and midwives I've had contact with have been more willing to listen to patients and have seemed less inclined to state (wrong) opinions as definite fact.
Oh, gads! Women have babies. This is not new. Nor is it a disease.
You did this already.
Fx
fx, you're retarded. Sorry to be unPC, but anyone who trots out the 'ol "Childbirth is natural. Nature is good. Nature will never let anything go wrong" is retarded.
Sorry. I actually should've said "Cognitively impaired".
When something goes wrong in lovely, natural, windchime evoking childbirth that has happened smoothly and naturally for years without any pesky hospitals and doctors, it goes wrong like LIGHTNING. Haemorrhage. Eclampsia. Pulmonary embolism. Amniotic fluid embolism. Peripartum cardiac failure. Foetal distress, cord around neck, respiratory problems. In the early 1900s, the maternal death rate was around 1 in 250 or even higher. It was very common for women to die in childbirth or in agony a few days later.
Now, so called "medicalising" childbirth has made those nightmarish days a thing of the past. Women who get pregnant today very very rarely die as a direct result.
We have been blessed with access to modern healthcare and we no longer see many things that were once a terrible part of everyday life. And many people without sufficient knowledge, brains or both assume that these things are not with us anymore. Children dead from diphtheria, measles, or brain damaged from SSPE. People crippled with polio. Young people dying at length from "consumption" ie. TB. And young, healthy women in their prime dead from a childbirth complication, maybe leaving behind a motherless baby and griefstricken family.
I do not wish for a return to the Dark Ages. I do not support this century's "Bonfire of the Vanities" where people burn science, technology and medical advances on their altar of blatant stupidity. They are the same people that would have burned witches hundreds of years ago.
Advances in medicine have been made and have saved millions of lives. This is not a bad thing. I find it difficult to understand those that mistrust lifesaving. I wonder are they stupid alone or also bad into the bargain?
Savanarola
In the early 1900s women were dying in droves of puerperal fever - brought on by another hospital acquired infection: doctors going straight from the mortuary to the labour ward.
Lets not go into the many and varied ways that doctors have complicated childbirth since they first started getting involved in the process at the behest of Louis XIV.
There are a small number of women who have complications of childbirth. Most women are perfectly capable of having babies quite naturally and don't need to be taking up hospital resources.
Fx
"And doctors are always so perfect of course. Like the GP that told my newly diagnosed 7 year old daughter that people sometimes grow out of type 1 diabetes I suppose"
Well it is obvious that doctors are not perfect. But doctors (as a class) are clearly aware of the natural progression of DM and medical science can control it. Thus you would be better off going to a doctor than, say, a shaman. Your point is??
Mandarin blog central, my point is that Dr C always runs down any NHS practitioner who is not a doctor, usually calling them quacktitioners. But I would much rather speak to a DSN (Diabetes Specialist Nurse) about diabetes than my GP because they know far more about the day to day management of diabetes and the problems people are likely to face. They will also be up to date with the available insulins and methods of delivery.
I have taken my child to the GP for unrelated problems and she has been told that her diabetes control is poor. It may be poor when compared to the type 2 diabetics the GP usually sees, but she has excellent control for a type 1 child. Her HbA1c (roughly, a blood test result that reflects average blood glucose levels over the last 8-12 weeks) is usually below 7% which is below the recommended target figure (only 84% of children in the UK currently meet this target). But a GPs insensitive and uneducated comments can cause much distress in this situation, possibly even causing children and parents to doubt the staff at the diabetes clinic if they don't know better.
Similarly, I would much rather have a midwife with me during a normal labour. Midwives are trained to manage normal labour and to recognise when it's going wrong. Consultants are trained to deal with labour when it's going wrong. They usually have very little to do with normal labour and probably have little experience of it.
I will be very interested to see the outcome of the study linked by midwifemuse above. I had a home birth at my previous address after 2 problem free deliveries in hospital (1st consultant led, 2nd midwife unit), but I was only 10 minutes away from the hospital by car and we lived opposite an ambulance station. It probably wouldn't have taken much longer to transfer to hospital from home than transferring from a ward to a treatment area within the hospital. The main difference between the consultant and midwife led labours for me was position. Flat on back with legs in stirrups with the consultant, kneeling up against the headboard or sofa with the midwife. Guess which works best when trying to push a baby out?
I spoke to a midwife recently about home birth in this area and she said that they have a very low threshold for signs of problems requiring transfer to hospital. However, I'm still not sure I would have a home birth here because it's a 40 minute trip to hospital even by ambulance. The study mentioned above will hopefully help mothers make an informed choice.
Yes, there are poor DSN, midwives, etc, and there are good GPs, especially if they have a special interest in a particular area, but on the whole I would trust the staff with specialist training above a generalist once a diagnosis has been made, or a midwife with normal labour above a consultant trained to deal mainly with problems.
‘my point is that Dr C always runs down any NHS practitioner who is not a doctor’
No he doesn’t, Jane. He actually has loads of respect for specialists such as DSNs who offer specialist advice on a particular area of medicine where they are trained and experienced.
It’s the ones who step outside their areas of expertise who arouse his ire; a closer analogy would be taking advice from a DSN on, say, MS.
As it happens, I agree with you re Type I diabetes – I’ve yet to meet a GP who really, really understands it. An an A1c of >7 in a 7-year-old is blooming amazing, you and your daughter should both be very proud of that.
'He actually has loads of respect for specialists such as DSNs who offer specialist advice on a particular area of medicine where they are trained and experienced'. Why does he have such a problem with midwives then?
I’m sure Dr C is perfectly capable of replying for himself, but my impression is that he believes women should be allowed to make their own birthing choices and midwives should facilitate those choices rather than hinting – as some do – that any one approach is in any way superior to any other.
But I confess as a non-medically trained bloke whose 2 children were both born by emergency C-sections, I’m not very well qualified to comment.
Hi rob, I think you're being a little over generous to Dr C. A quick search found the following practitioners referred to a quacktitioners:
incontinence nurse quacktitioner
cardiac nurse quacktitioner
Community nurse specialist quacktitioners
Macmillan nurse quacktitioner
mental health nurse quacktitioner
ambulance quacktitioner
hospital-at-night quacktitioner
He obviously also thinks of midwives as quacktitioners, I find it hard to see why he would feel any differently about DSNs.
Thanks for the vote of confidence re. my daughter's diabetes control. She was diagnosed at 7 and is now nearly 16. We have been very lucky to have a consultant and DSNs who have supported our choices in care (various insulin regimen changes, teaching ourselves carb counting and eventually an insulin pump). Her HbA1c has been up to 7.3% a couple of times but below 7% the rest of the time. Maybe if there were more DSNs, more people would be able to achieve these levels for their children. With an average caseload of 147 patients to each DSN compared to the recommended level of between 70 and 100, it's not surprising that children's diabetes care is generally so poor in this country. If the average HbA1c can be reduced the money saved in treating complications would probably pay for the extra nurses.
Where's Amy Tuteur?
Fx:
You are incorrect. Even as late as the 1950's in the UK, maternal mortality was extremely high. There is something called the "Birthday trust" or something like that(I cannot remember the exact name as I did not train in the UK) that looked at these deaths and ways to reduce them. It was not ye olde puerperal fever that caused these deaths or the majority of maternal deaths in general in the last century. It was problems like haemorrhages (commoner than you think), obstructed labour, cardiac problems, eclampsia, uterine rupture and so on and so on and so on. Modern medical practices have reduced this to such a low figure that no-one even knows anyone who has died in labour anymore. I certainly don't.
I am not an obstetrician or I could probably quote many more cases like this. In the hospital where I used to work, a 23 year old was giving birth in the women's hospital, attached to the main. Uncomplicated pregnancy. Full term. No previous cardiac history. Labour going ok for hours. She developed shortness of breath midlabour. Ten minutes later she was periarrest. She had developed severe pulmonary oedema and low output heart failure from a condition called peripartum cardiomyopathy.
A consultant cardiologist was there in ten minutes, an obstetrician in five. The baby was in foetal distress and the woman close to death. They actually did not think either would make it, and both were in ICU for a long time.
But they both lived and went home with the father.
Had they been anywhere else other than a large women's hospital attached to a large tertiary centre they most certainly would be dead now. There would not even have been time to get an ambulance. Pregnancy in humans is actually not as easy and natural a process as people enjoy thinking it is. There are a lot more complications in us than in most other animals. I have no idea why.
Yes, doctors in the past did some dumbass things. Bleeding people, purging, tincture of god knows what. This is how knowledge and best practices are built up. Trial and error, unfortunately. In any other profession, the error part simply isn't as catastrophic and doesn't lead to a hatred of the profession. Now that we have made, as a race, the worst of our bad medical mistakes over the centuries, we have a broad and generally sound knowledge base to build upon, and keep learning from our ever decreasing errors.
This is a good thing. This is a great thing. Chances are, you and your loved ones can expect to live to 75-80 in reasonably good health. You expect that you will never see your children die, this is now tragic and unusual. It used to be incredibly common. This is ALL thanks to medical research, studies, audits, different ways of trying things that over the years and years and years have taught us ways of curing diseases, of extending our lifespans, of reducing previous death sentences into manageable chronic conditions. Yes, some doctors make mistakes. They are human. But by and large, when you are sick, the best thing you can statistically do is still to go and see one. I suspect you know that though.
Savanarola
I appreciate your own experience.
However, this article in the American Journal of Childhood Nutrition suggests that it was, with respect, medical interference that contributed most to high rates of maternal mortality in the first half of the century. It was middle and upper class women who were most affected, not, as you might imagine, the poor - ie, those who paid to have physicians attending were more likely to die in and around childbirth than those who did not.
These days it's the other way around. Diet and lifestyle choices are major contributors.
Infant mortality is a different matter. The main causes are dietary, lifestyle and lack of prenatal care - from anyone, not just doctors. Very high infant mortality rates in the developing world.
The western world has very low maternal and infant mortality rates - around 5%. This has much to do with improvements in diet and health generally as you say.
There are some interesting figures here: http://www.archive.official-documents.co.uk/document/doh/wmd/wmd-01.htm
Here: http://bjp.rcpsych.org/cgi/content/full/183/4/279
and here: http://www.rcm.org.uk/info/docs/251004151759-320-1.pdf
This is not an either/or situation. There is room for both doctors and midwives in the care of pregnancy and childbirth.
However, in most cases in the west right now, women do not need anyone other than a midwife - a professional trained to deal with normal birth processes.
I understand this is not popular with doctors - they are trained to see pain as an indicator of something wrong ... and intense pain as an indicator of something terribly wrong. But pain in labour is normal. It's not nice, but it *is* normal.
The less interference with the process the better.
Fx
Consultants are trained to deal with labour when it's going wrong. They usually have very little to do with normal labour and probably have little experience of it.
Is this what you believe? You're spectacularly wrong. I'm a consultant in O&G. I've been involved in the care of probably around 10,000 labouring women in my career so far, and I'm a young consultant. The majority of these births ended as normal deliveries. We profer opinions in / see / get involved in about 50-70% of all women in labour for a variety of reasons, usually by request of the midwives providing care. We avoid intervention where possible. Why would I interfere when not needed, when there are so many women who DO need me to help them? To say doctors have no experience in normal birth...! Pure ignorance. You must be very blissful.
The bottom line is that this midwife will deliver 30 births a year and possibly be involved in another 30. Doctors experience those numbers in a few days. Her entire career experience of birth including outcomes and complications will be eclipsed rapidly by the most junior O&G trainee.
9 months experience and doing home births? Be very afraid if her backup can't make it in time....
Anonymous,
LOL, why would I be blissful?
If a midwife attends 30 deliveries a year and you experience that number in a few days, and you both work full time in the labour wards, you can't be seeing much of each labour. In our area, women are booked with just a midwife for care if they are low risk. Only high risk mothers get consultant led care, but even then, most of the care is carried out by the midwife. Yes, the midwife would consult a consultant if they have any doubts about a low risk mother, that's the way it's supposed to work. How many completely normal labours do you attend from the time the woman arrives at hospital through to delivery?
The only time I've seen a consultant during my three labours was during the first, after over 2 hours in second stage and struggling to push. Then the midwives threatened to call the consultant in the hope it would persuade me to push, LOL. So, maybe not all consultants work like this but in my admittedly limited experience of my own and about 15 labours in family members, we saw next to nothing of consultants and only then when there was a problem. Obviously we are glad you are there for when problems strike, but none of us expected to or saw them during normal labour.
Jane_t
"incontinence nurse quacktitioner
cardiac nurse quacktitioner
Community nurse specialist quacktitioners
Macmillan nurse quacktitioner
mental health nurse quacktitioner
ambulance quacktitioner
hospital-at-night quacktitioner"
no mention of Diabetic Nurse Specialist
if you look at your list you will see a pattern, it's where people are being forced outside their own area of expertise and experience.
Ambulance paramedics are wonderful professionals at extracting you from the wreck of your car and transporting you safely to hospital, at giving you the blood clot dissolving drug that limits the damage to your heart after your heart attack. But they are not good at assessing elderly patients with multiple problems who may or may not benefit from hospital admission, and increasingly that is the position into which they are being forced.
In an earlier post you expressed your preference for a specialist once a diagnosis is made, but increasingly these specialists are being asked to perform in areas with a less specific diagnosis is made and therein lies a danger.
At the other extreme when we get older and have more than one problem a generalist can take an overview of the whole picture while a specialist cannot.
A recent example from my practice of an elderly man with, among other problems, dementia and heart failure. The Heart Failure Nurse and the Dementia Nurse were both giving advice and demanding treatment which was within their guidelines and evidence based but both were making the other condition worse and confusing his poor wife. And both lacked any insight into the fact that this was a problem. Neither of them had the knowledge, experience or confidence to step back, talk to his wife about the pros and cons of various treatments and reach a joint decision about what was most important for her husband and her. To do that took a generalist, in fact it took a GP.
Obviously I have little or no experience or knowledge of most of the jobs/professions you have discussed above. I've only had contact with DSNs and midwives (or madwives according to Dr C). Both of these seem to have been around for a while, certainly midwives have, and appear to have excellent training for what they do - watching and guiding normal labour. I cannot see why Dr C has a problem with midwives as a whole (there will always be poor midwives, just as there are poor GPs) and cannot see why he would feel any differently about DSNs than he does about midwives (or any other specialist nurse working within the area they are trained for).
Obviously there is a place for generalists (or possibly a geriatrician in the example you gave) when more than one condition is involved. I still think there is a place for specialists in the situation you describe. Maybe a case conference should have been held so that the various specialists could discuss the best approach together. Maybe a GP would be in a position to chair such a meeting having some overview knowledge of the conditions able give advice on which condition should take priority after listening to the specialists reasons.
How many GPs understand type 1 diabetes well enough to offer useful advice to a patient (or carer of a patient) with type 1 and other, possibly conflicting, conditions? From my experience, not many, even for type 1 diabetes alone. But they may be able judge the comparable importance of different treatments once the specialist have shared their knowledge and reasons behind their choice of treatment.
Jane_t
Blissfully ignorant.
No I don't stay with a woman for her whole labour. Funnily enough this is poor use of my time. What the midwife does in her time is monitoring, some personal care, providing support, communication and advice, documentation and following midwifery guidelines or medical plans.
All of this is important. None of this needs much expertise that can't be picked up by a junior doctor in a few months of just being on a labour ward.
And by the way. You're low risk but you've seen a consultant in a third of your labours. Also there's antenatal admissions & assessments, clinics, after the birth. All the higher risk women who get seen repeatedly many times but then go on to have a normal birth. All the low-risk women who need some intervention or an opinion and then have a normal birth...
You really don't get it do you?
Any obstetrician has a vast experience of normal birth in women who may be low or higher risk. Can you at least show insight and admit that?
This midwife has had trivial experience. She has had a basic midwifery training plus a little hospital-based work. If a baby gets into trouble or mum collapses she has neither the theoretical background nor the experience to manage the situation. She and her booked women are being screwed into accepting grossly substandard care by a politically correct system and they don't even know it.
I am willing to accept that consultants have more experience of normal birth than I previously believed, you obviously have much more knowledge of this than I do. But my main objection to Dr C, and the main point of my previous posts, is his apparently routine dismissal of all nurse specialists. Yes, there are good and bad nurse specialists, just as there are good and bad GPs or consultants. But this doesn't justify condemning the whole group as quacktitioners. Do you think of all nurse specialists in this way? In your opinion, would it be better if midwives, DSNs, Macmillan nurses, etc, were replaced with more GPs (with the training GPs currently have). Or do you think there is a place for people with a less extensive general training to receive detailed training in a specialist area?
BTW, you mention that 1/3 of my pregnancies were consultant led despite being low risk but this was purely because all first pregnancies were allocated to a consultant in that area, at that time. I'm not sure how common this is?
Also, although a consultant was called towards the end of the second stage, he didn't actually do anything. So unless the threat of instrumental delivery to improve my pushing efforts counts as a consultant intervention, the only difference that the consultant led care made was that it took place in a standard delivery room where the routine use of a delivery bed with stirrups, and extended periods of continuous electronic fetal monitoring monitoring seemed to be the norm.
I know that 1st labours are generally longer than later labours and anecdotal evidence makes for poor science, but I still feel that delivering on my back with my legs in the air had something to do with a 2nd stage that lasted 2 hours 20 minutes, compared to a 2nd stage that lasted less than 20 minutes in an upright position in the next labour. I believe research evidence supports this theory (position affecting length of second stage) also, but have not had time to check.
I believe also that continuous electronic fetal monitoring is generally considered to be of benefit to the high risk mother but of questionable benefit to the low risk mother. NICE seems to recommend it for high risk pregnancies where there is an increased risk of perinatal death, cerebral palsy or neonatal encephalopathy or during induction or augmentation of labour using oxytocin, none of which applied to my first pregnancy/delivery. It appears to me in my ignorance that the only result of consultant led care in my case was an increase in interventions (continuous monitoring) and limiting of movement during labour and position during delivery that are more likely to lead to further interventions.
However, I do think that midwife led units should be next to consultant led units to enable easy transfer if problems develop. I believe the transfer rate for low risk pregnancies is in the region of 1/3? With these figures it seems dangerous to risk completely separate units which would necessitate a transfer via ambulance. Similarly, I personally would not risk a home birth unless I were within very easy reach of a consultant led maternity unit and not even then, not for a 1st delivery.
jane_t
He doesn't dismiss nurse specialists. You need to read his articles more carefully. He dismisses nurses filling a massively complex role - diagnosis - for which they are unsuited by virtue of a lack of relevant training, in other words a medical degree plus postgrad experience, and often sheer inability to think at a high enough level.
There's nothing wrong with nurses bettering themselves and improving their knowledge thus helping patients, but don't kid yourself this is cheap for the NHS. It's really expensive care, much more than medical care because they're three times slower. Hence the satisfaction rates in clearly defined areas like diabetic management.
Midwives are vital people in childbirth. This will continue, rightly so.
And your monitoring? Did a doctor strap this on? Low risk equals intermittent listening in - but this requires someone in the room a lot. Doable, but amazing how midwives just stick the monitor on.... so they can go and have a coffee, chat instead of being cooped up in a room with you all day!
Doctors will have been kept informed remotely about your progress, so you WERE being managed. You just didn't know it. Not intervening is just as important as intervening. Aren't you pleased your consultant did nothing? If a midwife could do forceps or vacuum, you'd be delivered by them. It takes confidence and training and experience to not intervene. (Or ignorance of course). Be thankful.
God awful dangerous and they have absolutely no clue.
Just for comparison:
Hours
37.5 a week (including two weekends a month); plus 11 on-call shifts (9pm-9am) a month.
Salary
c£24,000; plus £5,000 high-cost living allowance; plus £300-500 per month for on-call hours.
Qualifications
Access course in health and social care (equivalent to two A-levels);
BSc in midwifery studies, University of Huddersfield.
Mine when in house jobs in 1997:
Salary: £22,000. No overtime.
Hours: 126 hours per week (I am not making that up. I counted it)
Qualifications:
4-year honors undergraduate degree
5-year medical degree
Highs: perception of bright future
Lows: no future
Now, if you were 20 and looking for a career path, where would you go?
"He doesn't dismiss nurse specialists. You need to read his articles more carefully. He dismisses nurses filling a massively complex role - diagnosis - for which they are unsuited by virtue of a lack of relevant training, in other words a medical degree plus postgrad experience, and often sheer inability to think at a high enough level.
There's nothing wrong with nurses bettering themselves and improving their knowledge thus helping patients, but don't kid yourself this is cheap for the NHS. It's really expensive care, much more than medical care because they're three times slower. Hence the satisfaction rates in clearly defined areas like diabetic management."
So do you agree with Dr C's comments here, http://nhsblogdoc.blogspot.com/2007/05/quacktitioner-alert-13.html about epilepsy nurse specialists? He seems to lump all of them together as quacktitioners despite the fact that they are not diagnosing or working outside the area they are trained in. In fact, from this description you could replace epilepsy nurse specialist with diabetes specialist nurse where their responsibilities are described in my experience. Why do you think Dr C would feel any differently about DSNs?
"And your monitoring? Did a doctor strap this on? Low risk equals intermittent listening in - but this requires someone in the room a lot. Doable, but amazing how midwives just stick the monitor on.... so they can go and have a coffee, chat instead of being cooped up in a room with you all day!
Doctors will have been kept informed remotely about your progress, so you WERE being managed. You just didn't know it. Not intervening is just as important as intervening. Aren't you pleased your consultant did nothing? If a midwife could do forceps or vacuum, you'd be delivered by them. It takes confidence and training and experience to not intervene. (Or ignorance of course). Be thankful."
So I was being managed by a consultant but it's the midwives fault that I was stuck on a monitor and flat on my back during second stage; nothing to do with the consultant at all? Can you have it both ways? And I wish he had intervened. I wish he had told them to get my legs out of the stirrups and into an upright position so that gravity could help move things along. That would have been a useful, appropriate and research driven intervention in the situation he found, wouldn't it?
The midwife led unit had a completely different philosophy, encouraging movement throughout labour and experimentation with positions. This was in the ward next door to the consultant led unit. Is it unreasonable to assume that the difference is dictated largely by the person in charge?
"Is it unreasonable to assume that the difference is dictated largely by the person in charge?"
The fault is the midwife's. They are delegated the role of facilitating normal delivery. If she didn't get you upright that's her fault. As a doctor you can't micromanage everything on a busy delivery suite. That would reduced morale and clinical comfidence, and draw one's attention from more important stuff.
Positioning is basic midwifery. Her fault. So, if she can't do the basics correctly, then how do you think those of her ilk will cope with complex extended roles?
Answer: most don't.
You made a good point, although some commentators seem to have missed the wood for the trees a bit.Your life is so wonderful,Reading your article is a kind of enjoyment.Thank you.
Tactical Flashlights
r c helicopter
video game
希望大家都會非常非常幸福~
「朵朵小語‧優美的眷戀在這個世界上，最重要的一件事，就是好好愛自己。好好愛自己，你的眼睛才能看見天空的美麗，耳朵才能聽見山水的清音。好好愛自己，你才能體會所有美好的東西，所有的文字與音符才能像清泉一樣注入你的心靈。好好愛自己，你才有愛人的能力，也才有讓別人愛上你的魅力。而愛自己的第一步，就是切斷讓自己覺得黏膩的過去，以無沾無滯的輕快心情，大步走向前去。愛自己的第二步，則是隨時保持孩子般的好奇，願意接受未知的指引；也隨時可以拋卻不再需要的行囊，一路雲淡風輕。親愛的，你是天地之間獨一無二的旅人，在陽光與月光的交替之中瀟灑獨行.......................................................................................................................................................................................................................................................................................................
Post a Comment
Subscribe to Post Comments [Atom]
Links to this post:
Create a Link
<< Home