(1) Anonymous 6/21/2007 9:15:00 AM
BECAUSE CHILDBIRTH IS NOT A "PROBLEM"
"If we take advantage of modern medicine for other problems, why not childbirth?"

BECAUSE CHILDBIRTH IS NOT A "PROBLEM!!"


Suffering is not a mitzvah. But childbirth does not have to be equated with suffering.

I did not suffer through the births of my eight children. I looked forward for months to this amazing experience, to the elation I would experience, the "high" that Hashem provides with the natural opiate-like endorphins He created that "kick in" when a woman is truly relaxed, joyous, and not terrified of childbirth.
Childless for years, challenged with infertility issues, I looked forward for years to the privilege of being granted the opportunity to daven and birth our children in a normal, uncomplicated, "natural" way....
Already considered "high risk" because of the difficulty of becoming pregnant, I wanted to avoid hospital birth, and chose to birth our children at home, as is usual in Western European countries (unlike USA and Israel).

Though we needed the assistance of modern medical miraculous treatment, I did not want the birth experience to be considered a "medical emergency" ; it was not an illness that required medication and intervention.

We had enough with the fertility drugs and high tech procedures!


There does not need to be suffering. I wish I could have been your doula Emuna... that we could have met and spoken years ago. That you did not have to feel alone and afraid.

Please don't begin a mission to convert women to your way of thinking. Please respect that everyone is very very different and I would not want to be laughed at because of my enormous respect and appreciation for how Hashem created my body with the ability to birth babies without hospital practices that can also cause unnecessary suffering, complications and death, G-d forbid.

No women needs to suffer. If an epidural will alleviate her suffering, she should use it, b'simcha. There is no "right way" to birth.

But please don't put down those who do not want intervention, including those who are afraid to even enter a hospital because of the risks involved there, or because of the horrendous violation they experienced at a previous birth, G-d forbid.

May all women give birth swiftly, speedily, joyously, without complications, to healthy, wholesome children who will give nachas to our Benevelant Creator!


(2) Anonymous 6/21/2007 3:55:00 AM
Childbirth Without Fear
Emuna writes: " Thank God that the childbirth experience can be without pain and terror. Thank God the prospective parents can be free to focus on the upcoming miracle."
I suggest she read "Childbirth Without Fear."
No woman, whether or not she uses an epidural, should face childbirth with fear and terror. How sad. G-d has granted us so many miracles, including the phenomenal way He designed women's bodies for giving birth. We are very sadly out of touch with our own inner strenth.
Childbirth can be an empowering, intensively growth promoting experience of devakus Hashem.... of closeness to G-d.

I am very very sorry to read that without an epidural, childbirth was "Pain and terror" for you. That you were not able to focus on the miracle of the birth, that it was not a time of holiness and closeness to G-d.

Humor in medicine is very helpful. Humor in life is essential for positive living. However, it is hard for me to separate the "humor" of this article, from the seriousness of the subject. Advocating epidurals as though they are G-d's gift to humanity.... how sad. Maybe the readers should check out Michelle Thaler's article on Aish.com "Just Doing."

Yes, no one should judge another for the decisions they make. But to advocate epidurals.... when Hashem created our bodies so magnificently.... how sad. How tragic.



(3) Anonymous 6/19/2007 3:58:00 AM

Thank you, Rebbitzin Bravermen for your fantastic and timely article regarding pain relief during childbirth. Suffering is not a mitzvah! Choosing to suffer needlessly is amaratzius (boorishness). There is tremendous social pressure not to accept pain relief, and, in my opinion, it is mostly based on ignorance of Jewish hashkafah, and bad medicine. If anyone thinks there is a connection between being a good Jewish woman and not accepting an epidural, allow me to state publicly: Baruch Hashem, I am a married to a rabbi in Tsfat, and I have happily accepted an epidural. I am intensly grateful to Hashem for modern medicine and pain relief.

(4) Anonymous 6/12/2007 2:37:00 AM

This article is dangerous to womens health. There is no such thing as painless childbirth with or without an epidural- This misinforms women. Even
rabbis dont promote epidurals, Why should this woman be allowed to promote her experience as if it had anything to do with health or safety at childbirth.

If you want to post something informing women- then post something intelligent-

www.mothering.com/articles/ pregnancy_birth/birth_ preparation/ hidden-risks-epidurals.html

Until you publish that article on your website you are promoting bad outcomes and someday if some woman is paralyzed for life by an epidural from reading your stupid article about painless childbirth, she should sue you for promoting such crap. Every other year a woman in israel is paralyzed for
life by an epidural. I didnt read that in the article posted on your website.




(5) Jennifer 12/14/2006 10:52:00 PM
What's best for the child
I am quite sad to see this article. I've only given birth three times, so perhaps I'm not qualified to speak, but all three of my children were born at home with no "machines that go bing" (allusion to Monty Python) and no drugs. I did it that way because it was best for the baby and me. Anything a pregnant woman does will affect the unborn baby. Yes, labor was extremely intense for me. On the positive side, no drugs slowed down the labor, so it progressed as quickly and as naturally as possible. Afterwards, I was "tender," but I felt fantastic! In fact, my midwife had to reprimand me by telling me to take it easy because I was so naturally high from no drugs. The very best news: a drug-free, healthy baby. Our nursing relationship started off in the very best way possible.

Technology is wonderful for situations that truly warrant it. But why take drugs and go to hospitals to deliver babies when we're only pregnant -- not sick?

You said, "delivery with drugs is a lot more fun for mom and dad." What's "fun" in life is not always what's best. The baby's health should ALWAYS supersede mom's "fun."


(6) lisa 8/3/2006
I disagree
I had a 40 hour labor with my first, and at the 36th begged for drugs. Any doctor would have done the C, my midwife did not. My second came so quick that there was no time for drugs, which is what we wanted. It was the greatest experience, and twenty minutes after birth, I was in the shower, and walking around. So, yes, maybe the Hashem gave us the epidural, but there was no epidural for Shifra and Puah's labors, and I had such a positive experience from mine. I am not saying epidural is bad, but the experience, and recovery is so much better without.


(7) Birth Junkie 8/2/2006
Oy va voy!
I've just this article and Mrs. Braverman's article on breastfeeding. I am so incredibly disappointed in her and in aish.com for printing these pieces. The world looks to aish.com for wisdom and these articles are misguiding the public.Personally, birthing and breastfeeding my daughters have been the biggest accomplishments of my life. I had epidurals for my first two births, yet I felt that I had been cheated out of an important Rite of Passage. I had no medication with my third daughter (only a lovely, supportive midwife and my husband at a birth center ) and I finally felt that *I* had given birth to my child. In addition, there is no greater feeling in the world for a women than watching her child grow and develop from the milk that her body produces especially for them.I understand that many women are not able to tolerate the pain of labor (especially when pitocin is administered) and for them an epidural is a blessing. However, to teach women that epidurals are wonderful and risk-free on such a respected forum is shameful.


(8) Anonymous 6/24/2005
Crazy
So misguided, so misinformed. So sad. So sad. So dangerious. Points to consider:
1) If you were in the hospital, in bed, taking drugs... you did not have a natural birth. An educated woman should have been able to figure that out.
2) You failed to mention that drug use in labor is linked to adult drug.

Just call it what it is... you were unsupported, uneducated, unprepared, and underappreciated. No wonder you had to use drugs.


(9) Mindy E Troge 1/9/2005
In Praise Of Painless Childbirth
A couple of comments on your article on Painless Childbirth, now that my nausea has subsided.
I understand that your article was meant to be very one sided, but to generalize that you think everyone should use an epidural is outrageous. Who are you to make a medical decision for someone else? The parents who choose natural childbirth are likely doing so because of the potential risks of an epidural, which are clearly spelled out on the Epidural Consent Form. You can read this form at http://www.childbirth.org/articles/epi.html

Your quote "I'm in favor of anesthesia during childbirth. If we take advantage of modern medicine for other problems, why not childbirth?" obviously spells out your attitude, one that many other people do not share. Childbirth is not a "medical problem." Appendicitis and cancer are medical problems. Childbirth is a healthy part of a woman's life cycle, and something that is supposed to happen, not a pathological occurrance in a woman's body. It does not typically require medical treatment.

As a childbirth educator with 8 years of experience, 90% of my vaginally birthing students do so without seeing a need for pain medication. Over the past 4 years, of those who had the epidural/pitocin combination, only one has escaped a cesarean section. As you may or may not know, this major surgery not only carries increased risks of infection, hemmorrhage, bad reactions to anesthesia, damage to organs such as the bladder or bowel, respiratory depression in newborns, it also affects a woman's future fertility, and increases the risk of death not only to her, but to future babies that she may conceive.



(10) Bev Morris 1/5/2004
Thanks for the help
I'm pregnant with my first child, and I've been debating with myself and my husband about whether to have an epidural. I was raised at the apex of the feminist movement, and, though I hate the thought of a painful childbirth, I really was buying into everything I'd ever been told about how childbirth should be natural.

I had the same problems with the decision I made about not working. I'd always been told that women should work, period. However, I believe that one of the reasons our society is falling apart right now is that parents just aren't very involved with their children's lives. Typically, when both parents are working, no one has time to deal with their kids on more than a part time basis. So, I'm going to be a wife and a mother, which is a far cry from the life of a customs broker that I used to lead.

You raised some very good points about epidurals, and I will consider them when making my final decision. Thanks! :)


(11) Sarah Zadok 5/25/2003
Interested in a counter-argument?
Humorous article, but what a shame Emunah had such unpleasent natural birth experiences... I'm curious as to what kind of support system and education she received prior to birth. I myself have (so far) two very beautiful (natural) birth stories to share in addition to the myrid of others I have seen in my work as a labor coach here in Israel. What a bracha to be able to feel, to be able to endure, to be able to rise above and elevate a potentially "scary" experience into a life changing event that gives confidence, strength and power to a woman. I am no doubt a better person, a stronger and more confident woman because of my birth experiences. I thank G-d for the opportunity to have given birth the way our Mothers did... supported, guided, aware of a greater purpose and connected to The Source of Life who blesses us with the opportunity to be a true partner in creation... You know what, birth, it hurts, but that detail (yes detail)of the birth experience has been exploited. The pain is not the point, there is so much more going on. What a shame to spend such a beautiful and life changing event focusing on the pain. Birth is so much more. Listen, there are times when medical intervention is neccesary and drugs are exteremly helpful, Thank G-d that we have so many options... but who ever said that "painless" is good? Pain is a process intrinsic to many paths of growth and birth... perhaps it could be said that this too is intended?


(12) Anonymous 2/9/2003
painless childbirth
I know that this posting was older but I came across it recently and was so happy to hear someone supprt the use of epidurals. I have had one child and am expecting another and used an epidural with my first birth. I was induced as well. It was awful even with the epidural. All I keep thinking is what would I have done without the pain medication. I am happy that you support it. Not many people do these days. I have a friend who attended my birth and she had her first baby at home without any interventions. She is very self-righteous about being such a martyr for her labour and delivery. I am tired of hearing about it. Anyways, this is why I am so glad to hear from someone who has had so many children a different point of view. Thank you for that.

Sincerely,
S.


(13) Israel 5/6/2002
Other Painless Childbirth Methods
I read your article and I just wanted to let you know that there is another way of creating a painless childbirth with hypnosis, I know because I teach such a class and have done so successfully. Just thought I might let you know of other options that are out there. If you would like more info. Painlessbirth.net


(14) Heather 12/29/2000
my self-training in Lamaze worked- four times
While researching 'modern' trends in childbirth for a young friend, I stumbled on this site. Incredible!My babies were born in '65,'67,'69 and '72.
I had come across "Babies without Tears" in my local library, found the Dr Fernand Lamaze philosophy appealing and commenced to work my way through it,with my husband's support, much to the amazement of my GP and the fine public hospital staff who also attended me. Back then hospital policy meant my husband had to leave 10 minutes before our first daughter was born.My midwife wept because she had no choice but to toss him out.Word got around about this incredible 'method'.The hospital had 'caught up' with 'modern ' ideas by the time our son was born, and subsequently our next two daughters.Yes, it was very hard WORK- hard physical labour, but agony, no! Terrifying! No. Did I scream (or need to, or even cry?) No.Because I had a job to do and that job required concentration and no wasted energy.Was it the most wonderfully rewarding WORK I had done, and did we feel incredibly close and exhilerated? YES YES. I have been with a daughter and a niece in recent years during the births of 3 babies and have been disappointed to see the fussing and confusion which now goes on, with decisions to be made as to whether to stand on your head or swing from the curtain rails, to bathe or to pace or do ANYTHING, it appears, but to quietly put in place, common sense, and practised skills like saving strength and energy for the right moment;like knowing and applying how to push effectively (not at all like in the movies!) and like how to inform and co operate with a calm and encouraging team. Instead, staff have been so focussed on the technology and new toys, they pay little respect to the mother's 'job' and little attention to her actual progress.
Yes, that baby will come out,but wouldn't it be nice to come out of a calmly excited mum, who has been taught to 'listen' to her body and help it as to when to push, and taught to do it effectively.
And I am most thankful that my mother and the community of women around me considered it important not to fill up young mothers with fear of pain and disaster.They kept the tales to themselves.I don't knock modern medical procedures and know that lives have been saved by them and that there are wonderful, skilled practitioners. I also know there is 'an industry' outlook by others; and that expediency can sometimes rob women and their husbands of a wonderful, wonderful joy.The world can only be enriched by bringing children into the world in the most positive,joyful experiences possible, both during pregnancy and birth.


(15) Laura 11/19/2000
ambivalent about epidural
I think it depends upon the level of pain that one experiences. With the relaxation techniques that I used (a modified Bradley technique), it wasn't sufficient to warrant medications. Now, when I had stitches after the birth, feeling a needle coming in and out of me was not something I choose to feel. For that, I wanted an anesthetic.

On Shabbat we don't take medication for pain that isn't serious, not just because we are concerned about grinding, but perhaps because it is good to listen to what the pain is teaching us. The pain I experienced was sufficient to let me know it was time to push.

When I told my ob/gyn I had studied a Bradley method, she was worried that I would be opposed to anesthesiology for the sake of anesthesiology. I told the doctor, let's take a wait & see approach.

I think pain is a very individual thing. When I had blood drawn for a blood test, that hurt my finger and I screamed from the pain. The birth of my daughter's did not cause me that much pain. The stitching up afterwards made me queasy, uncomfortable and those feelings positively spiraled into a need for an anesthetic after the births.


(16) Anonymous 6/16/2000
Lets be thoughtful
I am an anesthesiologist and have given over 3000 epidurals for labor. I personally have not had one complication. I would not place an epidural if I felt I was harming mother or baby.

As has been previously commented on, statistics are meaningless unless you know the original article and how the study was done. So what have I learned from my reading of the studies available: 1) A properly place epidural does not cause back pain or paralysis 2) Epidurals do not effect the health of the baby or mother 3) Epidurals may slow labor by less than an hour, but if mother and baby are fine it is of no consequence 4) Epidurals do not effect the babys ability to breast feed.

Are there risks, yes but rare. In the hands of physicians who do many of them even rarer. So before you might need medical care find out the qualifications of the physicians taking care of you. Ask questions and make sure you get understandable answers.

the bottom line is as been stated before, We are all different. No one solution is right for all. Let the mother and father have all the information and make a choice of drugs or no drugs, but please let us not make them fell bad for what ever decision they make.

The birth of a child is such a wonderful miracle, let us focus on that.


(17) Anonymous 6/15/2000

i agree with you 100% with epidurals. when i gave birth to my son, many people tried to talk me out of it but knowing me with handling pain, i knew i had to take it. what's worse is my mother was with me in the delivery room and she still tried to talk me into not taking it while in labor. but now i am having my second and i know for sure i will take it unless G-D gives me no pain at all. by the way i envy you for haaving so many children and doing so much for the community at the same time. with G-Ds help, my husband and i want to do the same thing.


(18) Elana 6/13/2000

How did this woman miss the joy of childbirth? How did she have seven children naturally and manage to miss the great joy in being totally present? Fear and pain can nbe alleviated by education - what a far nobler, healthier and more harmonious banner to wave.

The reasons NOT to have drugs during birth are plentiful. I hope that those who read this article had the sense to see beyond it's cleverness, eloquence and humor and see the subjective experience of one woman. It's a shame to scare parents away from this most mystical, miraculous, joyful and yes, laborious, experience.



(19) Elizabeth 6/12/2000
Right On!
For the months leading up to the birth of my daughter I vowed I would "go natural." I had done quite a bit of reading about the pros and cons of opting for an epidural. My physician indicated that nearly all first time moms in her practice had epidurals. My former husband, a physician, weighed in on the subject, as did his medical partners. Still, I wanted to make my own decision.

Until I was confronted with hours of debilitating and excruciating pain, my goal was a natural birth. In the end I did get an epidural. There were some complications; I'm thankful the medication was available. And do you know what? I have no doubt that what I experienced was a "natural birth." After all, I had the blessing and privilege to welcome a healthy child into the world. Cradling my new baby in my arms, I gave no more thought to the question should I have refused all drugs? I was better able to appreciate the miracle of birth.

As I read this article I was brought back to the immediacy of the moment. While it was, and remains, contentious, looking at the issue of edpidurals versus unmedicated deliveries, seems like a lifetime ago after becoming a parent. As I send my child off into the world and watch her grow and develop, simultaneous pleasure, pride, and pain constrict my heart far more than labor pains. Irrational and not-so-irrational fears take root. Will she develop the right midot, faith, and love of Judaism? Will I be there to help her develop into the person she will become? Violence, war, indifference, injustice. Mothers the world over lie in bed at night and


(20) Elly 6/12/2000
painless and drug free
I want all mothers out there to hear the story of my mother who gave me the gift of her pain free labours and child birth. My whole life growing up she would tell me, with a wink ,not to pay attention to all those women who scream and cry during childbirth. We are different she would tell me , for us it doesn't hurt. This affirmation worked for all 4 of my deliveries. And now I want to pass this gift on to all of you. Childbirth is a fabulous all compassing body experience. But don't pay attention to all those women who complain about it. For us it doesn't hurt.


(21) Janice 6/12/2000
Epidurals DO have risks, even if, BH, this author didn't have any problems
She states "I have heard the argument" but that it isn't true. Well, those arguments are made based on case histories and statistics. Her one or two experiences are not all inclusive. BH, she did well. I, personally, know two who did not. Most of my friends did not use drugs for childbirth. I , myself, have had three deliveries, none of which was unmanageable without medication. While epiderals are miraculous for many women, the impression that they are easy and risk free is a disservice to those who seek the true knowlegde.

As for the "I have heard the arguments" but it didn't happen to me, so it must not be true feeling I got reading this, would the same argument be used not to wear seat belts, or to buckle ones children? Or to encourage one to smoke if you know someone who didn't get cancer? Personal experiences are wonderful, but they certainly don't give the full picture!


(22) Anonymous 6/12/2000

As a mother and doula I find this article extremely disturbing. Certainly it
is true that medications are available and helpful for labor, when
appropriate. Mrs. Braverman was denied pain relief by her insurance company,
something that is at best questionable, but that does not make Epidurals
appropriate for all women.
I have attended medicated births, unmedicated births and just as Mrs.
Braverman says, all babies do eventually come out. Women, however, are
empowered tremendously by a positive birth, and for most this means using
only such medications as are absolutely necessary.
I for one hope that she was only joking when she said she would next report
on why she like ceasarean births. As a woman who had one, I can tell her
there is nothing to like about it. From an 8 inch scar across my belly, to
infection, to significant pain in the area for more that 6 months, to
continued sensitivity in the area 7 years later, to a tremendously high
secondary infertility rate in c-sec mothers, there is nothing positive to be
said for unjustifiable surgeries.
May I suggest you find someone more based in reality for your columns on
childbirth?



(23) Chana 6/12/2000
Take It With a Grain of Salt, Don't listen to Ideologues
If Braverman's tone puts you off, the whole militant, machisma "I didn't even take an aspirin" tone puts ME off. Why not stop swinging from extemist pendulum to extremist pendulum and give the women who want to,or need to, "permission" to really empower themselves and choose what medication they want, if any. And by the way, let's stop using the word "Pitocin" to scare people. Here in Israel, we don't have scheduled births; the normal birth is the province of the on-duty midwife, and the staff ob-gyn only intervenes if there's a problem. We have a lot fewer c-sections, and the whole thing costs a lot less. By the way, I had 5 babies (bli ayin hara) without any anesthesia because I did not feel any compelling need for it, but I have a lot of friends and colleages that felt and acted differently. Isn't it obvious that different women have different labors, different pain threshholds, different preferences? Why this need to bully everyone else into doing it the same way? Isn't that what "informed choice" is all about?


(24) Dennis 6/12/2000
Consider medical appropriateness
As a board certified obstetrician I am very much aware of the appropriateness of epipural anesthesia for some laboring moms. This is especially true for protracted labors, labors with certain medical complications and labors in which the mom is "out of control". Epidurals also have the advantage of allowing mom to rest so that she is not so wiped out from the labor that she has difficulty enjoying her baby.
On the other hand there is no doubt that epidurals are associated with a higher rate of c sections and operative vaginal deliveries. Additionally, studies have shown that babies born to women having epidurals often don't breast feed as well those having natural birth. And there is more than just anecdoctal evidence suggesting chronic back problems in some women receiving continuous epidural anesthesia. At the same time,having a good support system while in labor has been shown to be very effective in actually shortening the lenght of labor and decreasing the need for medication.
My professional opinion is that epidural anesthesia should not be available to all patients. Each laboring mom should be evaluated individually and if medically appropriate epidural anesthesia should be administered.


(25) Adam 6/12/2000
Epidurals - a husbands view
Having read the other comments I am now more aware of the medical for/against arguments, however as a man I do not wish to be taken out of context.

Childbirth is difficult. The modern mortality rates are so greatly reduced by the intervention of modern medicine that both sides can argue "it's safer" or "it's more dangerous" and be correct depending on which statistics they thrust at you.

With both our children my wife's waters broke prior to the onset of labor and each time the doctor told us to come to the hospital for induction. For each delivery an epidural was administered, and we are fortunate to have two beautiful healthy children, and my wife suffered no complications. If anyone were to ask us, our answer would be that the woman is no less involved in an epidural moderated delivery, and the husband's knuckles are much less crushed afterwards.

In summary, sign me up for the epidural praise club.


(26) Lisa 6/11/2000
It's not so simple
I understand what you're saying about the advantages of the epidural, but don't delude yourself (or your readers) for one second into thinking that there's no risk involved. I know of a case (a woman in the neighborhood that I lived in when my two children were born) who took an epidural and it never wore off. She is now confined to a wheelchair, whereas she WALKED into the delivery room perfectly healthy and whole. Another friend of mine, who used to work as a midwife, told me that she has personally seen cases where the epidural was not just paralyzing, it was FATAL. I realize that the odds are with the woman that she'll come out of the experience okay (with Hashem's help) but the dangers are real and must be noted.


(27) helene 6/11/2000
Inductions and epidurals take birth from low risk to high risk...
I am a 24 year veteran of OB nursing and teaching childbirth education, and yes, many of my patients opt for the epidural...however this increase is from the more painful labor that inductions cause. A novel idea in 2000...spontaneous labor..a woman stays home until active labor, and doesn't get PITOCIN. Labor can be managed and celebrated with minimal intervention.
Due to the increase in technology, and "babies by appointment", medical costs are through the roof due to the excessive abuse of induction, and subsequent epidural, not without risk to the mother and baby.
You are doing a diservice to women by mocking prepared childbirth. Most epidurals are not given until the woman is 4 cm dilated, and she still needs to use breathing and focusing techniques until she gets to that point. The use of hydrotherapy, massage and ambulation(not possible with inductions) all decrease pain.
Thank G-d women now have a choice to use analgesia, anesthesia or psychoprophylaxis in labor. Please don't make a mockery of those who prefer a labor and delivery with minimal medical intervention.






(28) Michaela 6/11/2000
strongly disagree with author's overall tone
Sure Emuna Braverman wasn't the slightest bit "PC" in her article (as she herself stated). I wouldn't have expected her to be. But for many of us, the issues surrounding "medical politics" are less important in terms of "correctness" than in terms of our health and common reason. When she refers to the medical establishment as "the Almighty's messenger" I wholeheartedly agree in some cases. But if we are to truly "take full advantage of the benefits of modern medicine" we must look at the bigger picture of what medicine truly is. As "modern" as allopathic medicine is today, there are many cases - especially in the areas of minor ailments and disease prevention - for which it falls short (and may even cause harm). I do not take asprin for a headache or prescription antibiotics for a minor infection. There are potent herbal anti-inflammatories and antibiotics that have worked marvelously without the harmful side effects and inflated prices of most prescription chemicals. Modern medicine is indeed a gift from G-d when its limitations are understood and its use is moderated. But in most cases and for most ailments, I have put my trust in the medicines that are truly gifts from the Divine - a healthy diet, herbs, and plenty of laughter.