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Last month, the American Medical Association published a Viewpoint in it’s Journal explaining recommendations for exercise during pregnancy. Here are some key points from the statement. Always check in with your health care provider for personalized recommendations for your pregnancy. 

1. It is safe to exercise throughout your entire pregnancy– The JAMA Viewpoint states that moderate-intensity aerobic and resistance exercise is not associated with an increased risk of preterm birth or low birth weight in women with uncomplicated, singleton pregnancies. The Viewpoint also clarifies that it is safe to start exercising for the first time while pregnant, even if you have been previously sedentary, and that exercise is safe for pregnant women with health issues including high blood pressure, gestational diabetes, or overweight/obesity. Research has found that it is safe to exercise right up to the end of your pregnancy.

  1. Exercise will help you prevent excess weight gain during your pregnancy– Gaining too much weight while you’re pregnant is common no matter what your pre-pregnancy weight was. Research shows that women who exercise during their pregnancy are less likely to gain more weight than is recommended. Not exceeding weight gain recommendations will help you maintain a healthy weight after your pregnancy.
Pre-Pregnancy BMI Recommended Weight Gain

During Pregnancy*

<18.5 28-40 pounds
18.5-24.9 25-35 pounds
25.0-29.9 15-25 pounds
>30.0 11-20 pounds

*Singleton. Recommendations vary for women carrying twins, etc.

  1. Exercise lowers health risks for your and your baby– Regular exercise during pregnancy lowers risk of gestational diabetes, preeclampsia, cesarean delivery, pain in the back and pelvic girdle, and urinary incontinence. Exercise also lowers risk of newborn macrosomia (large birth weight) which is linked to childhood obesity.
  1. During pregnancy you should exercise at moderate-intensity– Research has found that moderate-intensity aerobic and resistance exercise is both safe and powerfully beneficial during pregnancy, but what does moderate-intensity mean? Moderate-intensity means that you keep your heart rate between 60-80% of your maximum heart rate. To determine your maximum heart rate, subtract your age from 220.  If you don’t have a heart rate monitor, you can use the “talk-test” as an approximate for moderate intensity. If you can’t comfortably talk, you are working too hard. If you can sing, you may be at low-intensity and can pick up the pace a bit. Your goal is to be able to talk but not sing. Brisk walking, aerobic dance, stationary biking, swimming or water aerobics are examples of moderate intensity aerobic exercise. Avoid exercise that takes you above moderate-intensity heart rate, increases your risk for dehydration, or raises your body temperature, like long-distance running, hot yoga, or lifting heavy weights.
  1. You should aim for at least 150 minutes of moderate-intensity aerobic exercise each week– This breaks down to at least 20 to 30 minutes most days of the week. Try not to let two days in a row pass without engaging in aerobic exercise.  Studies have found it is safe to engage in moderate-intensity aerobic exercise for up to 90 minutes at a time while pregnant, but do make sure to keep yourself hydrated while you work out. It is also recommended to perform moderate-intensity resistance training two to three times per week.

Choose an exercise you enjoy and get started today. You and your baby will reap the benefits for years to come!

Lindsay Pasdera, MS RDN

What are the benefits of a diet high in fiber? 

  •  improves digestive health
  •  lowers risk of colon cancer
  •  lowers risk of constipation, diverticulitis and hemorrhoids
  •  lowers blood cholesterol levels
  •  improves blood sugar levels
  •  supports weight management
  •  lowers risk of cardiovascular disease

How much dietary fiber do I need? 

  • Adult Women need at least 26 grams of dietary fiber each day
  • Adult Men should aim for 38 grams
  • For Children ages 1-3, the target is 19 grams per day
  • For children ages 4-8, the target is 25 grams per day
  • For children 8-13, girls should aim for 26 and boys should aim for 31.
  • Teens age 14-18 have the same targets as adults (26 & 38 grams respectively)

Pregnant women should eat 26-30 grams of fiber daily from food sources. This will help to prevent excess weight gain during pregnancy and help prevent constipation, which half of pregnant women suffer from. (Drinking plenty of water–around 80-96 ounces of caffeine-free, unsweetened fluids each day–and following physical activity recommendations, go hand in hand with fiber intake to prevent constipation.)

For children suffering from constipation, prevention should include 1) adequate dietary fiber (see above), adequate fluid intake (see below) and adequate physical activity (minimum of 60 minutes per day of moving play, sports, dance, walks, outdoor activity, etc).

Fluid Recommendations for kids:

For Children ages 1-3, the target is around 34 ounces of fluid daily. 

Kids age 4-8 need a minimum of 40 ounces of water per day.

Older kids should aim for a minimum of 64 ounces of water. 

How can I find out how much fiber is in my favorite foods? 

Use a calorie counting website, like

Which foods are high in fiber? 

Dried Beans & Peas (“Legumes”)


Whole Fruit

Whole Grains

Nuts & Seeds

Eating 5-9 servings of vegetables and whole fruit and 1-2 servings of legumes daily, and selecting whole grains instead of refined grains will go a long way to meeting your dietary fiber needs. Make small changes and work up to the recommended fiber intake over time. You can do it!

Lindsay Pasdera, MS RDN

What about “power pumping” breastmilk?

The idea behind power pumping is to trick your body into producing more milk by rapidly emptying the breasts frequently. Normally the breasts respond to growth spurts of the baby by the baby eating more frequently and demanding more food.  Power Pumping simply copies what babies do when they are “cluster feeding. Power Pumping can be used to boost milk supply at the end of a busy work week, after a long vacation, or anytime your usual routine has been disrupted and you are worried about your supply of breast milk going down.


To Power Pump:

Choose a time when you will not be interrupted and one hour after the last feed. Most moms like to use early morning. Follow this pattern:


1.Pump for 20 minutes, rest for 10 minutes

2.Pump for 10 minutes, rest for 10 minutes

3.Pump for 10 minutes.


If you are breastfeeding your baby, follow the usual schedule during the day, but do not go more than 3 hrs with out pumping or breastfeeding.


Be careful about over pumping. If you pump off too much milk (more than you need to feed your baby) your body will continue to increase production and you could end up with an over abundance of milk. It can take 2-3 days of Power Pumping and frequent empting (8-10 pumps or feeds in 24hrs) to see a difference in your supply.


If you are unsure, seek the help of a board certified Lactation Consultant or Lactation Specialist.


Rosanne Gephart, MSN, NP, CNM

A few early research studies indicate the benefits of mindfulness–widely identified in research of the general population–apply to pregnant women as well. Mindfulness practice can lower symptoms of stress, depression, anxiety and pain, while increasing resilience and self-compassion–all of which can make for a healthier pregnancy, smoother childbirth, and better postnatal attachment between mother and child.
So what exactly is mindfulness practice, and how can you incorporate it into your day?

Mindfulness is comprised of two key components: 1) present-moment awareness and insight, and 2) non-judgmental observation and acceptance of ‘what is.’

A few skills to actively practice in order to build awareness include:
  • Do one thing at a time. Multitasking is a myth– our conscious mind can only focus on one thing at a time. So try out mindfulness by bringing your awareness to the task at hand. When you are washing dishes, notice the sights, aromas and sensations of dish washing. When other thoughts slip in, note them and move your attention back to the experience of dishwashing.
  • Label your thoughts as thoughts. It’s easy to fall into the trap of believing our thoughts are objective reality instead of inventions of our mind. So try this simple trick: add the phrase “I’m having the thought that…” before any thoughts that bring up stress or another challenging emotion. Instead of, “I’ll never get everything ready in time,” “I’m having the thought that I’ll never get everything ready in time,” usually helps us stay calm and make better decisions.
  • Scan for emotions and sensations. Increase awareness of your feelings by checking in a few times a day. Notice if your holding tension in your neck or if you’re feeling resentful or exhausted. Once you’re aware of your feelings you can make a conscious choice about what to do in response.
  • Try a short guided meditation. I love guided meditations for beginners, and there are so many available for free on YouTube. Sit for 5 minutes or less when you first start. Your mind will wander (that’s a normal part of the process), but gently bring your attention back to the guide each time.
To increase your acceptance, imagine taking on the role of a nonjudgmental observer, like an anthropologist studying an exotic culture. The human mind has a natural instinct to label things as good or bad, attract or avoid. As you become more aware of your thoughts, notice how many of them judge reality in this way, and work towards neutral observational statements.
‘Accepting reality’ can feel like surrendering, but Mindful Acceptance is not passive, it’s active. Acceptance is an intentional willingness to acknowledge reality as it is, which moves us from experiencing emotional distress to choosing wise action.  It’s not “I can’t believe this traffic is so slow! If it doesn’t speed up soon I’m going to be late! This is awful and so unfair!” (judgment and resisting reality) or even “This traffic is very slow. I can’t change the traffic, nothing can be done. I guess I’ll just get there late.” (passive surrender), but instead, “This traffic is very slow. I may be late. Hmmm, I could take a different route, or call to let them know. Maybe I will leave earlier next time.”
Lindsay Pasdera, MS RDN
Did you know that a healthy gut microbiome is incredibly important for a healthy pregnancy? The gut microbiome is the collection of different microorganisms in the human gastrointestinal tract. There can be helpful microorganisms (“probiotics”) or harmful microorganisms in the GI tract. Having an unhealthy gut microbiome during your pregnancy increases risk of preterm birth, gestational diabetes, gestational hypertension, and excess maternal weight gain (1). Furthermore, you pass on your microbiome to your baby during birth, so if you have a healthy microbiome, you are giving your baby the best possible start.
Some lifestyle habits can influence the gut microbiome, so don’t smoke or use drugs, and do brush your teeth daily, prioritize your sleep and practice good stress management. But the biggest factor in the gut microbiome is your diet. The following foods are “prebiotic”- foods that feed the good bacteria in your gut so they can thrive. Eating more of these has been shown to improve the health of the gut microbiome:
10. Bananas, especially if a little under-ripe
9.  Jicama
8.  Greens, like dandelion greens, spinach, chard, etc
7.  Steel-cut Oats
6.  Berries (fresh or frozen unsweetened)
5.  Barley
4.  Cabbage & other cruciferous vegetables (broccoli, Brussels sprouts, cauliflower, etc)
3.  Garlic
2.  Beans & Lentils (all varieties)
1.  Onions, Leeks, Shallots, Scallions, Chives, etc
In addition to eating more of the above, include probiotic foods like unsweetened yogurt.  It’s also important to eat less sugar, artificial sweeteners, refined carbohydrates, and animal fats, which have been shown to increase the amount of unhelpful microorganisms in the gut. Pregnancy is a great time to invest in a healthy microbiome for you and your baby!
Wishing you and you family Happy Holidays,
Registered Dietitian Nutritionist Lindsay Pasdera

Eggs are a great choice for breakfast during pregnancy. Many breakfast foods are high in refined carbohydrates and added sugars, so replacing cereal, muffins, waffles or breakfast bars with eggs is a healthy swap. Eggs contain protein, essential fatty acids, choline, selenium, vitamin D, vitamin B12, and phosphorus. The hardest part for many women about having eggs for breakfast is having to cook during a rushed morning. Here is a delicious recipe for Mini Egg Frittatas that you can prep on the weekend and enjoy as a quick and easy breakfast all week long.

Nutritionist Lindsay’s Mini Egg Frittatas
1 tablespoon olive oil
1 medium onion, chopped
1 medium zucchini, diced
1 cup frozen chopped spinach, defrosted
10 large eggs
1/3 cup milk
1 tsp salt
1/2 tsp black pepper
1/2 cup shredded mozzarella cheese
Preheat your oven to 350F. Spray a 12-muffin tin with non-stick cooking spray or line with silicone cupcake liners.
Add the olive oil to a large saute pan over medium heat. Add the chopped onion and zucchini and cook, stirring occasionally, for 5-7 minutes until the veggies are tender. Add the defrosted spinach and cook for one minute longer. Remove the pan from the heat and set aside to cool.
In a large bowl, whisk together the eggs, milk, salt and pepper. Gently fold in the cooled veggie mixture and scoop into the prepared muffin tin. Fill each muffin cup 3/4 of the way full, being careful not to overfill. (If you have leftovers, scramble them up on your stove top).  Sprinkle the mozzarella evenly over each frittata.
Bake the mini frittatas in your preheated oven for 20-25 minutes, or until a knife inserted in the center of one of the frittatas comes out clean. You can enjoy immediately, or cool and refrigerate in an air-tight container for up to 5 days. You can store the mini frittatas in the freezer for up to two months.
Pair two mini frittatas with a slice of whole wheat toast and a serving of your favorite fresh fruit for a healthy breakfast for you and your growing baby.
Lindsay Pasdera, MS RDN

Even if you are not pregnant or planning to be, this topic should be of concern to you.  After all, Medicaid pays for almost half of all the births in the USA with your tax dollars. 4 million women will give birth this year and 13% will leave the hospital with at lease one serious medical complication (hemorrhage, infection, trauma) and a brand new baby. Plus, a surgical birth is not a “medical complication”….and the surgical birth rate is 32.7%. Put another way, one of every three women who goes to a hospital to have a baby ends up with (expensive) major surgery.

Your chances of having a problem and complication during birth are directly related to WHERE you have your baby!


Here are some simple things to look at, and if you cannot get the data from your hospital go somewhere else!

What is the surgical birth rate? How does it compare with other hospitals in the area?

Are women encouraged to have a vaginal birth after having a surgical birth (VBAC)?

What is the episiotomy rate? This procedure, once routine in hospitals, has been proven to cause many problems.  Practitioners who are aware of the latest evidence based practices stopped doing this 20 years ago!

What procedures are routine? Electronic fetal monitoring? IVs? Epidurals? The overuse of these procedures could lead to more interventions and more surgical births.

Mother and baby friendly policies lead to fewer surgical births, fewer complications and healthier moms and babies who are able to establish breastfeeding successfully before discharge.

Is your hospital baby friendly?  Do they follow these 10 Steps?

  • Have a written breastfeeding policy that is routinely communicated to all health care staff.
  • Train all health care staff in the skills necessary to implement this policy.
  • Inform all pregnant women about the benefits and management of breastfeeding.
  • Help mothers initiate breastfeeding within one hour of birth.
  • Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
  • Give infants no food or drink other than breast-milk, unless medically indicated.
  • Practice rooming in – allow mothers and infants to remain together 24 hours a day.
  • Encourage breastfeeding on demand.
  • Give no pacifiers or artificial nipples to breastfeeding infants.
  • Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.

Is your hospital mother friendly?

Your birth will affect your ability to breastfeed! WHO and UNICEF recommend that, to have the best and most successful breastfeeding experience, women in labor, regardless of birth setting, should have access to the following practices:

  • Provide care that is sensitive and responsive to the specific beliefs, values, and customs of the mother’s culture, ethnicity and religion;
  • Allow birth companions of your choice who provide emotional and physical support throughout labor and delivery;
  • Grant the freedom to walk, move about, and assume the positions of her choice during labor,
  • Provide care by staff trained in non-drug methods of pain relief and who do not promote the use of analgesic or anesthetic drugs unless required by a medical condition,
  • Require care that minimizes routine practices and procedures that are not supported by scientific evidence including withholding nourishment, early rupture of membranes, use of IVs, routine electronic fetal monitoring, episiotomy and forceps and vacuume extractor delivery;
  • Encourage care that minimizes invasive procedures such as unnecessary acceleration or induction of labor (pitocin) and medically unnecessary cesarean sections.

By asking the right questions you can be empowered to receive the care you deserve at your birth!

Rosanne Gephart, MSN, NP, CNM

The American Heart Association (AHA) recently came out with new recommendations to limit the amount of “added sugar” consumed by children ages 2-18 years to 24 grams per day. For reference, that’s about the amount in a scant quarter cup of gummy bears. Even when we think we’re making healthier choices, the added sugars may be piling up: just 1 serving of Honey Nut Cheerios and 1 Mott’s Classic Applesauce cup add up to around 20 grams of added sugar. Below you’ll find tips for cutting back on the added sugars in your and your children’s diet, as well as some information on why it’s a worthy effort.

The average American child consumes around 128 grams of sugar per day, or the equivalent of 2.5 pounds of sugar per week. (Check out this Forbes article for other sugar consumption statistics.) At more than 5 times the recommended intake, we’re putting our children at elevated risk for myriad health issues, including heart attack and stroke, type 2 diabetes, cancer, and obesity. And while it’s natural to enjoy sweets, it is possible to help ourselves and our children enjoy more foods without added sugars if we make it a priority.
Which sugars counts toward your added sugar grams? 
  • Any sugar you add to your own food or drinks. This includes white sugar, brown sugar, powdered sugar, raw sugar, honey, maple syrup, molasses, coconut sugar, agave nectar, corn syrup, etc etc.
  • Any sugar the manufacturer or restaurant adds to your food and drink. In addition to the above, this includes high fructose corn syrup, “evaporated cane juice,” glucose, sucrose, maltose, fructose, dextrose, fruit juice concentrates, maltodextrin and barley malt.
  • Many global agencies recommend counting the grams of sugar in 100% fruit juice as “added sugars” as well, because the sugar in fruit juice has been processed out of the fruit (in the same way table sugar has been processed out of sugar cane or sugar beets).  However, the AHA is not currently including 100% fruit juice in the added sugars category.
  • The sugar naturally present in whole fruit and vegetables and unsweetened dairy does not count toward your added sugar grams. These foods have been linked to lower disease risk.
Here are some amounts of added sugar hiding in “kid-friendly” foods:
  • Orange Crush Soda (12 oz): 43 grams
  • Capri Sun Fruit Punch (6 oz pouch): 16 grams
  • Chocolate Milk (8 oz): 13 grams
Hint: Water and unsweetened milk are the best beverages for kids. If your kids resist drinking unsweetened beverages, try using a fruit infusion pitcher or offering them diluted 100% fruit juice (equal parts juice and water). 
  • Kellogg’s Honey Smacks (3/4 cup): 15 grams
  • General Mills Trix (1 cup): 10 grams

Hint: unsweetened quick-cooking oats, with a teaspoon of brown sugar added at home, contain just 4 grams of sugar. Alternatively, sweeten oats with pureed or chopped fruit for a no-added-sugar option.

  • Yoplait Go-Gurt Strawberry Banana (2 oz): 5 grams
  • Dannon Fruit on the Bottom Blueberry Yogurt (6oz): 13 grams
Hint: plain yogurt sweetened at home with pureed (unsweetened) frozen fruit contains 0 grams added sugar. 
  • Treetop Cinnamon Applesauce cup (4 oz): 6 grams
  • Del Monte Peaches Fruit Cup “in lightly sweetened juice” (4 oz): 10 grams

Hint: fresh fruit has no added sugar

  • Uncrustables Peanut Butter & Grape Jelly Sandwich (1): 9 grams
  • Kraft Macaroni & Cheese (1 cup): 6 grams
Hint: Healthier options would include a turkey & cheese or peanut butter & banana sandwich on whole wheat bread.
  • Starburst (8 count): 23 grams
  • M&Ms (1.69oz package): 30 grams
  • Chips Ahoy Cookie Snack Pack (56-gram package): 16 grams
Hint: Fruit makes a great dessert! Save the highly sweetened desserts for special occasions instead of every day. When you do offer sweetened dessert, keep the portions small.
Here are some useful tips for achieving a healthy limit on your, and your children’s, consumption of added sugars:
1) Want your kids to eat less sugar? Eat less sugar yourself! Don’t expect your kids to give up things (like soda) if you’re not willing to give them up.
2) Eat more whole, unprocessed food.
3) Read nutrition labels and ingredient lists. If sugar is one of the first three ingredients in the list, that product should be a rare treat, not an everyday food.
4) Explore ways to reward, comfort and celebrate with your children that are not food-related.
Limiting your own and your children’s sugar consumption is a challenge, but it offers the incredible gift of long-term good health. If you get overwhelmed, start with decreasing the added sugars in weekday breakfasts, or school lunches, etc. This is about progress, not perfection. Any amount of sugar you cut back from your and your children’s diet over the long term will help. Wishing you success and much good health!
Registered Dietitian Nutritionist Lindsay Pasdera

1. Vitamin D is more accurately described as a hormone, not a vitamin. It is produced by the skin upon sun exposure, and regulates bone metabolism (keeping bones strong and healthy), strengthens the immune system, fights inflammation, and supports healthy glucose metabolism.

2. More than 40% of Americans are Vitamin D deficient. Individuals with low vitamin D are at an elevated risk of cancer, heart disease and diabetes.

3. Certain factors increase the likelihood of Vitamin D deficiency significantly:
Being an ethnic minority, especially with darker skin
Wearing sunscreen or otherwise having limited sun exposure, including living in a cold climate or northern latitude
Being vegetarian
Having a BMI over 30

4. You can be deficient in Vitamin D without having any symptoms. To determine if you are deficient, you can have a lab test done to check if your blood levels of vitamin D are in the normal range, which is above 32ng/mL (or above 75nmol/L).

5. Complications associated with inadequate Vitamin D during pregnancy include elevated risk of pre-term birth, cesarean delivery, preeclamsia, infection, and gestational diabetes. Further, a newborn’s vitamin D status is highly dependent on mom’s status, so infants born to mom’s with D deficiency are at an increased risk of abnormal bone growth, fracture and rickets.

6. It’s hard to get enough vitamin D through your diet. Some people recommend increasing sun exposure to increase blood levels of vitamin D, but there are concerns with elevated risk of skin cancer through this route. Vitamin D supplements effectively increase serum Vitamin D without skin cancer risk.

7. There is currently no universal recommendations for taking Vitamin D supplements in pregnancy. Most prenatal vitamins contain about 400 IU of vitamin D. A 2010 study found that pregnant women taking 4000 IU of Vitamin D per day cut their risk of pregnancy complications in half compared to women taking only the 400 IU in their prenatal vitamin. The American Congress of Obstetricians and Gynecologists takes a conservative approach and recommends supplements of 1000 to 2000 IU daily for pregnant women who are Vitamin D deficient. Their opinion statement does say “most experts agree that supplemental vitamin D is safe in dosages up to 4,000 international units per day during pregnancy or lactation.”

8. Vitamin D supplementation can be beneficial during lactation as well. Research indicates that having lactating moms take 2000 IU of Vitamin D per day works as well at protecting infant Vitamin D status (through higher levels of vitamin D in the breast milk) as directly supplementing the baby with 400 IU vitamin D.

Talk to your Nurse Midwife or Obstetrician about your risks for vitamin D deficiency and make a plan together about any supplements to take. Preventing or treating vitamin D deficiency will protect both your and your baby’s health.

Lindsay Pasdera, MS RDN

For starters, your daughter will find that once breastfeeding is established it is convenient, less work, requires no equipment and allows her to go places with her new baby and not worry about forgetting something needed for feedings.

The American Academy of Pediatrics recommends that a baby be fed exclusively breastmilk for 6 months and to continue a breastfeeding relationship for at least a year. Artificial baby foods have been around for a very long time and though they have improved over time they are not specifically designed for this unique child that has been born into your family. Breastmilk is the best food for the health of a baby and breastfeeding is also very healthy for the mother. As a new grandparent your encouragement and support can make the experience of breastfeeding more rewarding for your daughter.

You can help encourage your daughter by reminding her of all of the amazing properties of breastmilk that help keep her and the baby healthy.

For baby: lower risks of ear infections, stomach and intestinal infections, lung infections and asthma, dermatitis, allergies, childhood cancers, diabetes, and crib death. Babies who are breastfed show lower levels of stress hormones.

For your daughter: lower risks of ovarian and breast cancer, diabetes, heart disease, post partum depression, osteoporosis and it encourages weight loss by burning 500 calories a day!

Convinced that it’s important to help your daughter breastfeed? You can help! New mothers need lots of tender loving care and support to be able to give their babies the best food in the world! You can help in many ways, such as :

Help with household chores and errands

Hold the baby while mom eats, showers, or takes a nap

Prepare nutritious snacks for the family

Help with the care-taking of older children, animals, plants etc.

Help control the number of visitors and interruptions (monitor the phone) and encourage her to rest, breastfeed and recover from the process of birth.

Let her know that you are proud of her for breastfeeding and that you will be there for her to help her overcome any difficulties that may come up.

It is OK to ask for help! If significant problems arise, call and get the advice and support of a professional. Lactation Consultants often will come to the home and help the family in the first weeks to overcome problems. Many clinics have special hours just for helping mothers to breastfeed. Like any new skill it takes practice and patience. Your encouraging words and loving support will make a difference!

Better Beginnings Breastfeeding Cafe
Mondays 9:30am-11am
Knox Presbyterian Church in Santa Rosa, CA

Community Breastfeeding Cafe, Opens Monday!

Better Beginnings Breastfeeding Services
(707) 902-3031

La Leche League


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Rosanne Gephart, MSN, NP, CNM