What You Need to Know About Light Bladder Leakage

By Susan A Peck, RNC, MSN-APN

What do a 30 year old pregnant woman, a 67 year old who has 3 children – all delivered vaginally- and a 45 year who has never been pregnant have in common?  They are all experiencing light bladder leakage and each of them feels embarrassed to discuss it.  Bladder leakage is very common and can occur in any woman, of any age, and of any pregnancy status!

Light bladder leakage also known as urinary incontinence, is an involuntary loss of urine.  It is estimated to occur in up to 1 in 4 women.  The two most common types of incontinence include stress incontinence and urge incontinence, but some women can have a combination of both types.

  • Stress incontinence is the loss of urine (small or large amounts) from activities that cause pressure on your bladder such as coughing, running, jumping, or sneezing. It happens when the pelvic floor muscles- that support the bladder- weaken.  The weakened muscles can be caused by pregnancy, previous vaginal births, obesity or being overweight or chronic urinary tract infections.  Sometimes, incontinence may occur without any of these risk factors.
  • Urge incontinence is the frequent sudden need to urinate that often causes bladder contractions and the loss of small or moderate amounts of urine. It happens from bladder irritants such as caffeine or alcohol, excessive hydration, use of certain medications such as diuretics (water pills), or neurological conditions.  In some women, this may be called an overactive bladder.

As a Women’s Health Nurse Practitioner, I ask my patients about bladder leakage and incontinence- because most of the time they will not mention it to me first. Here are two stories which are very similar to real life cases I see every day.    The first was a 55 year old fitness instructor who has 3 children, all delivered vaginally.  She sees me once a year for her annual well woman exam and this year when I asked her if she had any bladder leakage, she said yes, that it just started about 6 months prior.  She was quite surprised by this because she teaches Pilates as well as Zumba and thought she had a pretty “strong core”.  But lately, in Zumba class she would feel dribbles of urine coming out.  She was embarrassed someone would see it on her pants, so she’s started to wear a pad to class, but hated exercising while wearing one. Patient B is 30 years old, a mother to a 2 year old son born via cesarean section and working full time.  When I asked her about incontinence, she told me that since her son was born, she leaks urine each time she coughs or sneezes and notices that it happens more when she drinks coffee – the caffeine she needs because of her busy life!  She was also quite surprised that the leakage is happening because “she is young and did not have a vaginal birth”.

Both of these women were surprised to know how common bladder leakage is, but very happy to know they are not alone.  During their pelvic examinations, I asked them to each perform a Kegel exercise- by contracting the pelvic floor- so that I could assess their pelvic floor tone.  The Patient A did the Kegel correctly, but had poor tone.  Patient B did not perform the Kegel correctly – instead she was bearing down/pushing out.  I routinely test my patients for their pelvic floor tone and at least 50% of the time, tone is poor, or the exercise is not performed correctly.

Below are some tips to help maintain good pelvic floor muscle tone, which is is critical to prevent or improve bladder leakage.

  • Kegel exercises are the easiest way to strengthen these muscles, as well as pilates exercises which focus on strengthening the core. Here is a link from the Mayo Clinic to assure you’re practicing them correctly.
  • Weight loss is very important in the management of bladder leakage. Even just a 5-10 lb loss can relieve some abdominal pressure against the bladder.
  • Try to reduce exposure to bladder irritants such as caffeine and alcohol and to not let your bladder get too full – even during busy days!
  • For some women, referral to a physical therapist that specializes in pelvic floor physical therapy can also be very helpful. Yes, there are physical therapists that specialize in this important muscle group!  In situations where these conservative measures do not help sufficiently, there are urogynecologist physicians – who are gynecologists who have a sub-specialty in pelvic floor medicine- who may offer other treatments including surgery.

Light bladder leakage is a common complaint among women of all ages.  If you are experiencing this, please mention it to your nurse or health care provider, if they don’t ask about it first.  Many women believe it is a normal part of ageing or a normal consequence of pregnancies or childbirth – but there are ways to help, so do not feel embarrassed or uncomfortable bringing up the subject and asking for help.


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Susan A. Peck, RNC, MSN, APN is a practicing Women’s Health Nurse Practitioner. For 20 years, Ms. Peck’s career has focused on women’s health care, first as a labor and delivery staff nurse and for the last 16 years as an Advanced Practice Nurse. She currently works in the Department of Obstetrics & Gynecology within Summit Medical Group, a large multi-specialty practice group in Northern New Jersey.

Ms. Peck’s areas of expertise include contraception, osteoporosis, general gynecology and prenatal care. She has spoken at several national and state conferences including the AWHONN National Convention.

Human Trafficking in Our Own Backyards

by, Leith Merrow Mullaly, RN, MSN, IBCLC

Learn more about AWHONN’s position on this critical topic.

Slim and obese, tall and short, strikingly beautiful and very plain, black, Asian and white…literally the girls who live next door.  These are the young women I support and with whom I work.  They are all victims of sex trafficking right here in the “good ole U.S.A.”

Most of us think of sex trafficking as something that occurs in Africa, Southeast Asia, the Middle East, Russia or South America.  Unfortunately it is estimated that there are almost 300,000 women, children and even men who are trafficked for sexual purposes in our own country.  I have been told by multiple young women that there is not a single hotel or motel in the United States where a prostitute cannot be obtained!  This includes the most expensive and elegant big city hotel to the most humble rural establishment.

Prostitution is much more lucrative than drug dealing.  A single pimp can earn more than $1.5 million every six months with 6 women or children in their “stable”.  The chances of being apprehended are fairly small and there is often no one to testify against the pimp.  I have worked closely with a young woman who finally agreed to testify against her pimp only when the F.B.I. put her into hiding.  Two previous potential witnesses had “disappeared” and are assumed to have been killed.  (It is most distressing to learn that this pimp is a husband and father with children in an elite private school.  He is a highly respected businessman who owns several companies and is known for his charitable giving!)

My husband and I serve on one of the few Foundation Boards in our nation that is providing real hands-on help to these young women.  This sheltered home, provided by  the county and located in a small city,  offers not only a safe escape away from their dangerous traffickers/pimps but most importantly, individual and group trauma-based counseling  because many of our residents are suffering from PTSD, dissociative and other personality disorders.  Most of our residents were on the street by age 14!   Many of our young women are pretty badly damaged and not easy to handle initially. They are combative and angry and extremely defensive.  They cannot TRUST!  They express profound shame and state “I feel so dirty”. We take them to free clinics to treat their STDs and obtain medications for their anxiety disorders, which are often severe.  We help them finish their GED certification and work closely with our community college on educational opportunities.  We offer classes on body image.  We try to introduce them to what a healthy male-female relationship should be via “Pizza Night”. One or two married couples, who really care, bring pizza and spend the evening eating and visiting.  Sadly, for some of our young women, this is a totally new experience. Things that you and I accept as common and expected, these women have never known.  We held the very first birthday party for a twenty year old!

One day a young woman decided she really wanted to move forward.  She asked if we thought there was a “thrift shop for prostitutes” where she could donate all her clothes “because some of these outfits were very expensive”! Instead, we had a big bon fire!  Today she is in college, hoping to become a nurse.  As nurses, we have seen and experienced so many facets of life.  We know about child sexual abuse.  Yet, have we really considered what happens to them long term?  Certainly many children receive help, counseling and appropriate adult love and support.   I must confess that I had not consciously made the direct connection between abused children and victims of sex trafficking.  Men in prison have bragged that they can spot a vulnerable young person in less than 2 minutes!  I was truly ignorant about the scope and size of sex trafficking…right here in our own backyard.  This is the impact and outcome for many victims of childhood physical and sexual abuse.  I sincerely hope that I may open your eyes and hearts so that when you see a prostitute, you see a victim and not a criminal.

When you see a young woman “on the street” or in your clinic, L&D or E.D. be alert to signs and indicators of possible human trafficking.  While not all signs prove human sexual trafficking, some of the following should be “red flags”:

  • No stable address & no family, community connections
  • Very unclear past history
  • An overbearing male companion
  • A “beaten-up” body, often with healing scars
  • A number tattoo (pimp’ s ID)
  • Emaciated, starved appearance
  • STD (almost 100%)
  • Scanty clothes (often 2 sizes too small & often animal prints)

When you encounter these kinds of signs we need to at least think “sex traffic victim”.  Yes, victim!  Most, if not all young women and to a lesser degree, young men, end up on the street because they are victims of repeated child sexual abuse at home.  Pimps brag that they can spot a “vulnerable prospect” in 2 to 10 minutes!

As nurses we need to grasp the pervasive nature of this problem…NOT in some far off country, but rather, right here at home…in our own backyards.  I was naïve about all this until I became involved with one of the very few homes in the United States offering a safe haven for these young women.  We work with the state police, the F.B.I. and Homeland Security to get sex- trafficked women off the street.  It is estimated that there are only 100 beds nationally for sex trafficked women over the age of 18 and only another 100 beds for those less than 18 years old.

I’ll be writing more about this topic and what we can all do to help these victims in upcoming AWHONN Connections blogs.

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AWHONN believes Nurses are ideally positioned to screen, identify, care for, provide referral services for, and support victims of human trafficking. Therefore, the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) supports improved education and awareness for nurses regarding human trafficking. Learn more about AWHONN’s position on this critical topic.

leithLeith Merrow Mullaly, RN, MSN, IBCLC
Leith Mullaly is a past president of AWHONN and has served at all levels of the organization. Leith has a passion for both nursing and the specialty of Women’s Health and Newborn care. Her focus within AWHONN has always been to mentor future leaders and encourage nurses’ participation in their professional association. She has experience as a Staff Nurse, Staff Educator, MCH Director, Clinical Faculty Member, Certified Lactation Consultant and Author. She is a nationally ranked speaker on topics such as Postpartum Depression, Breastfeeding, the Image of Nursing, Service Excellence, Perinatal Loss and Bereavement, Mature Primiparas. Her interest in care for Victims of Human Sex Trafficking has been a major focus for the past several years.

The Cornucopia of Contraception

by, Susan A Peck, RNC, MSN-APN

In 2000, as a new Women’s Health Nurse Practitioner, the provision of contraception to my patients was actually pretty simple.  Most every woman who wanted hormonal contraception used the pill, and there were only a handful of brand name oral contraceptives that we all knew and regularly used.

Shortly thereafter, in 2001, the contraceptive patch and the contraceptive vaginal ring were approved by the FDA.  These other two options quickly became competitors to the oral contraceptive market and gave patients and clinicians more choice, and ways to avoid the sometimes daunting responsibility of daily pill intake.

In the background was the IUD – only ParaGard and Mirena were available at that time.  Still holding on to the worries of the unsafe IUDs of the 1970s and 1980s, most women and clinicians were not supportive of these devices at that time – fortunately that has dramatically changed!  In 2013, the Skyla IUD became available and the Liletta IUD followed in 2015.  And let’s not forget about the contraceptive implant, Implanon (now Nexplanon) that was approved in 2006.

Barrier methods have also always been accessible to women, such as condoms (male and female) and various spermicidal formulations, as well as the diaphragm – did you know the “old” diaphragm is no longer available, but that there is a new one, Caya?

So, when we consider all of these options, and factor in the complexity of some women’s medical conditions or social practices, how can women’s health clinicians consider not only which method might be most acceptable to a woman, but also which method is the safest??  There certainly is a lot to keep track of with all of today’s contraceptive choices.  And if a woman does not use her method correctly, what can a clinician advise?

Fortunately, the CDC has recently published two documents, the 2016 US Medical Eligibility Criteria for Contraceptive Use (MEC) and the 2016 Selected Practice Recommendations for Contraceptive Use (SPR).  The references are invaluable for any clinician who is providing contraception to women.  I have a copy of both at my desk in my office and even after 16 years of practice, I regularly rely on their guidance to make the best, safest recommendations about contraceptive choices for my patients.

I’d like to tell you about two recent patients, for which both references helped guide my decision making. 

First, Jennifer, a 32 year old woman living with multiple sclerosis, has used oral contraceptives successfully for five years.  She enjoys the regular, very light periods she has with the pill, and is a very responsible pill taker – never misses one!  But, this year, when I see her for her annual exam, I learn that her MS has unfortunately taken a turn for the worse.  She is currently in a wheelchair more the 50% of the time and her mobility is greatly limited.  She is very hopeful that this period of immobility will be short lived – there is a new MS drug she is starting next month.  So, I begin to wonder whether an oral contraceptive is the best, safest method for Jennifer.  I use my 2016 MEC App on my phone and determine that due to her immobility related to MS (increased chance of hypercoagulable state) it may be time to change methods.  She and I discuss all options and she decides on the Mirena IUD.  Not only is she pleased with a long term method, she feels more comfortable knowing she is safe – it is one less thing she has to worry about.

My next patient is Mary, a 20 year old healthy college student who tells me that she wants to use the contraceptive implant, Nexplanon.  She is going back to school out of state in two days, and would really like to have the implant inserted today.  In the past, some clinicians have traditionally preferred to insert LARC methods during a woman’s menstrual period to “make sure she is not pregnant”.  However, this is often cumbersome for scheduling and delays an opportunity to provide effective contraception.  So, I use my 2016 SPR and review the section ‘how to be reasonably certain a woman is not pregnant’.  I determine that since Mary has consistently and correctly used condoms since her last period, it is safe to assume she is not pregnant. After receiving her informed consent, I safely place the Nexplanon and she is able to return to college with a highly effective long term method of contraception.

It is important to remember that in nearly all situations the use of a birth control method is safer than an unintended pregnancy. These CDC resources are invaluable guides for clinicians so we can be confident our contraceptive recommendations are based on the latest evidence.  Both the MEC and the SPR are available free – of- charge with the option of downloading an APP for your device.

Tell your colleagues and have these references close at hand!

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Susan A. Peck, RNC, MSN, APN is a practicing Women’s Health Nurse Practitioner. For 20 years, Ms. Peck’s career has focused on women’s health care, first as a labor and delivery staff nurse and for the last 16 years as an Advanced Practice Nurse. She currently works in the Department of Obstetrics & Gynecology within Summit Medical Group, a large multi-specialty practice group in Northern New Jersey.

Ms. Peck’s areas of expertise include contraception, osteoporosis, general gynecology and prenatal care. She has spoken at several national and state conferences including the AWHONN National Convention.

 

 

 

Like Mother, Like Daughter: Working to Wipe Out Diaper Need

by, Jade Miles

Michelle and Corinne

Michelle Delp and daughter Corinne

Helping mothers and babies comes naturally to mother-daughter team Michelle and Corinne Delp. This dynamic duo has made a big impact on families experiencing diaper need in their hometown of Rome, PA.

Michelle Delp, RN, has been a nurse for 30 years, and for the last 7.5 years she has worked as a maternal-child home visiting nurse for Nurse Family Partnership (NFP) of Bradford, Sullivan, and Tioga counties in Pennsylvania. She works with first-time low-income moms beginning in the second trimester of pregnancy through their child’s second birthday. NFP nurses offer the support these women need to deliver healthy babies, become confident parents, and achieve their life goals. Michelle is certified as a childbirth educator, birth and bereavement doula, and lactation counselor.

It’s no wonder that the apple doesn’t fall far from the tree; Michelle’s daughter Corinne starts nursing school at Arnot Ogden Medical Center this fall. Corinne has had many opportunities to learn from her mother. She shadowed her mother when Michelle was a camp nurse, and they have even found themselves helping out side by side at the scene of several accidents. Corinne’s natural caring instincts and up-close-and-personal experiences with her mom have put her on the path to becoming a nurse.

Before graduating from North Rome Christian School this past spring, Corinne needed to complete a senior year service project. Driven by her love for babies and children, Corrine—who also works as a nanny—chose to organize a diaper drive for the Endless Mountain Pregnancy Care Center (EMPCC) in Towanda, PA. She called it “Bottoms Up for EMPCC.”

delp photo 1Corinne first learned of EMPCC when they came to speak at her church and became increasingly familiar with the organization by serving at their yearly fundraising banquets. Knowing that EMPCC is frequently in short supply of diapers and moms can’t use food stamps to pay for them, Corinne felt certain that a diaper drive would be perfect for her project and would also serve a great need in the community. She fulfilled her 30-hour requirement while working tirelessly to market and organize the drive, as well as collect, transport, and stock diaper donations at EMPCC.

They advertised the diaper drive on Facebook for just under a month, and word soon spread about the event. The volume of donations exceeded Corinne’s expectations: The grand total came to 6,212 diapers; they had also had several people donate wipes. Michelle credits their success to the true sense of community in her small town.

Another clever idea? Add a little incentive to encourage folks to donate. Michelle and Corinne took advantage of a Target promotion and created a Target registry with diapers in a variety of sizes and also some wipes to help people reach the free shipping total. The promotion the first week was to purchase three packs of diapers and receive a $20 gift card; the second week, it as a $30 gift card with a purchase of two bulk packs or a $10 gift card with the purchase of two giant packs.

delp photo 3All items were delivered to Michelle and Corinne’s home, and they personally delivered everything to EMPCC. Both ladies said that hearing the UPS truck come by was always exciting because it signaled the arrival of more donations. In fact, North Rome Christian School administrator and EMPCC board member Lee Ann Carmichael decided to request that more shelves be built to accommodate the influx of diapers at EMPCC. At the end of the drive, Corinne’s senior class of 10 students filled those shelves to the brim, all as a result of the kindness and generosity of their friends, neighbors, and colleagues.

The experience left a lasting impression on this mother-daughter pair, and they were both touched to see people coming together to make a difference. “People are generous, even when they don’t have enough for themselves,” said Michelle, referring to several of her clients from NFP who wanted to donate leftover diapers from their children as they had changed sizes (Note: Most banks will accept loose diapers or open packs; just call ahead to ask).

“I learned that being able to reach out and communicate with others outside of my normal social circle is an excellent skill to develop,” said Corinne. “I live in a community that is very supportive of others’ endeavors. It’s beautiful to see a large number of people rally behind a cause.”

 Corinne and Michelle’s diaper donations are just one example of what nurses are doing to end diaper need—and their efforts will count toward our 2016 Healthy Mom&Baby Diaper Drive goal of 250,000 diapers donated. We want to hear your story, too! Go online to AWHONN.org/diaperdrive to let us know what you’re doing to help the 1 in 3 families who experience diaper need.

For more information on how you can start a diaper drive in your community, contact Healthy Mom&Baby Diaper Drive consultants Jade Miles (jmiles@awhonn.org) and Heather Quaile (hquaile@awhonn.org).

Jade HeadshotJade K. Miles, BA, BSN, RN, is a nurse consultant for the Healthy Mom&Baby Diaper Drive and lives in Raleigh, NC. 

 

 

 

Informal Milk Sharing in the United States

by, Diane L. Spatz, PhD, RN-BC, FAAN

Susan is a nurse in a Neonatal Intensive Care Unit (NICU) with a strong human milk culture.  Every day she provides evidence-based lactation care and support to mothers who have critically ill infants. She understands fully that human milk can be a lifesaving medical intervention and received two days of on the job education regarding the critical importance of human milk and breastfeeding.  Seeped in this culture, Susan also believes that nurses and health professionals have an obligation to help families make an informed decision and while it would be ideal if all infants were exclusively breastfed by their own mothers, this is not always feasible or possible.

Susan is also challenged personally Having experienced infertility for 10 years, she has decided to adopt a newborn. She has read the literature and met with a lactation expert .  Susan is aware that even with great effort and time investment, she may never achieve a full milk supply.  She is very concerned about giving her infant formula and asked the lactation expert about accessing Pasteurized Donor Human Milk (PDHM).

The Human Milk Banking Association of North America (HMBANA) is the organization that oversees non-profit milk banks in the United States.  Even though the number of HMBANA milk banks is increasing in the United States and the amount of PDHM has also increased substantially in recent years, PDHM is still prioritized to preterm or vulnerable infants in the hospital setting.  HMBANA milk banks do sometimes dispense PDHM to the community setting.  However, in these instances, it is for infants with special medical needs and usually requires a prescription from a health care provider.

So for Susan who is planning to adopt a healthy full-term infant, she will likely be unable to access PDHM.  Susan is considering informal milk sharing in order to supplement what milk she is able to produce through inducing lactation.  It is important for nurses and other health professionals to be aware that informal milk sharing does exist and also to help families make an informed decision.

There are many reasons why women or families choose to pursue informal milk sharing in addition to the reasons in Susan’s story, including:

  • Women who have glandular hypoplasia or breast surgery and are unable to develop a full milk supply
  • Men and women who adopt children and may be unable to induce lactation
  • Women who have had bilateral mastectomy prior to childbearing
  • When a woman dies in childbirth and her family members wish to honor her plans to breastfeed
  • A short term need for supplemental human milk due to early breastfeeding challenges or a delay in Lactogenesis II

Although very beneficial in all of the above cases, informal milk sharing is not without any risk because just as antibodies, white blood cells, and other immune components are transferred in human milk, viruses can also be transferred.  In addition, some medications transfer into human milk (most in very small amounts, but some in larger).

Mothers who are considering informal milk sharing should consider the following steps:

  1. Get a complete health history from the donor mother. It is essential to understand  the donor mother’s past and current medical history as well as lifestyle choices is essential.  It is also acceptable for the mother to ask the donor mother for a copy of her serologic testing from pregnancy.
  2. Find out how the milk will be expressed, labeled, stored, and transported. The donor mother, first and foremost, should have an excess supply of milk that she does not need for her infant. When mothers express milk, care should be taken to ensure the safety of the milk.  At our institution, we have mothers wash their pump equipment with hot, soapy water and rinse well after every use and have them sterilize the equipment daily.
  3. What types of containers will be used for storage (the recipient mother could supply these to the donor mother) and how will the milk be stored (fresh or frozen) and transported from the donor mother to the recipient. Conversations between recipient mother and donor mother should be on-going to ensure safety of the milk. In this area the research literature has also evaluated  the use of home heat treatment to “pasteurize” the milk. Research has shown that heat treatment of the milk on a stovetop is not the same as Holder pasteurization, this technique has the ability to destroy viruses.  It is important to note that heat treatment also destroys some of the beneficial components of human milk.

Recently, the American Academy of Nursing published a position statement regarding the use of informally shared milk. This, along with resources shared below can be a starting point to have these conversations with families who are interested in the topic.

As health professionals, is also important to understand that there is a difference between milk sharing –  mothers may share  altruistically and be commerce free or there may be  an exchange of money or mothers who are paid for the milk.  When financial exchange enters the equation, mothers seeking to get paid for their milk may be motivated to dilute or alter their milk.  We should advise parents to be alert and aware of this.

Until PDHM becomes universally available, if a family does not wish to feed their infant formula, the only other option available is informally shared milk.  Having transparent and honest conversations with families to help the understand this practice is essential.


Resources for Informal Milk Sharing

The American Academy of Nursing (2016). Position statement regarding use of informally shared human milk.  Nursing Outlook, 64, 98-102.

Martino, K., & Spatz, D. L. (2014). Informal milk sharing: What nurses need to know. The American Journal of Maternal/ Child Nursing, 39(6), 369-374. doi:10.1097/NMC.0000000000000077

Spatz,  D.L. (2016.) Informal Milk Sharing. American Journal of Maternal Child Nursing;41(2):125. doi: 10.1097/NMC.0000000000000225. PubMed PMID: 26909729.

Wolfe-Roubatis, E. & Spatz, D. L. (2015). Transgender Men & Lactation: What nurses need to know. The American Journal of Maternal Child Nursing,40(1): 32-38. doi: 10.1097/NMC.0000000000000097.

Israel-Ballard, K., Donovan, R., Chantry, C., Coutsoudis, A., Sheppard, H., Sibeko, L., & Abrams, B. (2007). Flash-heat inactivation of HIV-1 in human milk: a potential method to reduce postnatal transmission in developing countries. Journal of Acquired Immune Deficiency Syndromes, 45(3), 318-323.

Diane SpatzDiane L. Spatz, PhD, RN-BC, FAAN is a Professor of Perinatal Nursing & the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania School of Nursing sharing a joint appointment as a nurse researcher and director of the lactation program at the Children’s Hospital of Philadelphia (CHOP). Dr. Spatz is also the director of CHOP’s Mothers’ Milk Bank.  Dr. Spatz is an active researcher, clinician, and educator who is internationally recognized for her work surrounding the use of human milk and breastfeeding particularly in vulnerable populations. Dr. Spatz has been PI or co-investigator on over 30 research grants, included several from the NIH.  She has authored and co-authored over 80 peer reviewed publications.  Dr. Spatz has authored or co-authored position statements for the International Lactation Consultant Association, the Association of Women’s Health Obstetric & Neonatal Nursing and the National Association of Neonatal Nurses.

In 2004, Dr. Spatz develop her 10 step model for human milk and breastfeeding in vulnerable infants.  This model has been implemented in NICUs throughout the United States and other countries worldwide. Dr. Spatz has been named a prestigious “Edge Runner” for the American Academy of Nursing related to the development and outcomes of her model.  Her nurse driven models of care are critical in improving human milk & breastfeeding outcomes and thus the health of women and children globally.

Dr. Spatz is also the recipient of numerous awards including: Research Utilization Award from Sigma Theta Tau International and from the University of Pennsylvania:  the Dean’s Award for Exemplary Professional Practice, the Expert Alumni Award and the Family and Community Department’s Academic Practice Award   She is also the recipient of the Lindback Award for Distinguished Teaching. Dr. Spatz received the Distinguished Lang Award for her impact on scholarship, policy & practice.

In the university portion of her job, she teaches an entire semester course on breastfeeding and human lactation to undergraduate nursing students and in the hospital portion of her job, she developed the Breastfeeding Resource Nurse program.  Dr. Spatz is also Chair of the American Academy of Nursing’s Expert Panel on Breastfeeding and their representative to the United States Breastfeeding Committee.  Dr. Spatz is also a member of the International Society for Researchers in Human Milk & Lactation

 

Babies Have Back-to-School Needs, Too

by, Summer Hunt

This time of year from late July into August, many moms are preoccupied with back-to-school shopping for all the basics: pencils, paper, glue and the like, as well as products like paper towels, hand soap and facial tissue. Just as these items are important for school-age kids, babies and toddlers have “back-to-childcare (and preschool)” needs, too—and diapers top that list.

Did you know that babies and toddlers can’t attend childcare without an adequate supply of extra diapers? It may not seem like much, but for the 1 in 3 families who don’t have enough diapers to keep their babies clean, dry and healthy, buying extras typically breaks the bank. Without enough diapers, parents are forced to choose between work—and a paycheck—and taking care of baby.

The Harsh Realities of Poverty
Diapers cost $70-$80 per month, per baby, and parents can’t use food stamps for diapers—in fact, there is zero direct government assistance for diapers. Low-income families can’t afford to buy diapers in bulk, and many do not have access to big-box discount stores or online shopping. This means families hurting the most financially are hit hardest when it comes to buying essential care items like diapers. In fact, the poorest 20% of Americans spend nearly 14% of their income (after taxes) on diapers, according to the National Diaper Bank Network (citing 2014 government data)—that’s $1 out of every $7 of their average $11,253 income spent on diapers, or $1,575 a year on average.

Parents just want to do right by their children. We spoke with four moms last year who talked about their experiences with diaper need. These families are doing their best to keep their babies happy and healthy, even if that means going without or making tough decisions about paying other bills. And with 5.3 million babies in America living in low-income families, these moms are not alone in their struggles.

Nurses on the Front Lines
AWHONN is proud of all the work our nurses to do to take care of moms and babies, especially those in the most vulnerable populations. Our Healthy Mom&Baby Diaper Drive gives nurses the recognition they deserve when they go beyond patient care and collect items like diapers, wipes, clothes, car seats for their tiniest patients.

Across the country, at section and chapter meetings, through community baby showers and diaper drives, when donating diapers to diaper banks and women’s shelters, and in their own hospitals and clinics, nurses are on the front lines every day combatting diaper need for their patients.

Let Us Share Your Efforts!
What are YOU doing in your area to make sure that babies are clean, dry and healthy? Are you:

  • Giving out diapers at community and education events?
  • Participating in a diaper drive event with your local faith community or civic group?
  • Sharing diapers with families in need in any other way?

Tell us your stories at AWHONN.org/diaperdrive, or contact our Diaper Drive consultants Jade Miles and Heather Quaile. Our consultants can also help you increase your efforts or start something new and make sure that your current successes are counted in our final totals. You can also visit DiaperDrive.org to make a dollar donation that will be used to purchase diapers at wholesale for diaper banks across the country. Are you an advocate for cloth diapering? There are several diaper banks that accept cloth diapers, and you could even initiate a cloth diaper drive in your community!

As families everywhere get ready to head back to school, why not toss an extra pack of diapers into your cart to donate to your local bank? Or, head over to DiaperDrive.org while surfing the Internet for prime deals on books and binders and donate $20 dollars to diaper a baby for two weeks. You’ll ensure a brighter future and a better bottom line for babies everywhere—and that’s a guaranteed A-plus in our books.

Nurses Make Change Possible for Babies_1

Summer HuntSummer Hunt
Summer Hunt is the editorial coordinator for publications at AWHONN

Ladies on a Mission

Guatemala

by, Lori Boggan, RN

When we enter the medical profession, we make a lifetime commitment to the service of others.  As nurses, we serve our patients, our community, our friends, and our family.  No other profession has such a deep connection to and is so trusted by society.  We are the ones at the bedside day and night.  We are the ones that our patients trust with their privacy, their secrets, and their lives.

Volunteer nursing is no foreign concept for American nurses.  In fact, the earliest “nurses” were nuns, or family members of those active in the Civil War.  They were in the trenches before any formal nursing education or organization existed.

For most, nursing is a calling.  Nurses are innate caregivers.  What is it about a nurse that is willing to use her own money, travel to an unfamiliar place sometimes lacking basic accommodations, and work long hours without pay?  It is the drive to care for those in need.

The following interview is with one of AWHONN’s own that goes above and beyond.  Nancy Stephani Zicker, a labor and delivery nurse from Central Florida has journeyed to Guatemala yearly since 2014 to help less fortunate women in need of gynecological surgery.  She journeys with her friend and obstetrician, Dr. Cecille Tapia-Santiago, of Volusia ObGyn Daytona Beach.  In addition to gynecological surgeries each year, Dr. Tapia sees patients in the mission’s clinic and educates Guatemalan midwives.  I interviewed both ladies in hope to inspire others to join mission work.

How long have you been going on missions?

Nancy:  I have been going on yearly medical mission trips every March since 2014.

Cecille:  I have been doing 1-3 mission trips a year since 2000.


Where has your mission work taken you?

Both: Guatemala


Why Guatemala?  Is there any particular need there with regard to women and infant’s health?

Cecille:  Absolutely. When we go there we provide contraceptive care, well woman care, and manage surgical conditions (uterine fibroids, large ovarian cysts, and pelvic prolapse being the most common).


Describe a typical day in the life of a volunteer nurse.

Nancy:  Each year that I have gone, I have been assigned to work as a circulating nurse (and sometimes scrub in to tech or assist) in the OR. There are clinic nurses, OR nurses, PACU nurses and ward (floor) nurses.

FullSizeRender-100We go in to a completely bare room and make it a functioning OR.

As an OR nurse, we first have to unpack and sort all of our supplies, as well as set up the operating rooms. We arrive on a Saturday late afternoon and get right to work. Sometimes we set up in community centers and sometimes we set up in an actual hospital. This usually takes Saturday evening and all day Sunday to accomplish.

Monday morning, the surgeries begin. Depending on the number of cases scheduled, we usually are in the OR from 8am-5pm. Once all surgeries are done at the end of the week, we have to break down the ORs to leave the space as we found it and inventory all supplies so we can order more for next year.  We all have had to improvise and be creative with available equipment and supplies. It’s quite the challenge, but the entire team comes together and we make it work.z


20140306_102410Cecille, describe your work educating midwives in Guatemala

It’s THE BEST PART. Midwives in Guatemala are mostly lay (no formal training at all). Guatemala has one of the highest infant mortality rates in the world. We do 1-2 day seminars and teach basic infant resuscitation as well as basic management of labor, delivery and postpartum complications. The midwives have to deal with a lot of prejudice from the physician community and often won’t get paid for their service if the patient has to be transferred to a hospital.  So anything they can do to show their critics that they are furthering their education and are doing right by a patient is helpful.

Is there any one particular patient story that you can share that stands out in your mind where you felt you really made a difference in that patient’s life? 

Cecille:  One of the midwives came back to a refresher course and told us that she gave CPR to a baby with apnea. Initially the family was resistant and thought the baby was dead. The midwife pulled out her certificate from the seminar and showed the family. She told the family to let her try and do CPR. She successfully performed mouth to mouth and chest compressions and the baby was fine!  We also had a young lady with an enormous pelvic mass that was compressing her entire abdomen and pelvis. She had been turned down by everyone and when we saw her, she was cachectic and probably a few weeks away from dying. We removed an enormous yet benign ovarian cyst. It was over 50cm in diameter and weighed 25 pounds.

How has mission work changed your practice?

Nancy:  It has made me a better nurse. Seeing and working with the patients I see on my mission trips has renewed my love of nursing and my compassion for people in general. The patients I see on these trips are so profoundly grateful for the care they receive.  It helps to renew one’s zest for nursing.

Cecille:  It hasn’t really changed how I practice at home, but you have to be a particular type of person to do well on these trips. In order to do this type of work you have to be patient, flexible, meticulous, and creative. You can’t go to these trips if you’re going to expect U.S. standards of equipment, timeliness and availability of things you have every day at home (for example blood, cautery, suction, light).  I have seen time and time again physicians, nurses and staff struggle because they have unrealistic expectations of what it’s like to operate in third world conditions. And by the same token seen plenty (like Nancy) that just sail, adapt and just sail.

How has mission work changed you as an individual?

Nancy:  Personally it has made me realize that as humans we all want the same things- we want our children healthy, we want access to quality healthcare, we want to be able to be happy in our daily lives, and we want a peaceful existence.

Cecille:  It refreshes my choice and faith in my profession. Medicine has changed so much. The physician/patient relationship many times is not what it used to be. We live in a defensive medicine environment that often plays in to how we practice here. Over there, patients and families trust and believe that, just like at home, I do my very best to provide the very best care my skill set allows, and that I will never go above that skill set and take unnecessary risks. That trust factor makes any responsibility tolerable.

Guatemala

What advice would you give a nurse contemplating mission work?

Nancy:  It’s important to choose the right organization to join, one that interests you. Each one has a different application process and requirements, as well as when and where they go on their trips. They all differ with their missions and what they offer. I have gone on 3 trips so far, and have applied for my 4th with the same group. It’s called Cascade Medical Team, whose parent organization is Helps International. I have friends that have used various other organizations. It’s important to choose one that fits your interests and your budget, as well as the dates you’re available to go. Also, for me on my first trip, it really helped that I went with someone I knew and who had experience with volunteering for medical mission trips. Not only was she able to give me a heads up on what to expect, but it is just amazing to be able to share the experience with someone you know- someone who understands why you would want to, or should want to, volunteer for such a trip
.

How can a nurse prepare for his/her first mission?

Nancy:  Be open-minded. Prepare to go out of your comfort zone and learn new things, both in the nursing/medical field and also culturally.

FullSizeRender-101Where to next?

Nancy:  To date, I have only been to Guatemala. At this point in time, I only volunteer for one mission trip each year and I have found that I really enjoy helping the people there and so have concentrated my trips to Guatemala.

Thanks for sharing, Nancy and Cecille!  And thank you for your service!  For more information on their work with Cascade Medical Team, visit www.cascademedicalteam.org.

Lori Boggan, RN
Lori is a NICU Staff Nurse at Sahlgrenska University Hospital in Gothenburg, Sweden. After becoming a nurse, Lori traveled across the country to work a three-month travel contract in San Francisco, California. Nearly five years later her journey continued to Gothenburg, Sweden, where she now lives and works. She also write her own blog Neonurse at https://neonursetravels.com/ or on Instagram.

Specialty Training for Novice Nurses

by, Heretha Hankins, MSN-Ed, RNC

Twenty-five years ago when I was a young, new nurse there was a lot of talk about the nursing shortage. Every nursing magazine speculated on how patient care would suffer if we didn’t train more nurses. Several years ago I looked around and saw tangible evidence of this looming shortage for the first time in my career. At first limitless overtime was available and then came incentive pay and bonuses as an effort to cover the shortage. Finally, nursing broke the unwritten golden rule. We started accepting new grads into specialty areas.

When I started nursing school I knew I wanted to work in L&D but my instructors explained that I must first work “general nursing” (med-surg) before I could even consider a specialty like OB. Today there is such a low pool of applicants for multiple open positions we are seeing a growing trend of graduate nurses entering specialty areas. After six months they are expected to possess critical thinking skills; one year later they train another new graduate. As we see an increase in the hiring of graduate nurses into critical practice areas such as OB, ICU and ER there needs to be a change to the training approach. The “each one teach one” approach is no longer effective.

OK, so here is where I want to really talk to nurse leaders. How do you know when a nurse is successfully trained? Can you measure the progress? Is the retention rate of your unit impacted by turn over from the nurses with less than two years experience? When I asked myself these questions I was inspired to design and implement the Perinatal Nurse Training Program (PI.N.T).

Developing the Program

The PINT Program is a 16 week program which includes 72 hours of didactic information in the classroom setting with a curriculum and reading assignments. Peer-reviewed books are required purchases (build a practice on research not hearsay). We also incorporate AWHONN’s basic and intermediate fetal monitoring courses into the training to assure the information received is consistent with national standards. Yes, it sounds and looks like going back to school.  Didactic hours are spaced throughout the 16 weeks building on concepts as the nurse builds in practice.

Use of a focus plan and checkpoints makes progress measurable. The checklists are tasked-based because a new learner has concrete thought processes. Consistent feedback in 1:1 sessions helps to promote progress or strategize about practice opportunities. In the last four weeks there are two to three novice nurses assigned to one preceptor. This gives the novice an opportunity to strengthen a solo practice while keeping that preceptor safety net nearby. After the 16 weeks, periodic monitoring is used to assure practice assimilation, answer questions and offer support. By the one year anniversary of practice the novice must pass the National Certification Corporation (NCC) exam for fetal monitoring to be considered successful.

Prior to PINT unit based orientation was largely completed with using preceptor pairing. Small amounts of didactic were used but were generally attached to vendor presentations for products used in the practice. Many things such as fetal monitoring and high risk pregnancy care were covered by use of self-learning modules. It is also worth noting, prior to my arrival the educator position was vacant for approximately five years.

Road Blocks

The greatest obstacle identified was seen in the change with preceptor assignments. Traditionally a novice was assigned to one preceptor for all of orientation. In the PINT program the preceptor assignment is fluid but generally stable for two weeks. My philosophy for this approach is based in inherent human error and autonomous practice. No one is perfect and sometimes what works well for one may not work for another. Seeing multiple different practices allows the novice to build his/her own autonomous practice.

Measuring Success

My measurement of success for this program is in the pass rate of the exam and the increase retention of new hires on the unit. With a total of 71 novices trained to date we boast a 98% pass rate by one year of practice on the NCC exam, a two year retention rate of 75% and a one year of near 90%. Program evaluation surveys provide feedback from the participants regarding what they gained and what could be improved. The participants noted the program worked well for them and they appreciated the structure. I am most proud to know that this leads to increased patient safety and healthy moms and babies. As I recall that was what motivated me to want this practice when I was a new graduate nurse.

Advice For Nurses Wanting to Start A Specialty Training:

  • Provide didactic training on the routine patient type starting with normal before sending the novice to the unit or training on complex procedures.
  • Make time for didactic classroom throughout the process so time if given to build on concepts.
  • Start the process with cohorts so that each participant can connect with someone in the group.
  • Encourage journaling because it helps develop critical thinking.

HerethaHeretha Hankins MSN-Ed, RNC is a Professional Development Specialist at Holy Cross Hospital in Silver Spring, MD, affiliate of Trinity Health System. She is the creator/facilitator of the Perinatal Nurse Training (PiNT) Program which she has presented to the Central Virginia Nursing Staff Development Organization, Maryland Patient Safety Perinatal Collaborative and Trinity Health Perinatal Summit. With 20+ years of nursing experience she also freelances as a Nurse Education Consultant. Her professional passion is to train the best nurses to provide the best patient care. She is always willing to discuss this at HerethaHHankins@gmail.com or any other forum.

Confidence Building for Nurses

by, Lori Boggan, RN

I would like to call myself a bit of an expert on the subject of confidence.  Working as a travel nurse for many years, mine has been tested over and over again.  The one thing I have learned is that confidence comes and goes and that is perfectly ok.  Some days are better than others.  Travel nursing has forced me to learn new routines, try every new kind of IV catheter, learn each new unit’s policies, and adapt.  In the last five years, I have managed to find myself in another country and added the super challenging task of learning a new language to the list.  It has tested my confidence and given me the opportunity to reflect.  Here are just a few tips.

Develop Routines

There are certain tasks we as nurses do repetitively in our day to day work.  We take reports, check our monitors, calculate our drips, triple check our medications.  No matter how much time it takes initially, make these a part of your day to day routine.  It will be as subconscious as breathing eventually and once mastered, it leaves space for the most important task of critical thinking.  Why is my patient’s urine output low?  Why has my patient suddenly had multiple episodes of desaturation and apnea?

If At First You Don’t Succeed, Try, Try Again

So you didn’t get that IV or blood draw on the first stick?  Ask any honest nurse and they will tell you that it has happened to the best of them.  Having a bad access day does NOT mean you are a bad, incompetent, less worthy nurse.  It means today is not your day and that is ok.  Tomorrow is another day.

Ask

Asking a question is a sign of strength, not weakness.  No matter how small the question or how many times you ask, keep asking until you understand.  When starting in a new unit, whether you are a brand new nurse or a seasoned one, it is your duty to ask questions.  The ones to worry about are the ones that do not ask questions.

Never Stop Learning

That is why there is such an emphasis on continuing education hours when renewing your license.  Continuing education is critical.  There is always something new to learn or some change in research that may change your practice.  Be open to change.

Speak Up

If something does not seem right, follow your instincts and say something.  Chances are you are right.  Always err on the side of caution.  You will learn to trust your own intuition.  Perhaps speaking up can create a change in policy on your unit.

Leave the Bad Days Behind

So you were not super nurse today?  Today was not your day?  That’s ok.  You are only human.  There is no super nurse.  Anyone who pretends otherwise is kidding themselves. We all have had that day where you wake up late, spill your tea in the car on the way to work, walk into a frantic situation in the unit, and then are assigned said frantic situation.  You just want to turn right around and go back to bed.  Take a deep breath.  You will get through it.

While the list can go on and on, I think the most important thing of all is to remember that confidence comes with time and practice.  Each new environment and new job will test your confidence.  And remember, try not to compare yourself to anyone else.  Be the best nurse you can be.

LoriProfileLori Boggan, RN
Lori is a NICU Staff Nurse at Sahlgrenska University Hospital in Gothenburg, Sweden. After becoming a nurse, Lori traveled across the country to work a three-month travel contract in San Francisco, California. Nearly five years later her journey continued to Gothenburg, Sweden, where she now lives and works. She also write her own blog Neonurse at https://neonursetravels.com/

Thank You Nurses

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by, Pampers Swaddlers
Anne Gallagher-PhotoThe story of Anne Gallagher, staff nurse at the University of Illinois Hospital & Health Sciences, is one of the many stories that inspire and remind us of the dedication and care that goes into the nursing profession.

Anne has been a nurse for 38 years, and nursing runs in her family. Five women in her family were nurses, including her mother, who inspired her to eventually enter into the profession herself. Anne truly believes that nursing is more than a job, it’s a vocation that gives her life meaning. She continues to acquire new knowledge and experience to apply to her work with new parents. Recently, she completed a Master’s Degree from Write Graduate University for the Realization of Human Potential in Transformational leadership and coaching.

“It is my privilege as a nurse to accompany, educate and support people on this journey … to facilitate their development, and expression, and tune into their instincts and inner wisdom in partnership with their babies and staff,” says Gallagher.

We are proud to announce Anne Gallagher, staff nurse at the University of Illinois Hospital & Health Sciences System, as the grand prize honoree of the Pampers Swaddlers Thank You Nurses Awards program. Her understanding of what it means to become a brand-new parent, and the specific needs of newborns and mothers during labor, delivery and the first few days that follow, made her stand out. With this award we celebrate Anne’s contributions throughout her career and her ongoing commitment to the care of babies and mothers.

Anne beautifully describes how babies transform and even empower us. “It’s important for moms to understand that all the instincts are right there. A mother’s body is a baby’s natural habitat … the baby is going to help her. It’s a little being that wants to live and survive … when they see that, they are empowered, they know what to do! It’s a magnificent moment.”

At Pampers our mission is to care for the happy and healthy development of babies.  We know that nurses share this mission, and that’s why we proudly recognize and honor the essential role nurses play in improving the lives of babies and families through the work they do each and every day. In partnership with the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) we developed the Pampers Swaddlers Thank You Nurses campaign and awards program.

Through this campaign, we’ve encountered the stories of many nurses who embody the caring spirit and dedication of this very special career, and every single story has inspired us. To shed light on the integral role that nurses play in the first few minutes, hours and days of babies’ lives and the vital support they provide to their parents, the unique and compelling stories of three nurses were shared through short documentary videos: Anne Gallagher, RN, MSN; Capt. Navy Nurse Corps (Ret.) Trice Harrold, BSN, RN; and K. Michelle Doyle, RN, CNM, NYS, LM, each of whom deeply impacts the lives of families every day.

With this award and the entire Pampers Swaddlers Thank You Nurses campaign, we want to recognize the hard work and dedication of Anne, Trice, Michelle and all nurses everywhere.

Anne’s documentary video is available for viewing, here.

For more information about the Pampers Swaddlers Thank You Nurses campaign go to Pampers Facebook Page and join the conversation via #ThankYouNurses.

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