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Homebirth controversy


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  #41  
March 27th, 2013, 08:57 AM
ValyntineG's Avatar Based on a True Story
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Originally Posted by MyFantasticFour View Post
What a great read!
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  #42  
March 27th, 2013, 09:09 AM
MyFantasticFour's Avatar Mommy of 4
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I think I'm going to ask my midwife for her statistics just for this post. I know that my homebirth goes into a MANA statistics project though, so they are working on creating statistics.
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  #43  
March 27th, 2013, 06:39 PM
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Thank you for posting your statistics Val. I have a few of my own to post.

This is data from the CDC Wonder website, which publishes the causes of mortality for ALL deaths in every state in the United States, from any cause, as well a huge number of other health statistics. The website is http://wonder.cdc.gov/, anyone can log in and use the data that is published there, so you can independently verify this.

Looking at the most recent set of data, from 2007 and 2008, lets look at the Linked Birth/Infant Death records for white women between the ages of 20 and 44, with full term deliveries (37+ weeks and a weight of 2500+ grams). First lets see how many births occur in the hospital vs. outside of the hospital, for each of three categories of birth attendant: Medical Doctor (MD), Certified Nurse Midwife (CNM), and Other Midwife. This category of Other Midwife does not specify whether or not they are Certified Practical Midwives (CPM) or not. The category of MD does not specifiy if they are OB/GYNs or not, but knowing the US medical system I would suspect that they are. Feel free to copy/paste this into Excel to make it easier to read.

Medical Attendant "In Hospital" "Not in Hospital" Total % OOH
Certified Nurse Midwife(CNM) 302516 14778 317294 4.66
Doctor of Medicine(MD) 3652738 2429 3655167 0.07
Other Midwife 6855 19526 26381 74.02

We see here that a small percentage of births attended by CNMs (4.7%) occur out of hospital, a tiny percentage of births attended by MDs (0.07%) occur out of hospital, and a substantial percentage of births attended by "Other Midwife" (75%) occur outside of the hospital. There are some surprises here...I'm surprised that any births outside of the hospital are attended by MDs...maybe these are precipitous births that an MD rushes too? I'm also surprised that 25% of births attended by "Other Midwife" occur in the hospital. Maybe these are properly transferred births that developed complications? Maybe these are students training to be Nurse-midwifes, but not yet graduated?

OK, now lets look at the neonatal deaths (0 to 27 days after birth) occuring in each situation. Unfortunately this dataset does not contain info on stillbirths or babies born with hypoxic brain injuries, so death is the only adverse outcome we have to look at.

Attendant Birthplace Deaths Births death rate per 1K
MD Hospital 2065 3652738 0.57
MD OOH 5 2429 2.06
CNM Hospital 109 302516 0.36
CNM OOH 10 14778 0.68
Other MW Hospital 5 6855 0.73
Other MW OOH 28 19526 1.43

Hmmm...the highest death rate is among MDs attending out-of-hospital births. This would indeed be consistent with the possibility of these being precipitous or emergency births. Or maybe these are doctors attending planned home births, but I rather doubt it. The next highest death rate is with "Other Midwife" attendants at out-of-hospital births. Since the bulk of the births with Other Midwife attendants are OOH births, it does seem likely that these are planned.
The lowest death rate is among births attended by CNMs in the hospital...no surprise there since CNMs are highly trained professionals and they work with low-risk patients. Interestingly, the death rate for births that CNMs attend outside of the hospital is almost twice as high as for the births CNMs attend in the hospital. The second lowest death rate is among births attended by MDs in the hospital.
Now, lets calculate how many deaths would have been expected among births attended by "Other Midwife" attendants, if that death rate had been the same as it is for doctors or CNMs inside the hospital. For 19526 births, the expected number of deaths would have been 11 and 7, respectively. However, for those same 19526 births, the actual number of neonatal deaths was 28.
  #44  
March 27th, 2013, 07:07 PM
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Now that I'm done with my statistics post, I just want to point out that I have not made any personal attacks on anyone, and I have been the subject of quite a few. I was told that my opinions were based on outdated information and that I was uneducated, that I have been distributing misinformation, and even making deliberately misleading comments. Several people have taken offense at what they thought I implied, not what I actually said. I've made every effort to keep my comments matter of fact, and the vitriole that has been sent my direction is completely out of proportion.
For example, I have been accused of saying that "all CPMs are uneducated nitwits", which I have not said. I have said that some of them have only a high school education. You know what? A baker might only have a high school education, but that doesn't mean that baker knows nothing about bread or is an uneducated nitwit. A carpenter might only have a high school education, but still know a lot about how to build a house. However, if I had a choice between a carpenter with only a high school education and one with an advanced degree, and I learned that the houses built by carpenters with only a high school education were somewhere between 2 and 8 times as likely to collapse, I think I would go with the carpenter with an advanced degree. I wouldn't turn around and attack the person who disagreed with my established belief that carpentry is safe no matter what kind of training the carpenter has or where he builds the house.
  #45  
March 27th, 2013, 07:29 PM
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Most of the points you are trying to make, though, are based on your own speculations. None of it has been based on fact.

You did intentionally make a misleading statement about what CPM's need, education wise. You stated that all that was required was a HS diploma, when that was untrue and it was disputed in other posts based on the website that you linked.

You also totally ignored the entire bottom half of Brie's post which is pretty convenient, considering it almost completely disputed any of the points you had made thus far.

Now, you are grasping at straws trying to convince all of us that these statistics that you gathered from the CDC prove your point when the reality is, is that you are spinning it based on your own assumptions of how or why these situations occurred and, as you already stated, the website doesn't have information on stillbirths or babies born with hypoxic brain injuries. I could speculate that many of the deaths that occurred with other midwives was due to stillbirth or babies born with hypoxic brain injuries and then that blows your entire theory out of the water, since my speculation is just as justified as your own. Not to mention that you, yourself, stated that you don't even KNOW what other midwife actually means.

ETA: Keep in mind that I am saying this from an unbiased perspective. The only personal research I have done thus far is find out what midwives practice in my area, so this is an outside perspective from somebody just reading along. I can see why people are getting frustrated "debating" with you because you are either a.) ignoring their data or b.) spinning things to fit your own opinion, rather than posting unbiased sources that prove your point.
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Last edited by Babybear4; March 27th, 2013 at 07:32 PM.
  #46  
March 27th, 2013, 08:40 PM
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Well I put my two sense in regarding home births/birthing centre.
For some ppl this is a great experience, but for me it was not. My son died due to the care received. We were told that there should not be any issues during labour and that there is a doctor on call. Well the hospital we went to could not do a c section, so we had to be rushed to another hospital which was 20 minutes away. Our son did not have oxygen for 20 minutes according to the doctors. Well every minute counts with a baby is in distress. I will never do a home birth or use a mid wife again because of this.

But like I said some ppl do not have issues.
I think it is important to be aware of all aspects of homebirths.
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  #47  
March 27th, 2013, 09:20 PM
MyFantasticFour's Avatar Mommy of 4
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Quote:
Originally Posted by liz bevan View Post
Well I put my two sense in regarding home births/birthing centre.
For some ppl this is a great experience, but for me it was not. My son died due to the care received. We were told that there should not be any issues during labour and that there is a doctor on call. Well the hospital we went to could not do a c section, so we had to be rushed to another hospital which was 20 minutes away. Our son did not have oxygen for 20 minutes according to the doctors. Well every minute counts with a baby is in distress. I will never do a home birth or use a mid wife again because of this.

But like I said some ppl do not have issues.
I think it is important to be aware of all aspects of homebirths.
If you don't mind my asking, what happened? I will be sure to research my local hospitals for the case of emergency also, just in case. I'm so sorry
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Last edited by MyFantasticFour; March 27th, 2013 at 09:33 PM.
  #48  
March 27th, 2013, 09:37 PM
ValyntineG's Avatar Based on a True Story
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Out of respect for Liz, I am going to gracefully bow out of this debate.

I truly believe that every woman in this forum will take into account ALL the information they can regarding the births of their babies, which is a very personal choice. We are all mothers here and all of us obviously want to protect our future children to the best of our ability.

Liz, my heart breaks for you and I'm so sorry for your loss. My apologies if anything in this thread made you feel uncomfortable.
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  #49  
March 28th, 2013, 06:03 AM
Dolly Lama's Avatar Mega Super Mommy
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Quote:
My son died due to the care received. We were told that there should not be any issues during labour and that there is a doctor on call. Well the hospital we went to could not do a c section, so we had to be rushed to another hospital which was 20 minutes away. Our son did not have oxygen for 20 minutes according to the doctors. Well every minute counts with a baby is in distress. I will never do a home birth or use a mid wife again because of this.
I had no intention of participating in this thread because I have nothing useful to add, but I could not read this without telling you how truly sorry I am for your loss.
  #50  
March 28th, 2013, 06:46 AM
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I am so sorry for your loss Liz! :hugs:

I did not read all the comments, most were lengthy, and I just don't have time to read through!

BUT for me, home birth is not an option. I'm high risk to begin with, and even if I wasn't I still wouldn't. Way to many things could go wrong. What if my daughter was born full term, and was a singleton, there is NO WAY a midwife would even know what to do with her! Home birth is for some, and not for others, but it is not for me!
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  #51  
March 28th, 2013, 07:12 AM
MyFantasticFour's Avatar Mommy of 4
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Quote:
Originally Posted by babybatax2 View Post
I am so sorry for your loss Liz! :hugs:

I did not read all the comments, most were lengthy, and I just don't have time to read through!

BUT for me, home birth is not an option. I'm high risk to begin with, and even if I wasn't I still wouldn't. Way to many things could go wrong. What if my daughter was born full term, and was a singleton, there is NO WAY a midwife would even know what to do with her! Home birth is for some, and not for others, but it is not for me!
What do you mean?
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  #52  
March 28th, 2013, 07:23 AM
AIK112018's Avatar Elizabeth
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I read the first page - skipped to reply. I have a migraine and can't spend too much time online these days because it makes it worse...

I am not here to argue. I will say I had a terrible birth experience with my last pregnancy (in hospital) and my doctor has traumatized me. I am doing everything in my power to find a way to have a home birth.

Have any of you ladies ever watched "the business of being born" and "more business of being born"? It is truly an eye opener. I will say this movie did not influence my choice of having a home birth, I had already decided before I watched the movie. Just thought it was something you ladies would be interested in watching. Especially if you live in the US.
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  #53  
March 28th, 2013, 07:54 AM
MyFantasticFour's Avatar Mommy of 4
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Quote:
Originally Posted by AIK112018 View Post
I read the first page - skipped to reply. I have a migraine and can't spend too much time online these days because it makes it worse...

I am not here to argue. I will say I had a terrible birth experience with my last pregnancy (in hospital) and my doctor has traumatized me. I am doing everything in my power to find a way to have a home birth.

Have any of you ladies ever watched "the business of being born" and "more business of being born"? It is truly an eye opener. I will say this movie did not influence my choice of having a home birth, I had already decided before I watched the movie. Just thought it was something you ladies would be interested in watching. Especially if you live in the US.
I can't seem to find More Business of Being Born up on any sites yet but The Business of Being Born is amazing. It didn't really change my opinion but certainly reaffirmed my thoughts on the way birth works in this country.
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  #54  
March 28th, 2013, 09:33 AM
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Honestly, I think arguing statistics is pretty useless. I'm not positive about other countries, but in America homebirths account for less than one percent of all births. No matter what, your statistics will be flawed, when you compare 10 (at best) to 1000, there will be discrepancies, either for or against homebirth.

I think that it's very safe to say that every single woman in this DDC is doing what she thinks is the absolute best for her and her baby. I might disagree with your decisions, and you might disagree with mine, but it's easy to respect another mother, because I know that she's doing what she truly believes is right for her baby. There are risks in both hospital births and homebirths, and I'm sure that each of us have carefully weighed our options before making a decision.
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  #55  
March 28th, 2013, 09:40 AM
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Thanks ladies - My post is only intended to let ppl know that things can go wrong and it is important to be made aware of the good and bad. It is each persons decision to have a home birth. I tell ppl our story because I do not want anyone else to suffer a loss if the loss can be prevented. I believe in my heart that things may have turned out differently if we were somewhere that could facility a c-section.

Our Story:
We decided to go all natural and give birth in a birthing centre. My midwife stated that if there were any issues that I wasn't that far from a hospital and it would only take 20 minutes to get there, but not to worry.
The midwife would not induce me earlier than 41.5 weeks, so That is what we did. I have really bad contractions. One top of another. Once it was time to push, I pushed for 1.5 hours. Our son was suck. THe doctor was called in and he would not use forceps. I was rushed off to another hospital. Which was 20 minutes away. The hospital did an emergency csection, but our son wasn't breathing. According to the doctor our son did not have oxygen for 20 minutes, so he died.
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  #56  
March 28th, 2013, 09:54 AM
babybatax2's Avatar Platinum Supermommy
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Quote:
Originally Posted by MyFantasticFour View Post
What do you mean?
Regarding what?
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  #57  
March 28th, 2013, 11:30 AM
MyFantasticFour's Avatar Mommy of 4
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Quote:
Originally Posted by babybatax2 View Post

Regarding what?
About your daughter and a midwife not knowing what to do? I don't know if I missed a post or anything but I don't know the story.

Quote:
Originally Posted by breathing for two View Post
Honestly, I think arguing statistics is pretty useless. I'm not positive about other countries, but in America homebirths account for less than one percent of all births. No matter what, your statistics will be flawed, when you compare 10 (at best) to 1000, there will be discrepancies, either for or against homebirth.

I think that it's very safe to say that every single woman in this DDC is doing what she thinks is the absolute best for her and her baby. I might disagree with your decisions, and you might disagree with mine, but it's easy to respect another mother, because I know that she's doing what she truly believes is right for her baby. There are risks in both hospital births and homebirths, and I'm sure that each of us have carefully weighed our options before making a decision.
I wholeheartedly agree. I know that my midwife is working on statistics for MANA but I'm fairly certain that her 11 years of success aren't really documented much.
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  #58  
March 28th, 2013, 12:06 PM
babybatax2's Avatar Platinum Supermommy
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My daughter has several birth defects. She wouldn't have been able to breath. She needed CPR and to have a bronchoscopy an then trached immediately. No way a midwife would have been able to determine all that, and I'm not confident she could have gotten to a hospital in time.

I have very little trust in doctors or nurses.

Alls I can say is educate yourself, but know where hospitals are and children's hospitals. A level 3 NICU couldn't even handle my girl. We like to say she's above everyone's pay grade. ;-)
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07/2007 03/2011 01/2012
  #59  
March 28th, 2013, 08:28 PM
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Liz, I'm so sorry to hear about your loss, and I thank you for sharing your story with us. Out of respect for your pain, if you want me to drop this entire conversation, I will, just say the word.

Babybear4, I am going to respond to the points you made in great detail, and in the next post I will respond to the bottom half of Brie's post.

Quote:
Most of the points you are trying to make, though, are based on your own speculations. None of it has been based on fact.
I was very careful to make a clear distinction between what was fact and what was speculation. Perhaps I overdid it and made it sound like everything was speculation. Here are some facts that the data shows:

1) The death rate (deaths per thousand births) for births attended by non-CNM midwifes out side the hospital (1.43) was 2.5 times the death rate fore for births attended by MDs in the hospital (0.57), and 4 times the death rate for births attended by CNMs in the hospital (0.36).
2) The death rate for births attended by CNMs outside of the hospital (0.68) was
1.9 times the death rate for births attended by CNMs inside the hospital.

Quote:
You did intentionally make a misleading statement about what CPM's need, education wise. You stated that all that was required was a HS diploma, when that was untrue and it was disputed in other posts based on the website that you linked.
These are the statements that I made:

"I've heard that some women with only a highschool education are passing themselves off as midwives, when they don't have any ability to deal with complications. "

and

"However, there is a certification out there for mid-wives that have only a high-school education, and I was alarmed when I learned about that."

I did NOT state that "all that was required was a HS diploma", and I further clarified in later posts that a) when I say "only a high school education", I mean that someone has no college degrees, no formal education, above and beyond a high school diploma and b) when I say "only a high school education", I don't mean that the person's knowledge is limited to what they learned in high school. I gave the example of a carpenter who has only a high school education, but knows a lot about how to build houses (or cabinets or chairs or whatever).

So, lets have a careful look at the requirements for a CPM, as posted on the NARM website: http://narm.org/req-updates/. I'm cutting out parts that say things irrelvant to the discussion like "documents must be submitted in such and such a way" and replacing them with dots (....).

"New requirements for PEP-Entry Level applications effective September 1, 2012:
•All applicants will be required to submit evidence of a high school diploma or equivalent.
•All applicants must submit proof of completion of an approved module on cultural competency for health professionals. The online module offered by Georgetown University may be found at: http://nccc.georgetown.edu/features/CCHPA.html

......

NEW requirements for PEP-Entry Level applications effective January 1, 2013
The clinical requirements will be documented in four phases.

Phase 1: Births as an Observer
Document attendance at ten births in any setting, in any capacity
.....

Phase 2: Clinicals as Assistant under Supervision
Document at least 20 births, 25 prenatals (including 3 initial prenatal exams), 20 newborn exams, 10 postpartum visits as an assistant under the supervision of a qualified preceptor.

....

Phase 3: Clinicals as Primary under Supervision
Document 20 births, 75 prenatals (including 20 initial prenatal exams), 20 newborn exams, and 40 postpartum exams as a primary midwife under supervision.

....

Phase 4: Five Additional Births as Primary under Supervision
..."
So, in other words, as long as I have a high school diploma, fill out an online questionaire (took me 10 min; there were no right or wrong answers), attend 55 births in various capacities along with a bunch of other prenatal and postnatal visits, and complete the NARM test (not described above, it is described in their candidate information booklet http://narm.org/wp-content/uploads/2012/06/CIB0612.pdf as a 350 question multiple choice test), then I'm good to go. No need for college level science courses, no need for any formal medical training. If that doesn't fit the definition of "only a high school education", then I don't know what does. I'm not saying that no CPMs have additional training beyond that, I'm just saying that this is their minimum standard.

Quote:
You also totally ignored the entire bottom half of Brie's post which is pretty convenient, considering it almost completely disputed any of the points you had made thus far.
Very well, I'll go ahead and address it in detail after this post.

Quote:
Now, you are grasping at straws trying to convince all of us that these statistics that you gathered from the CDC prove your point when the reality is, is that you are spinning it based on your own assumptions of how or why these situations occurred ....
I find a neonatal death rate with lay midwifes outside hospitals that is 4 times the death rate of CNMs in hospitals to be very disturbing. I don't have to know how or why each individual situation occured to realize some babies died because they were born outside a hospital with a lay midwife who would have survived if they had been born in a hospital with a CNM or an MD.

Quote:
...and, as you already stated, the website doesn't have information on stillbirths or babies born with hypoxic brain injuries. I could speculate that many of the deaths that occurred with other midwives was due to stillbirth or babies born with hypoxic brain injuries and then that blows your entire theory out of the water, since my speculation is just as justified as your own.
No, you can't speculate that, because the definition of neonatal death excludes those. By definition, a still born baby is not a neonatal death because the baby was never born alive. Even if it was alive and healthy when labor started, and died during labor because there was inadequate fetal monitoring and noone realized it's cord was compressed, it is still not considered a neonatal death. By definition, a baby born with a hypoxic brain injury that survives past 27 days is not a neonatal death. That baby might have severe brain damage, and might need lifelong expensive medical care, but it is not a neonatal death. By definition, a baby born with a hypoxic brain injury that does not survive past 27 days is a neonatal death. I am sure you will want proof of these definitions, and I will provide that proof, but it is getting late and I'm not going to do it right now.

Quote:
Not to mention that you, yourself, stated that you don't even KNOW what other midwife actually means.
I do know that someone who is an "other midwife" is not a medical doctor or a certified nurse midwife, because people in those categories are already accounted for. I do know that they are not taxi drivers or people that just happend to be standing nearby, because then they would have been in the category of "Other" rather than "Other Midwife" (this category had an even higher death rate, but I left it out because it seemed irrelevant to the discussion- that may have been a mistake), so I do know that the people in this category identified themselves as midwives. What I don't know is if people in the "other midwife" category are CPMs or simply people who call themselves midwives but have not met the minimum criteria to be a CPM. I don't care if they call themselves CPMs or lay midwives or direct entry midwives or whatever...the point is that they do not have the medical training that an MD or a CNM has, and they are calling themselves midwives, and the death rate for these people attending births outside of the hospital is several times higher than the death rate for MDs or CNMs in the hospital.

Quote:
ETA: Keep in mind that I am saying this from an unbiased perspective. The only personal research I have done thus far is find out what midwives practice in my area, so this is an outside perspective from somebody just reading along. I can see why people are getting frustrated "debating" with you because you are either a.) ignoring their data or b.) spinning things to fit your own opinion, rather than posting unbiased sources that prove your point.
Thankyou, Babybear4, for your comments. I do have limited time, and I have been not responding to things that are a) statements of opinion, or b) statements of facts that are clearly well supported by data, or c) statements that are not supported by data, and that I don't have time to research and dispute right now. Obviously there is no way for anyone to know which category their statement falls in, and I can see how that would be frustrating. As for the need to post information from unbiased sources that prove my point, well, that is what I was trying to do with the CDC data.


Brie, I have run out of time to respond to the second half of your post. I have also run out of time to respond to anyone elses posts.
  #60  
March 28th, 2013, 08:48 PM
Keakie's Avatar Learning to walk in faith
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The ladies you're responding to stated that they have willfully stepped out of this thread out of respect for one of our members. I've chosen to do the same, especially considering you're simply sharing your personal opinion and speculations at this point, and the continued unwarranted and inaccurate criticism of others' birthing choices is getting really old.

I believe it's time to agree to disagree and move on.
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Last edited by Keakie; March 28th, 2013 at 08:55 PM.
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