just the character for him so whereas we've seen some players up on stage so far who seem to have hosts you know three or five characters a bunch of different tools these two are really just running it with set shion and with kung lao yeah and as of right now really two players one character a piece the entire tournament that's rare mind is the legacy of the great kung lao his legacy was dying and defeat cool he lives on is me that was pretty sad okay where's finals of here we go everybody mix of noise foxy has biggest he wants how many times has foxy been in this position oh no what a start and he got no almost got to pick up on the far guys they're so oh my goodness i would have cried to see that much damage on the screen teleports on in but yeah it's kind of a bill right there yeah as long as you react to it just like kung lao and really all of his games and yeah i mean that's not the focus of it right it's got plenty of other very close what a slight duck right there out of dragon oh what a short hop there out of foxy to go over the sneak attack trying to chip it out there it is anything was gonna do it at that point dragon put minus a couple frames on the screen he goes you know what i know what foxy's gonna try here he's gonna try to throw and he was ready to take it for how do you think you do that that's the game plan here david he's gonna try to get things going here ready for the stagger just just a forward for whoa that's the mobility of this character that's part of the strength now here's another part of the strength the giant damage massive damage looking for the falling forward for baby this is gonna be death oh my goodness this is gonna be chip out with z hat are you kidding me that's what i'm talking about the movement into the giant burst now all it takes is one out of there dragon happy to do that try to catch him foxy now has the corner again setting up z hat on the approach yeah great damage is he going for it again well i almost expected him to go for the crushing blow of the double dive kick there i understand one which see look at this pressure here from dragon and no keep up unfortunately for foxy who still has the corner ready again here he goes he was just due to ducking to dragon has such a good scope on what there's going to be a grab we've really seen that so far yeah so prepared we saw what he did to get sonic fox in the way that he was trying to approach the magic kind of shut everything down and same thing here against foxy preparation and dragon is amongst the best if not the best in our scene and exactly that preparation he keeps files of footage just hours and hours and hours and every single character every single player catalogs it does his homework i'd love to slow approach foxy grandpa in order to stay alive it's not quite enough and dragon had an actual understanding of when foxy wanted to try to come in and break away there didn't commit to the geyser which would actually would have gotten the win there didn't want to put himself in a personful situation so smart they're very aware so running it back foxy's winners finals also used to being in the position of being in a final against an american on american soil yeah well that he most certainly he's been here before of course oh wow i think he could have possibly something a little bit quicker there than yeah right more for those lower getting the optimal there his dragon so the simple combos can be really tight here's that slow approach from foxy threatening of course wow he's not going to teleport this is a fresh match so he does have that aerial boulder locked in loaded as a crushing blow oh i love that he used that opportunity to set up z-hat that allowed him to approach and the grab foxy tried to tech just didn't get the right side and they're back to control if that holder sailed through the sky one last breath available any two hits now for dragon uh-oh but it but the bar oh he may be in trouble if foxy finds the right combo here he can just about take it escape failed oh no on that tech not not going to give foxy the 310 crushing blow that he needed for the win there that was a clutch tech out of dragon again drag really keeping his eyes on things and he's done great at navigating those throws oh see what he gets just some space here and again using that opportunity to set up z-hat very cool pick up he's gonna go for it anyway still massive damage on that crushing blow even to begin with bigger than any combo that she has huge speaking of big damage into the knockdown here's the grab he needs a little bit more slowly approaches here foxy trying to move into the corner here he goes oh he just did it again just one one one just keep throwing it baby if you amplify that you can hold it for a little while you can let it go at various times i like the idea behind that didn't work out to try to throw off this time it's really a nightmare i mean because even if stan weren't an entire the conversion would it could have been just to understand one so no matter what i think dragon had that once the hat was down wow is dragon looking good two oh now winners finals to make grand finals to give him a nice cushion potentially for later on that's right now we're back into it it's still kung lao so there definitely been moments where i've liked what foxy's done okay chooses not to amplify there but i would say dragon has just looked so prepared his throw techs have been great how well just that and ducking his combo choices have been great his choices have went to you know sort of zone out as projectiles that's all been great those were not the throw the projectiles went for the approaches that teleports he's been ready for almost everything that foxy has thrown at him and but wake up jump is this calling card against some of these as well back to this controller or trying to be at least no keep up ready on tech yet again i don't think kung lao can do anything about that hell's rat on blog one of the people you know not many characters or there are a lot of characters that have punishments yeah i don't think one of them yeah kung lao just kind of screwed there just just just needs to use those negative frames to try to close the gap frame just like that you put in a punishable position z hat set up super plus again that's not close try it out no dice i'm sensing a little bit of desperation and that was gonna be it so many hold on hold on i'm definitely it oh my of course what else would it be other than grabbing that situation yeah i'm looking for the throw so match point dragon round two fight box trying to make that slow approach as we have seen walk and block walk and block and take up a little bit of session on time as well does not want it to be easy for her to just control oh so smart that's a crush i love that movement choice you guys see the breakaway now we're gonna punish on a spin relatively quick recovery on that now comes dragon just backs off oh yeah looking for the whole run right there and we can leave it's almost like against sonic fox when he's this comfortable none afraid to teleport in just to change things up that's right we've seen it a few times here against fox that was his first time going for throw off of ampli tn i believe the entire set dragon ready for the forward board ready for the throw it's anything that you're mixing yourself when you're trying to mix right right that's the worst-case scenario for a mix up dragon back to controlling things and he really sort of says foxy looking for what to do how does he get in how does he make such round worry about him from before how does he make her worry about his approach either one has really worked and when point dragon still and when you're you know primary source of damage mix up throat just isn't working what do you do what's the fault okay wait a minute you're gonna take this round with the fatal blow very prepared got a build on this one it's a DC the reactionary fatal blow goes very far the start-ups kind of slow and then he just kicks across the screen final round fight there's the boulder never know i love that hopper the far just makes that sure that you can consider not to do things not easy i know are you there oh my goodness pull out the galaxy brand call out from dragon to control that exact spot on stage dismantling another dimension in player 79 day but i can't even describe it you've seen so many buttons after that this time dragon was not worried about it here he is on the keep up sometimes risk is a very good tool to use against someone that is so good at walking your staggers and taking their turn huge one more set up and there's not going to be oh there's still not any defensive bar but dragon just almost ready to hit a block obviously not going to kill but he'll be able to control the stage after this and that's really what he wants i think this is really smart because this is not a fatal blow that's a you're gonna win or die by just just just throwing it this is where he dies right here though this screen control no no she will teleport at some point he knows it he doesn't want to overcome it there it is


Hi everyone, Joe for Jaspy's casebreaks.com coming at you with a fun one here. I think 2022 leaf exotic Multisport. It's a random hit break so this is gonna feature a lot of a Everything's numbered to ten or less and every card is animal print themed zebra peacock Tiger snakeskin parrot cheetah crocodile and a lot more. So it should be pretty fun It's also a random hit break. You are guaranteed You're guaranteed a hit So what we're gonna do is we're gonna open up the case select which half or it's a 20 box case We're gonna select which half we're gonna do we're gonna open up the boxes or yeah open up the boxes Type in the hits and then randomize the names and randomize the hits and see what you get wrap matched up with Also, we had a special little deal going on here a one-spot giveaway for the last three spots purchased Here were the last three spots. Let's do a randomizer here Let's see who's gonna win that final spot the one and three chance great odds here after ten top name after ten Kings just scored nice one two three four five And another five ten the hard way six seven eight nine and tenth and final time after ten Nancy congrats to you after ten you get an extra spot That makes ten spots total Now it can copy your names here And we're gonna do that randomizer in just a moment. Let's flip back to this screen and Let's pop this fresh case open there it is Exotic see which ten boxes we're going to do. Let's open from from here. Let's flip those over there So we got ten on the left side and ten on the right side We'll go one two three for the left side four five six for the right side And it's two so it's going to do the left side this side we will We'll save for Break two which is already loaded up in the store now. It's kind of hard to see but you'll know that there's that thin purple pen It's marked to so we know it's on the same case I know I did that because we don't have any more exotic in the shot. It's just this All right, we'll set that over there All right, and we'll just type the hits in the order that that they were that they were pulled What makes it worse row we're talking about fries customers just before sorry this video or fries employees not getting paid Or not being paid correctly because it's a new payroll system. It's a lot of Kroger stories in general, too What makes it works Kroger's are direct deposit only strong with that You actually want to check Rex? It's 2022 All right first exotic hit is Yarmira Yager Looks pretty cool the snakeskin in the background I'm assuming all the different animal prints are different numbers. We'll just we'll find out and I couldn't sign up for direct deposit fast enough And we've got Coworkin, Jr. Another snakeskin to 10. Oh, yeah, and these are all 10 and less right the snakeskins are all out of 10 We got a what is that a butterfly print? There's Jack Lider Maybe a monarch butterfly Three out of four someone's getting a train whistle there next up is Is Jason Taylor? That's a that's a parrot print probably a macaw four out of Six pretty cool I'm liking this the second half in the store Guaranteed it and no randomizers if you get if you get a duel next up snakeskin Kenny pick it four out of ten No, Peter will not like this break. They're not a pen. So although it says on the back of the box No animals were harmed in the creation of this product. So I can't get too mad. Oh snakeskin Gareth Bale whales Four out of ten. I think some people were speculating is this Gareth Bale's last World Cup whales was bounced out of the tournament. I think I think he suggested that He'll go as his as long as his body will allow him He's like qualifying starts again in March. I'll be ready. All right. We got more snakeskin Joe Montana two out of ten snakeskin Jimmy Johnson hair perfectly in place three out of ten Two more to go and then we'll pause the video and we'll type in all the hits will come back with a randomizer We got a tiger print Haley Deegan five out of ten The race car driver, I think she's in truck series now So I don't know I get to get a maker way to to I was gonna say bush, but that was a long time ago Xfinity series And maybe a cup car someday All right 10th and final second half in the store if you want to run this back to ask these case breaks.com It's a quick fun easy little break. We got zebra print. That's a kabebe and And that last name All right, we're gonna pause the video when we come back. We'll have the hits all typed in We'll run the randomizer and we'll find out. We'll see who gets what stick around. We'll see you on the other side Hi, welcome back everybody. So as you can see right here, we got the hits all typed in You got your names right here You got your new dice right there. Let's roll it. Let's randomize names and hits Three and a four seven times Your names first one two three four five six and seventh and final time Got Anthony down to Anthony three and a four seven times For the hits good luck one two three four five six and seventh and final time good luck There's the Gareth Bale. There's the Jason Taylor top and bottom and Here's how it works out for everyone Anthony with the Gareth Bale probably one of the the greatest Welsh soccer players of all time He's here in LA now a place for LAFC Nancy with the Haley Deegan tiger John with the Jimmy Johnson snake Chad with the Joe Montana and Kenny Pickett snakeskin parallels Nancy with the Yarmier Jagger Chad with the Jack Leiter three out of four and all aboard the Big Hit Express Nice that butterfly a plant look print it looks really cool And the Khabib Zebra to nine Ed with the Cal Ripken six out of ten and Anthony with the Jason Taylor parrot parallel four out of six Very nice, and there you go ladies and gentlemen second half is in the store if you want to run it back I think it looks pretty cool, and I think I overheard Jason talking about like Crocodile parallels turtle parallels a lot of other animals that are that are in the mix So thanks for watching. Thanks for breaking with us, and I'll see you next time for the next exotic break. Bye. Bye


Puff goes from extremely animated to almost a statue again. When the question comes up, it doesn't really get to a question. He just talks about an interview and he sees it coming. Now, it was the documentary that claimed, which we know wasn't true. Yeah, yeah, Chesa, we don't talk about things that are nonsense. And so he tries to shut that down. And we see him get really quiet. He pulls that mic up. He scoots down a little bit. And he takes his pen and he starts pushing it into his face. And that's one way we get rid of built up stress and tension. That's another way to pacify yourself. And he starts chaffing and redirecting and ends up talking about God's mission that God wants him to do. He starts talking about how he's changed and how things are different. He gets these specifics of what a great guy is now. But he used to be not a great guy. So that that to me right there says a whole lot when we see and hear all that.


Hello, hello everybody. Welcome back to my channel and welcome to another podcast episode. We're on episode eight now, which is kind of wild. Isn't that wild? I feel like I started this little series, whatever you want to call this. I don't even really know what this is yet. I don't know if I ever will, but I started it just thinking it would be like a fun little thing that I would talk about stupid little silly things, whatever came to mind. And I don't know, something flipped in my brain within the last couple episodes where I'm just like, I have so much that I want to share and do and tell you guys.  It's stuff that kind of changed my life and changed the way that I view life, the way I view myself, the way I view those around me. And I don't know if this is just what happens when you get into your late 20s, if something just flips in your brain or I don't know, but I really do have a heart to just, I don't know, share these things with you guys. But of course, I always wanted to just be like a casual hangout. So we're just gonna sit and we're gonna just hang out for the next however many minutes. And we're just gonna talk about some things. So let me get comfortable. I side note I had to paint something a spot on my wall today. And I was taking the can of paint out of my closet and I was wearing shorts. And somehow with a can of paint, managed to break open the skin on my knee. And now I have a cut on my knee and it hurts. So anyway, ignore me. I don't know why I felt the need to share that. But like I said, we're just chatting. So this episode titled I think I'm gonna call it like it's glow up season or something cheesy like that. But this episode started in my brain as a silly little TikTok that I made. Now I don't TikTok like too seriously, I just think it's fun.  So I made a TikTok last week that was like, if any of you are on TikTok, you probably know the sound that like went viral. And it's like, Oh my goodness, I love this question. I think that one. And people were getting super, super creative with it. So I was like, I want to make one. And I think I wrote like, as the question that I love being asked, like, how did you fall in love with yourself again and just like, give your life a glow up inside and out? And I didn't really think anything of it. I mean, yes, it's true. And I feel like I have been trying to do that. And I have done that. But I just didn't think anything of it. I just posted it. And then I got a message or two being like, yeah, so like, how did you do that? And I was like, okay, yeah, we can talk about this. And it's funny because I knew that there were things. But when I sat down to write my notes, because you guys know I always write notes, when I sat down to write the notes, I was like, wait, like what did I do? Like it took me a second to really sit back and think about, okay, what did I actually actually try to like actively do and change in my life that changed my mindset that changed my attitude that changed my heart. And so I finally came up with things, I think I have a list of like 10 or 11 things. And I would love to come on here and just sit and speak freely without any notes. I am just like, simply not gifted enough for that, like I can't, I can't do that. I will start rambling, I will trail off, I will, like I just need a plan. So I will be looking down at my notes at my phone. But yeah, I have just 10 or 11 things that I have changed. This is not me saying that you have to do any of these things. I feel like I always make this kind of disclaimer. I'm not saying you have to do any of these things in particular or do these things the way that I did them. But if you are curious of how I have just like found such joy in life and such like happiness and I feel so lighthearted and I have a lot of hope for the future. These are some of the things that helped me to do that. And if you watched the vlog that I just posted before this video, I said that I am in just this era of if I don't like something about my life, I have the power to change it. No one else can change it for me. And so like, for example, I don't like how crooked my bottom teeth are. So now I'm going to get that fixed.  Now that's something, braces is different. Not everybody can do that. And I feel very like blessed that I can do that. But it's just just just an example. But I am very much in the era of like, if there's something I don't like about my life, I'm going to change it. I'm only going to be in my 20s once. I only get to live once. So if I'm not enjoying it, what am I doing? Right? So that's kind of, that's that's the era I'm in. It's up to me. No one's going to do it for me. Here are some of the things that I implemented in my life to get to where I am now, I guess. Okay, so number one, and these are really in no particular order, but I tried to like get them to all relate to each other as we go. So the very first thing that I have implemented, and I actually started this, like late December, but I have like really taken it to heart now. And it's that I keep my notifications silenced on my phone for the first hour that I'm awake. That's not to say, like if I wake up and I have a text from my mom, I won't answer it. Or if I have a text from, you know, my best friends and I say good morning to each other every morning, like I do all that, that's not what I'm saying. But like, I'm not going to go scroll through Instagram. I'm not going to scroll through TikTok. I'm not that's not that's not how I want to start my day, whether we know it or not. Consuming like what we consume is what stays in our minds throughout the day. And if that's how you're starting your day, social media can be a really chaotic thing. It's just notification and notification and pictures and words and, and sounds and music. And it's a lot. It's a lot. It's very stimulating. And I think we don't realize it anymore because we're so used to it now. But starting your day off like that chaotic for me, it was just, it was just too much. So for me, this personal preference, this is what I do. This is my routine. As you guys have seen, I wake up and that first hour is reserved for me and the Lord. Now not every single day looks the same. If I have a really early appointment, let's say I'm going to wake up, brush my teeth and go out the door.  But nine times out of 10, it is. And it just having that like peace in my head in my mind to start my day, it just, it changes the rest of my day. Like those notifications on Instagram, that Instagram reel that my cousin sent me because my cousins and I, we send a lot of reels back and forth. That reel that my cousin sent me will still be there in an hour. That notification on TikTok will be there in an hour. It just, it's just what works for me. So I try my best. The first hour, I really like I keep my phone on do not disturb. I have a bunch of different like do not disturb settings that I use for different things. I will keep my phone on do not disturb. But even after that, like usually the next thing I'll do, because this is just how my routine works is the next thing I'll do is go and get on the treadmill. So I try to like keep my mornings super productive. And then I try not to go really on social media until after 12 p.m. So afternoon, then I'm like, okay, now I'm free to scroll, check the things, see what everybody's up to, because those things will still be there. They'll be there. But to just consume myself with all that like as soon as I open my eyes has proven to me to be beneficial. So that's the first thing I did. And again, like I said, I started that back in December, but I feel like even more so now I see like why I'm doing it and how like the difference that it makes in my life. So that's the first thing. Number two is kind of this very much relates to social media and the topic of social media is I unfollowed muted unfriended. What else unfollow block mute unfriend anyone or anything that disrupted my peace. If there was an influencer that I was following that I constantly kept comparing myself to got to go. That's something that I struggle with. Not everybody is like that. I personally struggle with comparison people online. And there are there are reasons for that. I know why that that is in my in my life in my mind. And that's where my mind goes like to instantly compare myself to somebody else. We're working on it. We're working on it. But in the meantime, I'm not going to subject myself to that. If there is someone there was actually I shouldn't name names, but there were two very famous content creators on Tik Tok that and this is not me saying that they're bad people at all. It was just I had to be I had to be cautious of what I was taking in. It was a lot of just like like complaining a lot of a lot of like nasty vocabulary, just a lot. And I used to love listening to them. They made me laugh. I was just interested in their life and what was going on and what was their latest dilemma, the latest drama in their life because it's entertaining, right?  We're human.  That's that's why they're famous. That's why they get all these followers. They're good at what they do. And honestly, they're making a life for themselves. And I think that's so respectable. But for me, it was just it was just not sitting well in my spirit. It made me feel very heavy. And so I just removed all those people every time I got like a little nudge in me to be like, I don't think that makes you feel good. I didn't even second guess it. I was like, okay, delete, unfollow. These are also people that I've never even met in my life and that I will probably never meet. So like, what does it really matter, you know? So anything that made me self conscious anything that made me sad or anything that was a reminder of something that I didn't want to think about gone. And it can be a little weird and it could feel wrong when it's someone that you know personally someone that you've met or maybe someone you went to school with or maybe someone that you met through someone else or whatever the situation is. It can feel weird. In those situations, maybe like there were a couple that I didn't necessarily unfollow, because it felt unfriendly. But I'll just mute. I don't need to you know, I don't need to see your story, you know, like things like they're always they're always different ways to go about it. And I don't think it is a disrespectful thing. Of course, every situation is different. But I don't think it is a disrespectful thing. I think it's just about protecting your peace. And another thing too, from a Chris Christian aspect, for me was now I am following a lot of Christian influencers who share positivity, who share scripture, who you know, who post like prayers for their followers in the morning, like different things. And that like, it invites peace. And I think and this is just a little tangent, I wasn't planning on talking about this. But I think another way that that's helped me too is that sometimes I feel very alone in my Christianity just because I don't have too too many people in my life that are walking that same journey that I am. And it can feel very isolating. And it almost kind of makes you feel like you're we you're not weird, but you are the different one. You are, it's very isolating. And surrounding my for you page and my what's the Instagram version explore page and my feed on Instagram surrounding myself with that extra Christian content. It makes me feel like you're not weird.  It's a different walk than everybody else. And that's okay. So really make your for you page and everything that you're consuming make it benefit you.  I don't look like him. Or I don't have a car like that or I don't have an apartment like that unfollow. I saw something the other day I'm going on a lot of tangents. I'm only on point to I saw something the other day on TikTok or Instagram. I don't remember, but it was a real and it was it said social media is designed to make you think that you should be somewhere else with someone else doing something else. It always is going to make you crave some sort of happiness from something that you don't have. And if you're constantly chasing that happiness, that happiness is never going to be within you. You're never going to really have it. So the instant that social media starts to make you feel like that, take a step back or just really look at who and what you're following. I didn't expect to take so long on that point, but it made a really big difference in my life. The next thing is I brought in counseling or therapy into my life. And I know that there's a big stigma around therapy. A lot of people see therapy as being weak. A lot of people are not good at asking for help for a long time. I wasn't, I kept everything in here and in here. Like I didn't even tell friends and family certain things. I just kept it all in here because I didn't know how to ask for help because I didn't want to admit that I needed to help or that something was maybe wrong. And I honestly think that learning how to ask for help is a really strong thing to do. And I always say this and I'm joking when I say it, but I'm also really not joking. I always say that the world would be such a better place if everyone got just a little bit of therapy. And when I say everyone, I mean everyone. Not to say that you have to be in therapy your whole life, but if everyone just got like a month of therapy right now, I honestly to God believe that this world would be a better place. I do. Because we all have things from our past that stay with us. Every single one of us do. Whether it's from childhood, whether it's something that maybe you went through in high school, whatever it is, we literally all have those things. And my, the pastor of the church that I've been going to recently this past Sunday, he said something that really like stuck with me. He was like, if you don't transform it, you're going to transmit it. If there's something in you that you are not dealing with, you're going to deflect it on others. So for example, after my last relationship, I learned, okay, one, maybe I don't really know how to be in a relationship properly because there was a lot about that relationship that wasn't, that was kind of toxic on both sides. I also lost my ability to trust and blah, blah, blah, x, y, z. And I really sat down and I was like, if I don't fix this, my next relationship is going to be a disaster. So I sat down and I put in the work and I'm not saying I went to therapy just for relationships. I went just to become a better person to be a stronger person to get to know myself, have more self awareness. It's just so important. I like can't stress it enough. I just every the first session is always weird. It always feels weird. I remember I was shaking before my first one. I cried during my first one. It was just a lot. It was a lot. The first one's the hardest. And then after that, once you get to know your therapist too better and you become more comfortable with each other, it just gets so much better. And it just comes out like word vomit and you're like, I have so much I want to tell you and so much I want to talk to you about. So that's the third thing I did. And it made a huge difference. And I'm still doing it. And yeah, I can't recommend it enough. So it doesn't make you weak. I think it makes you pretty strong actually. The next one, this is just like a personal thing. I do something I learned and I'm not going to talk about it too much. But the next one is if you want, if you're craving the presence of people in your life more, if you want to hang out with your friends more, if you're feeling a little lonely, don't wait for people to invite you out. You can invite people out and that sounds so dumb. And you're probably like, yes, duh, like it's a two way street. But I realized that for a long time, I was kind of relying on people to invite me to lunch or invite me out or or make plans with me. And I don't know where that comes from. I don't know if I felt like a deep sense of like, oh, I'm going to be bothering them if I asked them to hang out with me. I don't know where that comes from. Now that I think about it, something to talk about therapy, just kidding, not really. But I've kind of taken it upon myself. I'm like, if you want to have people over, if you want to host people in your home, because lately my apartment's been feeling a little quiet, a little lonely. And I love my alone time, don't get me wrong. But like, I miss having people here. It's been a while. I was like, okay. So let me invite people over. So now in October, for example, I two Saturdays back to back, I'm hosting two different groups of people. But I'm excited about it.  I'm talking skincare routine. I'm talking about lighting a candle just to watch Netflix on a Tuesday night.  And I think, honestly, I think YouTube helps me with that. If I'm being 100% honest, like making these videos, making morning routines, making, you know, but even on days where I don't film it, I still do the same things because that's like my, that's my routine now. If like this past Saturday, I stayed in, you saw it on the blog, I stayed in for the first time in a very long time by myself on a Saturday night, made myself dinner, lit a candle, watched a movie, read before bed and was in bed by like 12 31 o'clock on a Saturday. And it was so nice. And I woke up the next morning feeling so refreshed. So romanticizing my self care, honestly has been top tier. And it like really makes you feel like you're like, you're that girl, like you are that girl that does those things, you know, and like really takes care of yourself.  Yes, I didn't used to floss every day, sue me, I'm sure some of you don't either. So don't, you know, don't judge me. Um, but just prioritizing your self care. And it really helps you to do it more often when you romanticize it. So that was a big one for me. The next one is pretty straightforward. I made my home my sanctuary.  When you're sad, you're going home to your home. When you're happy, you're going home to your home. When you want to hang out with people in your home, you're going to your home. That is your that is your like, what's the word I'm looking for? That is your like home base lack of a better word like that is your that's your spot. And whatever that looks like for you for me personally, making this place my sanctuary is making sure that it looks nice, having a nice aesthetic that I like, having my little fireplace, my little electric fireplace in the corner, having my fake olive tree in the corner, you know, getting I got a brand new mirror that I haven't shown you guys yet in my living room that I am obsessed with. And I look at it all the time and I love it. Like that's making my home my sanctuary for me. That could look different for you. But just make it a place that you love to come home to. Like I come home and I look at things and I'm like, oh, it looks so nice in here. Oh, it smells so nice in here. I got my little air wick plugins. Make your own your sanctuary. That's one of my favorite ones too, because it's fun. It's fun to do. I want to like restain and recolor my kitchen cabinets and I'm getting new bookshelves in here. And yes, it all takes money. That's why you do a little by little by little by little unless you got it like that, then props to you. But your girl doesn't so little by little. But it just it makes a difference, man. I love coming home. And I think that's really important because not everyone can say that I genuinely love coming home. And I think that that's important. The next thing I did to have my little glow up. And this is more of a mental thing. Like none of this I hope you notice when I say glow up. I really don't. I don't mean like physical. I really don't. I mean like mental, emotional, spiritual glow up. That's what this video is. I should have said that in the beginning, but saying it now. This one is definitely a big mental one. I replaced old memories with new ones. And a lot of times, you know, I'm sure we've all been there. We're like, oh, you don't want to go eat at that place because that reminds you of someone that's no longer in your life anymore, whether it be a friend because I have people that I used to be friends with that I no longer talk to. It could be our relationship. It can be an X where you're like, I don't want to think of that person. So I don't want to go there. And I think that's normal in the beginning. But at a certain point, I think it becomes important to replace those old memories with new ones with new people so that the next time you think of that restaurant, I'm just using that as an example.  Does that make sense? And I actually learned that from Lily, Lily whispers in the ASMR community. I learned that from her when I was like 13. She said that in a video once probably, she probably didn't even think anything of it when she said it. I have never forgot it. Okay. Fun fact. I have never forgotten that she said replace your old memories with new ones. So let's say, for example, you and your ex went for a walk in that park a lot. And now every time you pass by it, you're like, uh, you know, because those are the last memories you have there. Go take your friends there and have a picnic. Create new memories in place of the old ones so that you don't shy away from places or things because you don't want to think of whatever it is you don't want to think about. Replace it with something new. Replace it with happier, happier memories. Don't just shy away from places because you don't want to deal with it. And that really changes, it changes your mentality. It just makes you more, it's just uplifting to think about it that way and have more, the more like loving and happy memories you have, just the more uplifting I feel like it is or makes you, makes you feel a big thing. This is a big thing. I have three, three more points. This one is so broad, but it might be one of the biggest ones on here. And I have really learned to change my mindset in everything. So it could be something big and it could be something small. For example, we all have that thought of, oh, I really don't want to go to work today. Change your mindset to say, I'm so happy I have a job. I really don't want to make my bed or I really don't want to scrub my bathroom clean right now. I'm so grateful that I have a bed to sleep in. I'm so grateful that I have a home to take care of or I don't really like, I don't like that food. I don't want to eat it. Thank you God that I have food because there are a lot of people in the world that don't. And this is easier said than done. We're all human. We all have things that we want to complain about every day. It just is, it is just is what it is. That's how we are as people. This really comes with like checking yourself. Like it didn't come easily to me at first where a lot of times I would think like, oh, I don't want to do this. And then I have to check myself and be like, Sam, no, think about it like this. It takes a while. You kind of have to like train your mind, but it just like, it just really like not to reiterate what I kept saying before at the last point, but it really just like uplifts you. And there are some days that it's going to be harder than others. But like today, I was feeling a little sluggish this morning. I actually I'm off today. So I got off from work. So I was feeling very sluggish. My morning was a lot slower. And I was like, I don't want to read the Bible. I don't really want to pray right now. I'm being 100% honest with you. I just do some days you just don't feel it. And I changed my mentality. And I said, Sam, you have a you should be you should feel lucky that you have a Bible that you are able to own one where some people in other parts of the world aren't allowed to you have a freedom of religion, you could do whatever you want. Be thankful for that. And as soon as I said that to myself, I was like, well, okay, yeah, that's that's that is correct. So just changing your mindset, it makes you more of a grateful person. It makes you more of a generous person. And I just think if everyone adopted that mentality a little bit, again, just like the therapy thing, I think that the world would be a better place. And I think society would be much more friendly and not as like cutthroat. Everybody wants to fight each other. So yeah, just changing your mindset. And also like, I have been trying to change my heart to be like more patient with people. And more loving, like I just want to love on everybody. Like I never used to be like that before. But like this past weekend, Saturday, I was running errands and like, I just wanted to start up a conversation with the guy that worked at the post office. We started talking about the weather. I never used to be like that.  And so I changed my mentality where like, maybe some of you can relate maybe sometimes you're you're at work and a coworker comes up to you and you're like, I don't really want to talk to you right now. Like, you know, that I've been telling myself, you know what, no, put the phone down, stop looking at the computer for a second and talk to them. They came over because they want to talk to you and say hi, have a conversation with them, make them feel seen, make them feel like you want to talk to them, make them feel wanted. And so I have just really been, this is what I tell myself all the time.  And once you start thinking like that, where you're like, I know how much God loves me. God loves him or her the same amount. So I want to honor that person. Because by doing by honoring that person, I'm honoring God. Once you started doing that, you're just like, Oh, wow, I want to kind of like love everybody. I'll tell you a funny story. I like two or three weeks ago, I went on a date with a first date with someone. And I knew very early on in the date that this just we just weren't a good match. Not a bad person at all. I just knew that that there wasn't going to be a second date. The very next day, I told him very nicely that there wouldn't be a second date. But the way I went about it, I really like prayed about it.  This guy is your child, whether he knows it or not, whether he has a close relationship with you or not. You love him. And I don't want to be mean to him. I don't want to ghost him. I have made a pact to never go somebody again, because I have been ghosted. I think it's disrespectful. I think it's immature. I think, whatever, I could go into ghosting that kind of a whole conversation about that. But I won't right now. And I have ghosted in the past. I'm not going to sit here and say I never have. It's the easy way out. I have done it. I get it. I get why people do it. I have made a pact to never do that again, because I know how it feels. So I don't want to make somebody else feel that way. So this guy, I sent him a really, really nice text. I validated him. I thanked him again for the date.  Maybe the person that you don't want to see anymore isn't a sweet, genuine person, but it differs situation to situation. But I just straight up was like, personally, I just don't think we're a great fit. But I wish you all the luck in the world and take care of whatever smiley face. I made it such so, so nice and sweet. And he really appreciated the honesty that I did that. And then I wasn't trying to like string him along. So that just, that's just one example, but like really just seeing the people around me as God's children, whether they have a close relationship with him or not, it doesn't matter. It doesn't matter because God, God loves everybody the same case you didn't know that. So that's how I like try to see people now. And it really, it helps. It helps with like road rage situations. It helps with just any situation. It just, and then that makes me feel peaceful because I'm not getting all riled up and annoyed at somebody, you know, so changing my mindset. The next one is going to be different for everybody. As far as how you, how you could do this, but I have learned to just fill my spirit with joy. Whatever that looks like to you, for me, it's having fellowship in my life, inviting people over, hosting people. I, as I've expressed with you guys before, I have joined a new church in this actual this coming weekend. I'm actually volunteering for the first time and possibly joining the staff, not as a paid person, but as a volunteer. And I'm meeting people and I'm, you know, I'm in the process of building a like-minded community of Christians around me where I felt like I was lacking there a little bit. So all of that fills me with joy. So find whatever fills you with joy, whether it's a person, whether it's a place, whether it's an activity, just find what fills you with joy and then put as much of that into your life as you can. And for me to finding joy has been, and again, this is, this may not be for you, but for me, I get a lot of joy from reading the Bible because I am learning what God says about me. Because what he says about me is what matters. What other people say about me, I could care less at this point. What he says about me matters. That gives me confidence. That gives me joy. That gives me peace. So whatever that looks like for you, I encourage you to seek that as hard as you can and implement as much of it into your life as you can. And the last thing I want to end on this. I don't want to talk about it too much. I don't want to get into a tangent because I actually want that this topic to be our next podcast episode. But it's don't seek fulfillment or validation in people or things. And we're all guilty of this, especially just as in the society that we live in now. We're so consumed with like numbers. How many likes did I get on Instagram? Oh, this selfie didn't get as much as this one. Does that mean that I look bad in this picture? What does that mean? What are people saying about what I'm posting? Or jumping from relationship to relationship because you feel the need to fill somebody or no, you feel the need to fill that void that somebody can fill. That's what I meant. Or feeling like you need constant validation from a guy or girl or multiple at the same time because it makes you feel good. That stuff feels good for a second. But in the long run, it really when you think about it, it means nothing because that means again, it's like chasing happiness, right? You could keep chasing it and chasing it and chasing it until you can't anymore. But if you're if you're chasing something, that means you don't have it, right? So if you're constantly chasing it, you're constantly saying that you don't have it within you. It has to come from within you. And for me, the way that I get that into me is through the word word. That's a different podcast episode. But just don't seek validation, affirmation, fulfillment in things because things are temporary. What's in you is what's going to stay with you. And that's what matters. So I'm at a point now where I, I feel like I used to be so consumed with the idea of like, oh, am I going to marry? I'm getting older. Like, who am I going to marry? Who am I going to date? Like I used to be, and I still do think about it a lot, but not as much as I used to. I feel like I used to be like obsessed with it. And I felt like my parents are like, I want grandkids. You know, and it's, it's a pressure that I know a lot of us experience. But at the same time, now I'm just like, I needed to get right with myself first. And now I'm at a point where I'm like, I'm so content with who I am. I know like what I bring to the table.  You know, like, it just, it has to come from within me. And yeah, social media is fun, the likes are fun and whatever. But that can't be the end all be all. Does that make sense? I would like to expand on that one in a future episode. I feel like I talked a lot. I went on many tangents. But those are just some things that I have implemented in my life that have made all the difference. I'm sure there are things that I'm missing. But that's just a little starting point. So anyway, that is going to be it for today. I hope that you guys enjoyed. I hope that you took a little something away from this. I look forward to reading your comments down below. And as always, thank you so much for being here. And I will see you guys in my next episode very soon. Bye guys.


And now, into the session we are waiting for. I'd like to introduce the speaker for the day, Royzin Lenon. She's going to make a presentation entitled, Changing the Face of Mid-Be Free Care Through Advanced Practice in 21st Century Island.  Currently, living and working in Ireland as a registered advanced midwife practitioner, but worked in Scotland as a midwife for many years. Privileged to be a midwife and part of so many families pregnancy journey. Special interest in aromatherapy and reflexology and post-dates, pregnancy treatments and she's also an IBCLC that's lactation consultant. She's been involved in many audits and research projects and have been, have had a few articles published. Currently learning Spanish to keep the brain active with the hope of being able to travel again and put the lessons to good use. Royzin, you're most welcome. Thank you, Carol, and thanks for that lovely introduction. And thank you, everybody. And thanks for the opportunity for speaking today. It's a great privilege to be part of this great international day of the midwife.  I know the theme for this conference is birth equity for all. And starting on my first bit, I like to think that part of my role is to empower women on their journey to motherhood. And within that, I love this Michelle O'Don't phrase, to change the world. We must first change the way the babies are being born. And currently in Ireland we're on a big, big change into rolling out midwifery-led care and expanding the whole service because up to now it's kind of been an obstetric model with a small input to midwifery care. So it's exciting times in Ireland. And she's given us the title and that's just the hospital where I work. So I'd like to say that I have no conflicts of interest. I would also like to apologize if I am not totally gender inclusive and I talk about females and not the pregnant person. To be fair, at the moment all the ladies that have been through my service do identify as females, but I do know that that's not always a case around the word. So I hope I don't offend anybody. This study that I'm going to talk to you about is part of my yearly key performance indicator that I have to do within the hospital to show what the outcomes are of the ladies that come through my service. And I've drilled down it further just to benchmark it against the Cochrane Data Review of 2016, looking at continuity care for midwifery models. So just to benchmark it against something that's been out there before and to see where I'm going along in that pathway. For those that don't know Sligo or Ireland, Sligo is on the Northwest. If you're into English literature, it is WB8 has done a lot of his writings here in his poems and we have been in a lockdown no more than the rest of the world and limited to five kilometres since Christmas. It's just extended to county level and we've been very blessed in that within our 5K we have this wonderful walk that you walk through some woods up a little hill, well, decent enough hill and you're looking out over Balasadir Bay, Sligo Bay and out to the Atlantic Ocean. So it's been a walk that I've done with my husband and my poor fourth year student and daughter who has been home from Glasgow for the last year at the table. So we've been very lucky. So if you ever do get a chance to come and visit Sligo, it rains a lot, but it is some fantastic scenery and some beautiful beaches. So to put where I am in perspective, advanced practice around the world is very different.  So my service is based on local service needs. Advanced practice in Ireland being nursing and midwifery has to take a complete episode of care from admission to discharge and the whole idea is that you're promoting wellness, healthcare choices and you work within a specific caseload that has agreed inclusion criteria. You have clinical guidelines or other policies to govern your practice And what you're doing is that you're working within the free philosophy of care, but at an advanced level, using advanced clinical knowledge, critical thinking and decision-making abilities. And that's all based within codes of conduct from the nursing and midwifery board of Ireland. And then that's just the flavor. It's two years minimum post-graduation, educated to a master's degree. You have to get 500 supervised clinical hours within your area that you're going to be working at the advanced level. You have a medication prescriptive authority. So within my practice, I've a big list of drugs that I can prescribe, which really covers all eventualities of the ladies coming to my caseload. And for advanced nurses, they have to have ionizing radiation prescribing as well. Now, when I went to register, I know it was questioned and they did ask what I, you know, why didn't I have that? But I have to say as a midwife, even as an advanced midwife practitioner, if any of my ladies are needing to get an X-ray or to go through a CT machine or an MRI, they're needing even more input than an obstetrician. So I just feel that, no, that is definitely totally outside it. So I don't have that. So there's five domains that govern advanced practice. And these are the same five domains that are set down for the registered general nurse and registered midwife, but it's just at the extra level of care and autonomy that's the extent of scope of practice. So within the respect for the dignity, the person is you're looking at the self-determination of the individual, that your care is in partnership with the woman. Again, like your professional responsibility is like no other codes, it's same codes around the world that you're responsible for your actions, inactions and emissions. Your quality of practice is to be safe, quality, cost-effective service and demonstrating leadership within that practice. The trust and confidentiality rolls out, the service users, the maternity team and the advanced midwife practitioner working as the link and the patient advocate between all members of the team and the other specialties. And then collaboration with others, basically for the goal that we want is that we've got a good outcome for a moment, baby. Taking into that then within your job description which you develop to suit and reflect what your advanced practice is, there's six core concepts. And they're as detailed before and to put it into context with me, I work within the midwifery philosophy of care. Advanced practice means that I've been able to stay as a clinical hands-on midwife with a career pathway moving forward and extending my knowledge of my base and my services. The focus and the health and wellbeing, it's evidence-based practice, person-centered, individualized and tailored care to the woman, but like I said before, working at that higher level of thinking and decision-making. So the professional values and conducts no more than anything is that you're accountable and responsible within the boundaries of your job description, your inclusion criteria, that you've timely referrals to and from the service and discussions with the family, the women and the clinical team that other team members that are involved in our care. Clinical decision-making means that I have to be able to undertake a full physical examination as required. I can order tests, investigations and then by putting them all together and interpreting them and then care planning with the right therapeutic interventions, which could be looking at just health care changes. It could be prescribing medicines just depending on what the findings are. The knowledge and cognitive competencies look at leadership that you're the lead expert within your service that you're involved in research and audit, education and ongoing continued professional development and evolving the services needs be. Communication and personal competencies go within the health care professionals, the obstetric team, the women and the family, other specialties. And within Saiga we're very lucky in that we've got a range of specialties that most times as clinical nurse specialists that you can pick up the phone to and refer the ladies very, very quickly to. So we're spiritual nurse specialists. If I've got a lady that asthma is playing up, the diabetic nurses, it's just fantastic. It's so seamless and so flow through. It's brilliant all together. Our leadership and professional scholarship competencies then are evolving the service, identifying the gaps, implementing change and evaluating and that's done through collection of key performance indicators that are set into the job description and also undertaking audit and research into the service. So putting it all together then, care is as per the three C's that are set down with the nursing and midwifery board of Ireland and that's for all nurses and midwives and that's what you're practicing within compassion, care and commitment. And I think that reflects around the world wherever people are working. And the previous slides are just put together that basically this is what my care is all about. It's the safety and autonomy of the woman, respecting her choices, values and beliefs, responsible and accountable, safe, compassionate, respectful care, equal partnership with the women and communicating and collaborating with the woman and the multidisciplinary team. And that is basic standards of advanced practices set down with the nursing and midwifery board of Ireland. And put into context, I have clinical guidelines and just that's how strict and sort of governed that the practices that I have one that tells, supports how I will telephone a lady and give her information, how I will do my physical assessment. So it governs all bits of practice. So as long as you're working within the job description and your clinical guidelines and your conclusion criteria, your practices is safe and it's safe for the woman as well. It's all brilliant. And then the accountability areas are a little bit different than other branches in that you're professionally accountable to the director of midwifery, obviously to the nursing and midwifery board, the service use in public and the laws of the land. I forgot to put that one in. And you're clinically accountable to consultant obstetricians. So just a different little bit of way of working than you'd normally be as a midwife. And this quote I just love, it's birth is not only about making babies, birth is about making mothers strong, competent, capable mothers who trust them, says and know their inner strength. And I think that at the end of the day, that's what's about that you're empowering the woman on her journey and you're doing this so that you've got a mom who's taken a baby home and hopefully having a very satisfied experience of her care and moving forward to take her family on through the next step. So the AMP service was introduced into Sligo in 2017. Like I said, it's a complete episode of care and I take a medium risk pregnancies, which in Ireland is set out as assisted care pathway. Usually within midwifery care, it's normal risk and that in Ireland is known as supported care. I first meet the ladies at about 18 to 22 weeks and I take them through to postnatal discharge. I have admission and discharge rights to the services. Like I said before, I can prescribe medication. I've referred pathways to all specialties within the service and close links with the multidisciplinary team. Now where the service does fall down at times is I work Monday to Friday just so if any of the service users come in at the weekend, then they fall under the remit of the oncologist et cetera team. And then just a flavor of what my caseload looks like, just a benchmark it against where people that are working as midwives are saying, well, what's different with advanced practice is that I take a slightly extremer edges of ages. So 16 to 45, I started off with stable medical conditions and if then they needed changing of medication, like say thyroid medicines, that then they would revert back to the consultant. But within the links with the other areas, some of the consultant physicians were like, well, why is this lady going back to the obstetrician? Sure, I'm winding her for a thyroid or diabetes. You know, I'm looking after that, you're looking after our pregnancy. So we brought her back and that did change. The station on diabetics and diet group B strip, you can see them there. So it just puts into a little bit of perspective. And the other little bit that I take is where is that there is a midwife led anti-natal clinic. They take the ladies up to 39 weeks. And before I started the service, they would have gone back to consultant care for post-states and planning what they come to me now. And then if they're needing an induction, they take all that. Or sometimes they fall out the support to care pathway and they move into medium risk. They sometimes transfer care to me. So it works nicely. That's great. I love it. So that's a long-winded bit of what advanced practices, but I felt it does just benchmarking and it was relevant. So what's my study about? That's what I'm here to talk basically not just about the other bits. So what, like I said, for parts of the key performance indicators is to look at the birth outcomes and other bits for the service users. And most years what I do is I benchmark it. I take what this sort of births different things and benchmark it against the rest of the maternity unit within the hospital. But like I said, this time I wanted to just drill it down against the carbon data review for primary and secondary outcomes to midwifery lead care. And I benchmark it against a similar case load of ladies that were tending for obstetric lead care as per my inclusion criteria. And for those that I'm sure you're all familiar but just to recap what those primary and secondary outcomes are, it looks at the birth outcomes as in usually there's higher vaginal birth rates, there's lower epidural rates, more intact perineums and less babies born preterm. And then the secondary outcomes that Cochrane review came out with there was less labor interventions, less use of analgesia in labor, perineal tears, postpartum hemorrhages, breastfeeding rates, abgar scores less than seven at five minutes, birth weights less than 2.5, resuscitation and then ICU admissions. So it's just putting against all of that. So the study was, apologies, I didn't go forward. The study was a retrospective study. It took place from the 1st of November, 2019 to the end of November, 2020. It was anonymized data and it was taken from the maternity information record. Now the record we have is very nice. You can do a stat generator, you can put in what criteria you want and you can pull it over onto spreadsheets so you don't actually link it back to PCNs or hospital numbers and then you can benchmark against the different bits. So we included everybody that had come to my service and that came to 324 women and they were ladies that had the full episode of care through me. So I discounted the ladies that came at 39 weeks and onwards from the midwifery led care or ladies that had been transferred to obstetric care someplace through the pregnancy. When we did the stat generator through the maternity information record, we pulled out 672 ladies that had similar caseload and data. So we decided that we would put them all in because if we tried to sit them down, we might lose some of that. And as we were using percentages comparing it, that we felt that was a truer reflection of what was going on. And like I said, we excluded the supported care and all the rest. So the breakdown of the parity, the purple lines are the advanced practice service and the green is the obstetric led service. And the obstetric led service means that, like myself, they would see the ladies, the care is shared between the ladies general practitioner and at the clinics then, it could be a different obstetrician they see each time, it could be a junior, it could be senior, it could be the consultant just depending and they would have a midwife that checks in, does their ops and that's the midwifery input with us. So just to put it into perspective. So between the parities, they were very similar spread out. The age ranges, again, I had slightly more with me. So at 20% of ladies were over 40 and I know that for the obstetric led care, that sort of 30 to 35 group had a higher bit. But on the whole, they were fairly similar and evenly spread. And just within the cohort group, and for those that are very quick to calculate things, you'll realize that the numbers don't add up to 100. Excuse me. That's basically because some ladies had two things going on. So they might have had BMI and anxiety and depression. They might have had BMI and GDM. So it was just to give a flavor of what's looking. And between them fairly similar, except I know for my service, I had more ladies that had anxiety, depression. Some of them were on medication, some of them weren't and similar to the obstetric led care. But the rest of the ones were fairly similar between the underlying medical problems of previous postpartum hemorrhages, the group B streps, all that. The data analysis, like I said, we captured it from the data generation. We looked at them, we did numbers and percentages to do a statistical analysis. There was nobody in the hospital does it. So I was very lucky in that my daughter is finishing off her finance and business. And she helped it. And her friend, who is a credit risk analysis, he did also the data. And between the two of them, they numbered crunch. They came up with exactly the same statistics. And it was actually very interesting, the conversations, because they hadn't a clue of what I was looking for. I really didn't have a whole lot of a clue of all these great big logistic regressions that was getting bandied about. But at the end of the day, the numbers proved what it was and came out. And so it was interesting and a nice steep learning curve for me. And we took a p-file of less than 0.05. And again, obviously anything that was less than 0.001 was really, really statistically significant. So the results, and we looked at the primary results, as you can see breaking down, statistically there was similar vaginal birth rates. This was a bit that threw me, and that's where there was numbers, but I was told the numbers can't lie, so that if the stats are driving it and saying that the probability was less than 0.01, that was down to the numbers and that the obstetric lab care actually came out better than that. The MP service had higher instrumental birth rates and the emergency sedentary section rate was less with myself, regional analgesia use was less, intact perineums were very similar and preterm births were less for those coming through the AMP care service. For the secondary outcomes then, induction of labor was less for AMP care and induction of labor resulting as the sedentary section was fairly similar. And when we drilled down into that, the actual induction of labor is that ended up in sections for within my case load were more ladies that were post-states or there was probably 40 to 50% of them had had prolonged rupture of membranes that went on to have the sedentary section was within the obstetric lab group, most of the ladies were less than 40 weeks to station and had various reasons for induction like previous quick labors, maternal requests, different things. So it was just an interesting breakdown. There was less sort of amniotomies done within the AMP group. It wasn't statistically significant, less use of oxytocin, similar rates of no analgesia, more ladies used entinox only in the AMP group and the opioid use only was less within the AMP group than in the obstetric lab group. Also from that then, the perneal tears within the two groups were fairly similar, but the Pseotomy rate was slightly less in the AMP group, which that was even considering that the instrumental delivery rate was higher, was interesting, and the third degree tears were very similar as well, but the PPH loss or more than 1,000 was less within the AMP group. For the babies then, there was more ladies initiated breastfeeding at birth in the AMP group. The breastfeeding at discharge was higher in the AMP group, but again, wasn't statistically significant. Birth weights was, there was more babies born over 2.5 kilos in the AMP group. Apgars less than seven were fewer in the AMP group and the resuscitation rates were fewer as well, and the neonatal intensive care admission rates were fewer. The vaginal birth after society section doesn't come into the midwifery led care and cochlear review, but I put it in there because it is part of my case load. As I put in, I think there was 18 ladies in total attended my case load that had a previous design section and were aiming to have a vaginal birth. Out of the ones that didn't attempt it, three ladies were breached and obviously that was a repeat elective section and one lady at 38 weeks was all for having a vaginal birth, but at 38 weeks, just something just said no, so she asked for an elective section. Out of them, the ladies that did go on to labor, there was an 85% rate that did achieve it and the ones that didn't have a vaginal birth, there was various things between meconium, maybe scar pain, maybe bleeding, was in the obstetric lead group, there was only 58% of the ladies that actually achieved a vaginal birth. So, experiences have clearly shown that an approach which demedicalizes birth restores dignity and humanity to the process of childbirth and returns control to the mother and that has shown to be the safest approach and that again is Michelle O'Donnell. And like that, I think that's sort of what I'm trying to do to give that back to women. Yes, obviously, if more people have a vaginal birth, yes, that's probably the goal in a lot of studies, but I have to say for my philosophy, if a lady has a satisfying experience, even the ladies that opt to have an elective section after the vaginal birth, but they leave the hospital feeling that they've been listened to, that they've had choice, that they've had good care and that they're going home to move forward, minding a baby and look after a family, I think that's really what it's all about. But again, it's just trying to get everybody safe. So, what do all these mean? So, benchmarking it against the Cochrane Review, there were similar findings in that there was lower preterm births and lower epidural rates and the intact herniate rate was similar. But what was different was the spontaneous vaginal birth rate was similar. The instrumental rates were higher within the AAP group, but the emergency scenario injection rates were less within the group. Secondly, outcomes similar was that there was less artificial rupture of membranes, less episiotomies and pernial tears were similar, but I think the third degree tears overall, there was less that required suturing and similar opioid rates. The difference was that there was actually lower induction of labor rates. And again, that might be different to the Cochrane Review because traditionally are the midwives in that care then going on to induce ladies and that was something that I just didn't really drill down thoroughly with, but probably did look for the birth outcomes first. There was lower oxytocin rate. And again, like as I always say, once you add in oxytocin to the equation and something goes wrong, that's where everything seems to just tie back onto that. So less oxytocin is obviously better. Lower postpartum hemorrhage rates. And again, that's going to affect going home, breastfeeding, all the rest. And then, like I said, similar in the one of GZ rates. So they were different to the Cochrane Reviews. For the babies, it was very different in that there was less babies that occurs less than seven, less babies requiring resuscitation. And interestingly, the babies that needed resuscitation weren't always the ones in the emergency zone section group, sorry, the less NSU admission rates and then the higher breastfeeding rates. What does that mean then? Well, expect to me at the end of it, it means that it does show that it does work, that you can roll out a similar continuity of care model against an upper level of risk ladies, just using advanced medical practice. So it's something that could be looked at and developed, but it's certainly, it's made a difference with our unit. I'm certainly going back to the theme of this year's conference, equity for all. It's not equity for all, but it's offering choice and a little bit of difference and expanding midwifery model of care and philosophy to more women than one it did before. The AMP care is less interventions. So expect if you're looking at cost effective and keeping things normal, that certainly comes into it. And then the baby outcomes exceed the findings from the others. Again, less separations of mommies and babies, less stress at the moment, the initial point of delivery because you all know, even with the baby's lying on mom's chest and it's crying, she's always still gonna say, is it okay, is it okay? But obviously if you have to take it away to the results of tearing two extra bits, that's a whole different ball game and extra stress levels from everybody. The strengths that we kind of pulled from it was that, and this is where we could have had even better rates or maybe worse, I don't know, but all the ladies come in through our obstetric led delivery suite unit. So it's core label ward staff and midwives that look after them. If there's things that need reviewed, it is on the oncologist team that usually make the decisions. So again, both groups were subjected to similar care and the lottery of that core label ward staff. So that was kind of doing that a little bit. The demographics of women were very similar and the cohort of women were similar. Yes, it was just about the double of amount in the obstetric led care. But like I said, we didn't set them down just so that we could compare it more accurately than you might just lose certain different cohorts and different bits. The limitations with it was that, it was retrospective as opposed to prospective. The other bit is the input of what goes into the maternity information record. You're relying on that being accurate because we certainly didn't pull the thousand charts to go trailing through. So some of that input might have been not accurate. I know from my own stats, certainly from what I would do from keeping a record was similar to what I pulled from the stats generator. So I know from that that was fairly accurate. And the other bit is in the obstetric led care. Like I said before, there's different levels of experience and expertise of the obstetricians looking after the women that are coming through that. Once the ladies that were coming to me, it was the same person that they were seeing each visit. I am not anti-obstetric team because we all have a great big place to play. But I do have to say I like this quote. So the midwife considers the miracle of childbirth as normal and leaves it alone unless there's trouble. The obstetrician normally sees childbirth as trouble. If he leaves it alone, it's a miracle. I have to thank all these people. And at the top, I certainly have to thank the women who have opted for AMP care in Sligo. Because when we started off, people were like, I'm not sure I have to see the doctor. I have to see the obstetrician.  But as women have come through the pathway, the best bit now I have to say is women are actively seeking, looking to seek and they come to the service. So that's great in itself. And I have to thank the consultant obstetricians because without their support and the director of midwife free and Miss McDermott who's now retired because she started the ball rolling. Without them, I wouldn't be where I am here today. So, you know, it's all part of a team. They're the kind of key core members. And then like I said, the rest of the midwives within the unit, the healthcare workers, everybody that's in the team is just part of it. So I'd like to say thank you very much for listening to me. I'd love to take any questions or comments. And what I would really, really love to ask and find out from people if they wanted to put it into the chat box is, you know, are you guys working as autonomous midwives? Are you working within an obstetric led care model? Is there a advanced practice within your areas? And what else? And they're just little bits I'd love to know and I'm happy to take any questions. There's loads of comments. I haven't had time to look at them there but it looks like it's interesting reading. So thank you very much. So thank you. Thank you very much, Rezin. That was a great presentation. We have a few minutes for questions. And I'm sure you're looking at the chat box. There's a question from Loreadana Zodan. I want to believe that you can be able to see it but I can also read it. What is opinion if all midwife in Ireland would study and become advanced midwife practitioner? Do you think the service to women will improve? I think it would be great. And like I said, we're just trying to at the moment expand the midwifery led model of care. So the midwives working as autonomous practitioners. So some units around the country, so there's 19 maternity units in Ireland, are working at that and some are just developing it. And currently there are 12 candidate advanced midwife practitioners going through the program to set up and expand the midwifery led models to care within their units. So that's exciting and it would just make such a difference, you know, just that kind of working at that level, offering the choice and then linking in with the obstetric team because absolutely we do need them and just sort of flowing it more. But what the women traditionally kind of have lacked here is not that midwifery model, not that input, not that health promotion bit. And that's the bit that I think that we can change to make a difference. The other one that I see there, I see Sheila there is just acting about interpartum. I forgot to say that. No, I don't do interpartum care. We looked at it and we looked to see if we'd do that, but that would mean probably 30 to 40 ladies a year and the actual service needs analysis looked to just kind of trying to change bits. So if I do have ladies that are coming to me that need induced, I will come in, I'll do their induction, but hand it over and liaison with the core labour ward staff who provide the interpartum care. At the moment, the service has been a bit disjointed because our anti-natal clinics have been away from the main hospital. So before that, I was certainly more of a presence on labour ward, but now I'm lucky if I'm up there once a day. But it's getting that bit. And before I was maybe downstairs in the clinic, if somebody needed sutured and none of the midwives in the labour ward sutured, I'd do the suturing. I'd quite often be the second midwife in at the birth of those any of my ladies in birthing, but that isn't as fluid and joined up in the last year just because of COVID and the restrictions. Hopefully that answers your question, Sheila. There's another question here. Was there a comparison of ramp and other midwives? Because that service is so limited, so traditionally through the midwifery anti-natal clinic, there's about 10% of the whole case load come through. They only provide the anti-natal care. They don't flow back into the wards and everything. So what I would do is I would gather the stats from them and do birth outcomes in that. And for within them, the vaginal birth rate tends to be similar to the MP birth rate and emergency sections. And then obviously the inductions in that don't kind of come into it because they would fall into my stats. And just we're hoping that we have got now same and two waiting to go into post to roll out sort of midwifery led care and early transfer home. So she's going to be rolling out that midwifery led service within the unit. And hopefully in the next few years then we'll see an extra change with that. So that will be following ladies on the clinic interpartum postnatal and going home. So that'll be interesting and really exciting. Looking forward to all that happening. Okay, thank you very much. There's a couple of more questions but I think we have some lifetimes to take one or two. There's one from Iska who's saying considering the importance of advanced midwifery model of care, why are many hospitals still keen on OLC especially private hospitals? I think a lot of it is that it is recruitment. It's the training and it's also then just getting the local service need. Because I have to say when I started the journey I thought my vision was about supervising consultative obstetrician shared that vision but we hit many walls on the way and even down to there was one stage I was just going to leave and the lady that's practice development that coordinates all that I remember phoning her and said, look, that's it and I remember her saying to me, Roting, you signed a contract as a candidate at AMP your job description is to get registered as an AMP so suck it up and get on with it. So I sucked it up, I got on with it and that's where I am now but I think that's you really need to be committed. It's a steep pathway, it's a steep learning curve and it's just trying to get everything into place and just get the agreement locally to put it into place and to practice at that level. So I think that's why it's kind of slow to take off and I know last week I think it was I tapped into a conference from the UK and they were talking about fans practice and they're similar, they're small but I'd say beginning to start going to grow and leaps and bounds as well. Okay, thank you, lots of comments, great presentation you've done a good job, it's lots of accolades. There's one more here that I'm seeing, does Ramp have more autonomy than other midwives? I don't know if there's more autonomy than other midwives and you would like if you're working as a midwife you've got that full, you know, package of care and decision making for your ladies and I know the midwife rules in the UK have changed but when I was training there I think it was rules 30 and anything out with the norm you have to escalate care up to and similar to me, so out with my inclusion criteria and my guidelines, so if I come across something that I haven't got that skill set or I'm not quite sure so for example, a lady coming for clinic her blood pressure's up, we've done her blood she's now showing that maybe her urea is 3.84 she's 36 weeks, she might have come back to my clinic and we've done those, I'll link in with the consultant, consultant obstetrician at the clinic and say look what are we going to do? Now sometimes it'll be a case of the blood pressure's fine we'll should keep an eye on this lady twice a week if there's anything untoward come back to me or it could be right, okay, let's decide we're going to induce her so you've got that kind of flow way through and that immediate access to the consultant so for that, yes, I've got extra clinical decision making around the ladies that I'm caring for but there is a limit within that and then I report back to the consultant from that so hopefully that answers what the question that the person is asking. Okay, I don't think there's any more questions and I want to believe we're all comfortable now and thank you once again, Rosine, that was a great presentation, the accolades like I've mentioned are awesome, yeah, good job. And I think the other bit that I didn't say is I think from this study and looking at it what the next step that's looking forward to is to try see then as the community model and the midwifery care model comes into play and we have that kind of home from home room that there will be more people taking within that and not automatically doing the artificial rupture of membranes and I mean, so many ladies sit at my clinics and say, oh yeah, but once they break my waters I'll labor so once I'm in there I'll get them to break my waters and I'll have the baby then in no time. So it's changing the women's mindset, changing the midwifery mindset and it'll just be interesting to see if that changes a lot of things moving forward as well. Okay, thank you very much, Rosine. Thank you once again, thank you all for being around and just a few more slides and then we can get to the end of the session.