Rises in Rates of Cesarean Section Births

Rises in Rates of Cesarean Section Births In recent history, advancements in medical technology have resulted in an increase in labour and birth interventions. This has in turn, greatly increased caesarean section rates. Birth was once a natural, normal event in a woman’s life, however this has been replaced by a maternity system where intervention is routine and interferes with the normal physiological birth process, putting women and their babies at risk unnecessarily (Romano Lothian, 2008). Normal birth is associated with the best emotional and physical outcomes for women and their babies (New Zealand College of Midwives, 2009). However women have lost confidence in their own ability to give birth without the assistance of technological interventions. Where midwives previously spent their time supporting and comforting labouring women they now spend their time managing technology (Romano Lothian, 2008). This essay will discuss factors which promote or adversely affect the normal physiology of birth and how we can promote the normal physiology of birth within a public maternity hospital setting. Environmental factors which may negatively or positively affect the normal physiology of labour will also be explored. Normal physiological birth follows a natural sequence. Regular painful contractions of the uterus, stimulate and progress the cervix to efface and dilate along with foetal decent. This results in the spontaneous vaginal delivery of the baby and the placenta without complication to either mother or baby (Page McCandlish, 2006). It can be difficult to facilitate normal physiological birth within an environment dominated by a medical approach, where technology and medical expertise are highly valued. The midwife leaders need to show strong leadership to support all midwives. Midwives need to be well educated and competent in the facilitation of normal birth to increase the rate of normal physiological birth (Midwives experience of facilitating normal birth in an obstetric-led unit: a feminist perspective, 2009). Many of the factors that promote normal physiology are environmental in nature. When women are in labour they are extremely sensitive to feeling observed, disrupted or disturbed, this disrupts the natural hormone responses and progress of labour. Women generally find a warm environment preferable so that they feel comfortable to take off their clothing if they wish to do so. When women labour in a calm and quiet environment they feel a change in consciousness to a more primitive brain where birth instincts take over. Privacy and a home like environment also help to facilitate normal birth (Sara Wickham – Midwifery: Best practice, volume 5, 2008). Migrant women have reported that privacy is of particular importance to them (Hennegan, Redshaw Miller, 2014). Women benefit from freedom of movement during labour (Thies-Lagergren, Hildingsson, Christensson Kvist, 2013) and if given the opportunity will instinctively choose a variety of movements to help them cope with labour inclu ding walking, swaying, standing, leaning and the hands and knees position. Allowing freedom of movement benefits the mother in a number of ways including comfort, shortening labour, increased uterine contractions and less need for pharmacologic pain relief. It can also correct poor progress, malposition and sometimes foetal heart rate anomalies (Romano Lothian, 2008). When women push spontaneously without being coached they are less likely to require suturing from trauma and have less pelvic floor dysfunction than women who are coached to push (Romano Lothian, 2008). The AWHONN (2013) recommends women should not push until they feel the urge to push and should do so spontaneously without direction. Women’s experiences of control during labour and birth are overwhelmingly associated with their involvement in the decision making process (Christiaens, 2010). The process of writing a birth plan also increases a woman’s feelings of control as it gives her the opportunity to think about possible scenario’s and plan her responses and choices (Kuo, Hsu, Yang, Chang, Tsao Lin, 2010). Freedom to move around, scream out or make decisions about who enters the birthing space contributes further to the perception of control (Ford, 2009). Women also feel more in control if they have access to information during labour (Tiedje Price, 2008). Health care providers can help to facilitate a woman’s access to information by answering any questions she may have allowing her to make informed choices. When women feel a sense of personal security, derived from feeling respected, trusted and supported by the health care provider who is looking after them, they will experience less fear and an increased feeling of control (Meyer, 2012). Continuous support for women in labour from a female with specialised training is thought to reduce anxiety and stress hormones known to cause vasoconstriction and lower uterine blood flow, which may slow down progress and potentially harm the foetus. Continuous support is said to increase the chance of a spontaneous vaginal birth, lower the use of analgesia, epidural, risk of caesarean and instrumental delivery (Sosa, Crozier Robinson, 2012; Romano Lothian, 2008). These are all important factors in the facilitation and promotion of normal birth and positively affect the woman’s labour and birth environment. There are also many factors that adversely affect the normal physiology of birth, including induction of labour which increases a women’s need for analgesia or epidural and puts her baby at an increased risk of needing neonatal resuscitation. Induction of labour also increases a woman’s risk of caesarean section, instrumental birth, shoulder dystocia, intrapartum fever, low birthweight babies and admission to neonatal intensive care (Tracey et al, 2007). Augmentation of labour can be a tempting option to speed up labour, however amniotomy and oxytocin administration are not without risk. Options such as changing position and talking to women about their emotions, which are low or not risk options, can be as effective and more pleasant for labouring women (Romano Lothian, 2008). Amniotomy can increase the risk of infection, may cause pressure injuries or ruptured placental veins or arteries resulting in significant foetal blood loss. It is also associated with cord prol apse (Cohain, 2013). If amniotomy is carried out early in pregnancy it can set off a cascade of intervention and increase the risk of caesarean section. If labour is still not progressing oxytocin is usually administered and makes contractions stronger and more difficult to cope with as it is exogenous and does not cross the blood-brain barrier, so endorphins are not released to decrease pain perception (Romano Lothian, 2008). Oxytocin administration also puts women at risk of hyperstimulation (Selin, Almstrom, Wallin Berg, 2009). Other interventions such as intravenous cannula and electronic foetal monitoring are also used in this intervention and there is an increase in other interventions such as epidurial which all have added risks. Amniotomy should only be used if progress is truly abnormal while oxytocin augmentation should only be used if labour is truly prolonged with sluggish uterine activity (Romano Lothian, 2008). Epidural analgesia relaxes the pelvic floor muscles mak ing foetal decent and rotation difficult (Al-Metwalli, Mostafa Mousa, 2012). The absence of pain in labour can interfere with the natural oxytocin release. There is also a risk of hypotension so electronic foetal monitoring is used along with an intravenous cannula. Women who use this type of pain relief are less likely to have a vaginal birth and at a higher risk of instrumental delivery, prolonged labour and fever. Their babies are more likely to have infection (Romano Lothian, 2008). All of these interventions carry risks to mother and baby and adversely impact upon the normal physiological birth process. Some of the environmental factors that adversely affect the normal progress of labour include restriction of eating and drinking which began in the1940’s when general anaesthetic was commonly used in obstetrics to reduce the chance of aspiration. General anaesthetic is now rare in obstetrics as is aspiration due to the use of airway protection. Women prefer to have the choice to eat and drink during labour and there is no benefit in restricting them to do so (Singata, Tranmer Gyte, 2013). When women are prevented from eating or drinking they are hydrated with iv fluids, this is also used to access a vein in case of an emergency. Although emergencies do happen there is no evidence to suggest iv access in low risk labouring women improves outcomes. Women with Intravenous lines are not free to move around, may have increased stress levels, may result in fluid overload in both mother and foetus and does not adequately hydrate or provide nutrients. Continuous foetal monitoring has been found to reduce neonatal seizures when babies have been exposed to high doses of oxytocin but has not been linked to positive long term outcomes. It does however increase the risk of caesarean section and instrumental delivery without a clear benefit to the baby and reduces the mother’s ability to mobilise (Alfirevic, Devane Gyte, 2013). These environmental factors have a negative affect on a woman’s normal progress in labour and should be avoided if possible. A midwife-led continuity of care model has been found to benefit women and their babies in a number of ways when compared with medical and shared models of care. Benefits include decreased use of epidural, less episiotomies and instrumental births and less preterm birth or loss of baby prior to 24 weeks gestation. Women also had more chance of having a spontaneous vaginal delivery. As a result a midwife-led continuity of care model gives women the best chance of having a normal physiological birth (Sandall, Soltani, Gates, Shennan Devane, 2013). For a midwife to promote the normal physiological birth process and give effective and appropriate care, she needs to establish a relationship with women antenatally. It is important for the midwife to get to know each woman and her wishes and dreams for her impending birth (New Zealand College of Midwives, 2009). This allows a partnership of trust and respect and helps to alleviate any fears or anxieties and share appropriate and correct information before the birth. When women talk about their fears with the midwife, she will be better informed and able to provide woman centred care (Pairman, Tracy, Thorogood Pincombe, 2010). Midwives need to use evidenced based practice staying within their scope of practice. Whenever a midwife interacts with a woman, she needs to support normal physiological birth and the natural cascade of normal labour. Every interaction she has with a woman affects this cascade either positively or negatively (New Zealand College of Midwives, 2009). When wome n are in labour midwives need to consider the woman’s birth plan while maintaining a private warm room. It is also important to encourage her to find a comfortable position with appropriate comforts such as pillows and beanbags. Encouraging partners to support women by providing drinks, cool washers, and other physical support is an important midwifery role (Pairman, Tracy, Thorogood Pincombe, 2010). Midwives need to be unobtrusive and well prepared with safety equipment. When women are in the second stage of labour midwives need to encourage position changes to help decent where appropriate. Soothing hot compresses can be used on the perineum and vulva while the midwife gives clear and calm reassurance until the baby is born and given to the mother for skin to skin contact. These factors will help midwives to facilitate the normal physiological birth process (Pairman, Tracy, Thorogood Pincombe, 2010). Midwives need to practice cultural safety by reflecting on their own cul tural values and identity in an effort to recognise the impact their own culture has on their practice. It is important for midwives to understand their position of power within the healthcare system (Page McCandlish, 2006). It is in most women’s best interest to have a normal physiological labour and birth as it provides the best physical and emotional outcomes for both mothers and their babies. It is the midwife’s role to ensure birth proceeds as normally as possible and interventions are only used when absolutely necessary. To achieve this, midwives need to understand the factors that promote and adversely affect the normal physiological birth process and any environmental factors that may negatively or positively impact on a woman’s labour and birth. There are a number of different models of care available to pregnant women, however it has been found that a midwife-led continuity of care model gives the best possible chance for a normal physiological birth and labour. Midwives need to create a calm, quiet, culturally safe, supportive environment where women feel safe and secure to use their natural birthing instincts and encourage position changes where appropriate. The environme nt needs to be well equipped with comforts such as pillows and beanbags and any safety equipment that may be needed. Although it can be difficult to facilitate a normal physiological labour and birth within a medically dominated environment, if midwives have strong leadership and are well educated to facilitate normal physiological birth they are more likely to increase the rates of normal birth.

Play activity for children Essay

Play is an essential part of every child’s life and is vital for the enjoyment of childhood and as well as social, emotional, intellectual and physical development. Having the time and space to play allows children the chance to keep them physically active and it gives them the freedom to make their own choices about what they want to do. Research shows that play has a range of benefits to the child, family, and the community, as well as improving healthy and quality of life. Play also helps the child improve their self-esteem, self-awareness and self-respect, it gives child a chance to mix with others and develop new skills. Playing can help Manshu with her potty training, such as role-play with dolls could help Manshu understand all about what potty training involves. It could also make the child become much more relaxed about this step in life. For Jessica play (role-play with dolls) could help her understand all about her baby sister and what is happening in the changes at home in her life. Whilst children are in my care I will do my best to offer a range of activities for children to participate in, I will also allow children to give a choice in which activities that the want to participate in, as this will allow the child to become more independent. I feel that it is important for children to be encouraged to do as many activities as possible rather the same thing all the time. By rotating the toys that you have out available for the children to play with it means that they will be learning through play on a range of toys rather than being able to play with the same toys all the time. I think that i t is important that children learn about different cultures and that not all people have the same abilities, children can also learn about these topics through play using ethnic dolls, puzzles, books, art and crafts and cooking food from different cultures. This means having materials, toys, resources in your setting that reflect the diversity of our society. Thus play can help Manshu with her potty training, such as role-play with dolls could help Manshu understand all about what potty training involves. It could also make the child become much more relaxed about this step in life. For Jessica’s play (role-play with dolls) could help her understand all about her baby sister and what is happening in the changes at home in her life. Domestic routines that children can be involved in and how this supports their learning: Activity How can this benefit the child Helping to prepare snacks/food Helps children develop a good understanding of hygiene practices which helps develop personal, social & cognitive development. Using tools (suitable for children) to cut/prepare the food/snacks helps their sensory development and also builds their physical development. Setting the table at meal times This will help develop their independence, it also helps them to learn to follow instruction helping their language skills, matching children’s place mats to their cups & plates can also help learn matching skills, helping their cognitive development. Children could help to tidy up which would develop their social & emotional development. I would make a game out of this & count the things they pick up, helping their mathematic development. Hanging clothes on the line This will help their understanding of how the wind and heat dry things and how we use water for things and not others. Games can also be made of if this using the colours of clothing and pegs etc. Messy Play with Household items e.g. shaving foam, water Messy play encourages children to use their imagination and be creative which helps build self-confidence and self-esteem. Tidying up Children could help to tidy up which would develop their social & emotional development; I would make a game out of this & count the things they pick up, helping their mathematic development. Getting ready for the school run/going out Getting ready to go out children can learn about different body parts as they put on their coast, wellies etc. Then when outside you can help the child’s knowledge & understanding of the world. Climbing & playing on outdoor equipment helps a child’s physical development & co-ordination. It is easy to think about what learning can be achieved from a particular activity but I am aware that some activities may include potential weaknesses for some children, for example ‘preparing snacks and food’ and ‘setting the table’ will not be suitable for younger children in the same way that older children would not benefit from a ‘messy play activity’ which is why having a variety of activities the children can participate in on a daily basis is paramount to their learning. Through observing and keeping a written record of observations of children at play, is a way for you to learn how the child learns, what they enjoy, the development stage they are at and how to plan activities for that child. As children learn through play, when you observe them at play, you will learn the stage they are at, and this will allow you to plan for them individually. You will also learn what kind of learner the child is. Keeping a record of a child’s development is very important, so you can recognise if they are advancing or maybe falling behind some early learning goals. Observations are a great way of sharing information with parents too. Keeping observations will allow you to plan efficiently for each child, knowing where to focus some learning and for you to plan different challenges for the child to allow them to progress. Keeping a learning journal and incorporating your observations into this along with pictures and pieces of the child’s work, will a llow you to keep a good chronological diary of the child’s progress, and make planning run smoothly and well. Children need to be treated as individuals, equally and with respect. The children’s act 2004, has the requirement to treat all children as individuals, and with equal concern. Every single child is different, will enjoy different activities, dislike different activities, and have their own way of learning, through play, and other activities. It is the responsibility of the child carer to ensure they cater for each and every individual need. To do this effectively, you will need to plan for each child, taking observations, and get to know the children in your care well. Everyone that comes to your setting should be welcomed and respected, their beliefs and interests respected as well as their personalities, needs, values, abilities and interests. It is essential that you do not discriminate for any reason, and offer an inclusive environment, and cater and treat everyone equally. Meeting the individual needs of every child is so important, as this ensures they are receiving the best possible care, their rights are being met, opportunities, and an environment that lets them grow and learn at their own pace, securely, safely and happily. The rights of every child are paramount in childcare, when you acknowledge the rights and individuality of every child, you can offer an inclusive setting, where everyone is treated equally and with respect. The best interests of the child must be the primary consideration in all activities concerning the child, and children have the right to be protected from all forms of discrimination. Drop-in sessions can be invaluable in providing support and an opportunity to share ideas, good practice and resources. Planning special days out with the children to the park, museums, libraries etc. can help a child’s development. You could take a camera & let the children take photos, making a storybook all about your day. Meeting up with other childminders for picnics and other days out can help the children form new friendships & help you learn and develop by discussing different ways of play. Other forms of play you could do at home are ‘keep fit’ session, there are a lot of cd/DVDs out there that are made for kids & adults to do, children will find this lots of fun & will help develop their physical development. Whether the day is spent inside or out it should be both fun and informative for the  children and offer a variety in their learning. Although routine is great for children at times it may benefit the children for me to slightly change the routine for example whilst Manshu is potty training I may decide not to attend childminder drop-in or any other sessions to stay at home and develop her potty training in my home, once competent I would reintroduce the outings. Another example of when I might need to slightly alter a routine is if a child becomes unwell and is waiting to be collected early the other child(ren) may need to sacrifice their outing/activity to ensure that the unwell child is safe and comfortable until collected. Regardless of the activity I always adhere to The United Nations Convention on the Rights of the child act which was drawn up in 1989. The act consists of 54 articles stating that all children must be shown respect and that their well- being is the principle factor. The three main areas of this act include:  · Provision (access to food, clean water, housing, education, healthcare etc.)  · Protection (being safe from abuse and discrimination.)  · Participation (having their views heard and participating in making decisions.)

Differences Between the French and Spanish

Englishmen migrated to the New World because they wanted independence, political freedom, and economic opportunity. The Spanish came as conquerors; the resulting political system was entirely autocratic and solely devoted to the furthering of the motherland. Spain gave its colonies little self-rule. Instead, Spanish rulers dictated all the policies of its New World territories. The English and Spanish both wanted to explore and find new territories too politically and economically control. The Spanish colonies developed economically by using the Encomienda system.In this system, Spanish lords exploited and manipulated Native Americans and used them to do manual labor on the land. The Spanish looted large amounts of gold, silver, and other valuables from this new land. This tradition continued into the seventeenth century as Spanish ships would come annually to bring gold and other valuables back to Spain. The Spanish tax burden was very unevenly distributed: it fell more on the poor than the rich, heavily on the agricultural sector, and on Castile far more than Aragon or the Basque country.But the Spanish government's expenditure continued to climb: – in the first twelve years of Philip III's reign, he spent over 40 million ducats on the Low Countries' wars alone. To cover the shortfall, the Spanish government both borrowed money by being interested in bearing state bonds and assigned the revenues from future years to the bankers if they would pay the defense contracts for the present year. By 1607 the government had a debt of almost 23 million ducats and had assigned away all its revenue for four years ahead. By 1644 the crown's income was pledged to 1648; and by 1664 the crown owed more than 21 million ducats.The English Colonies had abundant natural resources. Their economy prospered in the fur trade, fishing, lumbering, farming and other industries that produced raw materials. This abundance of natural resources stimulated trade into the colonies as developed industries in Europe required raw materials to convert into refined goods. Combined with England's tradition of partial representation, the English Colonies had a large degree of self-government. In 1603, moderate Puritans in England hoped the new monarch, James I, would be sympathetic to their iews, since he had been raised in Calvinist Scotland. Although this did not prove to be the case, the Puritans still tried to work within the religious system while he was king. The colonies all had some form of a representative assembly that was voted in by popular support. While only white male landowners could vote, this still constituted some degree of democracy. In some colonies, even the governors were decided by popular vote. The English and Spanish colonies were established for completely different reasons. England colonizes North America.English colonies were first established by the Puritans who were seeking refuge, freedom of religion, and economic opportunity. The Englis h colonists enjoyed far more freedom. English had established dominance in North America. The Spaniards came to America's on accident in a futile attempt to find an alternate trade route to china, with a thriving community, complex architecture and cities of gold. Conquistadors, soldiers, and missionaries were the primary Spanish colonizers; farmers and traders came later. Colonies were governed by crown-appointed viceroys or governors. Settlers had to obey the king's laws and could make none of their own.

The Target Customer Segment That Uber - 1048 Words

The specific environment, which is the set of forces and conditions that operate beyond an organization’s boundaries but affect its ability to acquire and use resources to create value, of a company is impacted by their customers, distributors, unions, competitors, suppliers, and the government. All forces impact Uber and how the organization reacts to its general and specific environment. The target customer segment that Uber is trying to attract to its company are people who do not own a car, don’t want to drive themselves to a party, want to travel in style, or want a cost efficient cab waiting for them at their door. Specifically, according to Vugo, a rideshare advertising firm, the majority of Uber customers are between the ages of 25 and 35. In addition, the typical rider is male (60%), has at least a bachelor’s degree (80% of riders), and are considered to be affluent (56% of all rideshare passengers reported a household income of at least $71,000). If the demand from these customers’ change, then Uber will be forced to evolve to retain the customer segment, while adapting to the new segment. According to Anne Freier, in her article â€Å"Uber usage statistics and revenue† on Business of Apps, Uber currently offers their service to sixty countries, have eight million users, and give over one million rides daily.1 By offering more specialized rides Uber is trying to gain a larger market share and customize the experience to their customers. They are continuing to expandShow MoreRelatedBusiness Model Analysis On The Management Of The Enterprise And Operational Design1143 Words   |  5 Pagesenterprise and operational design to conform to profit-making goals by implementing the segmentation of business activities. The research report will employ the business model canvas to study and perform data analysis on the quickly growing taxi company Uber Company. Data analysis is the deliberate activity of collecting and pre senting data in a form that highlights useful information that is helpful in decision-making (Boyd, 18). Data analysis can be described as the implied process of taking the wholeRead MoreInternal And External Forces Impact On The Organization1178 Words   |  5 Pagesan organization’s boundaries, but also affect its ability to acquire and use resources. The specific environment is impacted by their customers, distributors, unions, competitors, suppliers, and the government. All internal and external forces impact Uber and how the organization reacts to its general and specific environment. The target customer segment that Uber is trying to attract to its organization are people who do not own a car, don’t want to drive themselves to a party, want to travel inRead MoreUber Leading On The Sharing Economy1575 Words   |  7 PagesUBER Leading in the Sharing Economy Enterprise Strategy KELLY: THIS WAS A GOOD PAPER AND I APPRECIATE THE TIME YOU SPENT EDITING AND PROOF READING IF FOR EFFECTIVENESS. YOUR WORK WOULD BE MORE EFFECTIVE IF YOU DREW MORE CONCLUSIONS FROM YOUR ANALYSIS. FOR EXAMPLE, IN THE FIVE FORCES, YOU SHOW MUCH THAT SUGGESTS THAT THE UBER BUSINESS MODEL WILL HAVE TROUBLE PRODUCING SUSTAINED PROFITABILITY. IF THAT IS SO, THEN WHY IS THE FIRM SO HIGHLY VALUED AND EXPANDING SO RAPIDLY? THIS SUGGESTS THAT THERead MoreAnalysis Of Porter s Five Forces Of Competition Framework1539 Words   |  7 Pagesnew market entrants, and established firms as well as the power of buyers and suppliers. One of the main topics with this framework is the availability of substitutes which addresses the sensitivity to the price of a product or service and when customers will switch. Porter’s framework does not include the availability of complimentary products. The threat of entry addresses the attractiveness of the industry including the requirements and cost o f becoming established and competing, whether productsRead MoreUnethical And Socially Responsible Business Actions1080 Words   |  5 Pagesmany illegal, unethical, and socially responsible business actions taking place. When something is illegal it means that it is forbidden by law. While many love the convenience and simplicity of Uber, the business model has been criticized as illegal. Uber treats its drivers as independent contractors and Uber should not be allowed to set prices, which is called price fixing and is illegal. They have been challenged numerous times and are at risk of being found guilty of antitrust practices. An unethicalRead MoreThe Marketing Model Of Uber1784 Words   |  8 PagesBetzanely Bueno Uber Uber is a San Francisco based high tech company that sources ride transportation service and food delivery service through a mobile app. Uber was founded in 2009 by Garrett Camp (co-founder of StumbleUpon, a web discovery platform) and Travis Kalanick. The company’s mission statement is â€Å"transportation as reliable as running water, everywhere for everyone.† Accordingly, Uber is the largest and most well-known mobile ride sourcing company in the industry. It has expanded toRead MoreHow Zipcar Has Become More Than A Car Rental Service1054 Words   |  5 Pagesconsumer involvement and market mediation. The nature of exchange, consumption and brand community are discussed. http://jcr.oxfordjournals.org/content/39/4/881 â€Æ' Many studies have shown car sharing reduces the cost of transportation for a large segment of urban dwellers. It also reduces the number of cars on the road because the members do not own cars. Zipcar is a company founded in 2000 by Antje Danielson and Robin Chase. By 2010 it had over 8000 vehicles offered to over 560,000 members inRead MoreCase Study : China s Auto Industry Essay1472 Words   |  6 Pages China has the youngest premium car buyers in the world, and these tech-savvy customers are demanding connected cars at far higher rates than elsewhere. In fact, several surveys have shown that when making purchasing decisions, Chinese customers are more concerned about a car’s in-car technologies than its design or performance, and would be willing to change brands for better connectivity. Secondly, Chinese customers are willing to spend more for safety features, and would pay more for vehicle managementRead MorePredictive Analytics And E Commerce And Internet Based Services Industry1722 Words   |  7 Pagesstrategize and also redefining customer expectations. Analytics is the new differentiator between success and failure in the cut throat e-commerce and internet services based industry. The huge proportions of data generated from the increasing number of smart phones, the social networks and the ever more penetrating internet are automating customer centric marketing and other services. The idea is to predict what a customer may want to buy even before the customer realizes what they need. The techniquesRead MoreMod Assistants : A Service Company1503 Words   |  7 PagesCurrently, the business is small (about 10 clients as of right now). Initiating service requires sending a written request via the website; this builds on their commitment to providing a personali sed service and developing a relationship with the customers/clients. Personal services are priced at $135 for 4 hours a week, $250 for 8 hours a week, and $35 an hour for more specific time requirements; additional hours are added at a discounted price. Business services are priced the same with the exception