A Special Thank You to Our Preceptors

Elizabeth Rochin, PhD, RN, NE-BC
Vice President of Nursing, AWHONN

After long days or nights, and years into a career, we as nurses may forget what initially brought us into nursing. If you want to remember, simply ask a student. In fact, I had the opportunity to ask fourteen nursing students just today why they chose nursing as a career path.

Here is a sampling of what they said:

• “I wanted to make a difference in someone’s life.”
• “There is nothing more pure than helping someone in need.”
• “I knew since I was three years old that I wanted to be a nurse. I think I inherited it, my mom and grandmother are nurses.”
• “This is my second degree. I discovered in myself a very strong need to help others, and went back to school. This was the right decision.”
• “I was originally in sales and marketing, and realized that I loved making connections and promoting relationships. This was the perfect way to do both.”
• “The first time a patient said, ‘You’ll make a great nurse,’ I knew I made the right decision.”
• “I can’t imagine doing anything else. This is the perfect way to give back.”
• “To use my hands to help heal a patient, or help to bring a new life into the world, I can’t think of anything better.”

Most of us will remember thinking about one or more of the quotes above, and will bring us back to our own days as a student nurse, and renew the passion in our work.

For the next several weeks, colleges and universities throughout the nation will graduate the newest members of women’s health, obstetric and neonatal nurses. We congratulate and welcome you to your new lives and careers. Nursing offers such diversity in career paths, and the opportunities for expert bedside care, advanced practice and nursing leadership roles have never been greater. There has never been a more exciting time to be a nurse!

But it is also important that we understand and remember that at one time or another, we were all new. None of us came into nursing knowing everything. We all needed a hand to hold us steady, and a guide to offer direction and counsel in how to move from a new graduate to a team member who could safely and effectively care for patients and their families.

Occasionally we forget what it felt like to be new. And we must be willing to remember. The greatest gifts we can bestow upon our newest nurses are understanding, time and expertise. We must commit to assisting our new graduates to grow and develop, and assist them to make the difference they want to and know they can make.

I would like to take this moment to thank all of our outstanding preceptors who strive to give our new graduates (and all new nurses, for that matter!) the best possible experiences and learning opportunities. Preceptors are those nursing team members who work with a new nurse for 12-20 weeks, and sometimes much  longer, to ensure appropriate training and competence. Preceptors are the “life blood” of nursing, and your effort and dedication to your orientees and organizations does not go unnoticed. Thank you for taking on this vital role and for shaping the next generation of women’s, obstetrics, and neonatal nurses.

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Liz  has over 25 years of Women’s and Children’s experience and  has devoted her professional career to the care of women and children with roles as a staff nurse, nursing educator and most recently executive leadership. She has presented nationally on patient experience and mentoring new nursing leaders. In 2008, Liz was named to the Great 100 Nurses of North Carolina, and is a member of Sigma Theta Tau. In addition to her clinical work and expertise, Liz has taught at the baccalaureate and graduate levels at East Carolina University College of Nursing. She is board certified as a Nurse Executive by the American Nurses Credentialing Center.

Navigating a Labor Experience: As A Student

By: Amy Smith, Student Nurse at MGH Institute of Health Professions, Boston

I could feel the excitement in the room as I entered. The couple was receptive to my questions and suggestions; and the woman was more than happy to involve me in her care.  I tried to build rapport even though I was nervous in my role as a nursing student. This was the first time I had assisted a woman in labor and, after her membranes were artificially ruptured, her contractions started to come about two minutes apart.  At one point, I had my hand on her back and her husband smiled at me across the room and signaled for to me to remove my hand!  It was a great moment in which the support person and I connected!  I remained quiet during her contractions and I asked her if she wanted me to breathe with her but she said she had it under control. I kept thinking back to my own labors and what I felt I wanted from support people so I asked her if she would like lower back counter pressure but she refused.  The family had not done a childbirth preparation course so I assumed that their interest or skills with working through labor was limited.  I thought that they would need my help more yet her prenatal yoga practice seemed to have given her the tools she needed to get through her labor. The tools I offered her personally were meditative.  I told her to focus on her favorite place, to discuss her needs and frustrations with us in between contractions and reassured her that I was there for her to breathe with her and regulate her breathing as needed.

Reflecting on the Nursing Care Women and Babies Deserve virtues I used during this experience, I believe they were humility and engagement. Humility in that I had to understand I did not know what was best for this family. I assumed they would want and need what I needed during childbirth or skills I learned from the comfort measures video I used to prepare for this clinical experience. The woman decided what she needed and I was there to support her. In respecting their wishes I could engage with the family. Before I left them for the day they commented, “We felt like we had our own doula”.  It was easy and a pleasure to engage with this couple and follow their commands and offer suggestions. I told them I had never wanted to stay at clinical so much as I did with them. I will always remember this family.

 

Additional Resources

AWHONN’s Nursing Care and Women Babies Deserve Poster –  AWHONN’s statement on ethical nursing practice, Nursing Care Women and Babies Deserve, is rooted in the American Nurses Association’s Code of Ethics for Nurses, and provides nurses with core elements of ethical nursing practice for our specialty and corresponding examples of the virtues of ethical practice in action.

Read a commentary about Nursing Care Women and Babies Deserve in AWHONN’s journal Nursing for Women’s Health. Consider submitting your own story of how you or your colleagues practice nursing care that women and babies deserve at https://www.awhonn.org/?NursingCare

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Amy is an ABSN student at MGH Institute of Health Professions, Boston.  She was a stay at home mother for 12 years,  a community coordinator for a non profit kids running program and a volunteer at Dana Farber Cancer Institute in Boston before deciding to enter the nursing field.  With extensive volunteer experience from a camp for blind & visually impaired adults and children, to co-president of an elementary school PTO, she enjoys working with diverse groups of all ages.  Amy aims to work in labor and delivery after graduation in August 2017 but is also interested in global health and epidemiology.  She has intentions to keep making a difference in the lives of those she may never meet again.

Childbirth While Recovering From Addiction

By Tasha Poslaniec , Perinatal Quality Review Nurse

The first time that I cared for a patient who was both recovering from drug addiction while experiencing acute pain, was in Labor and Delivery in 2014. Neither of us was prepared for this. We both exchanged the same shell-shocked, “What do we do now?” look several times that shift. I had a profound realization that day; I needed to come up with a better plan.

My initial idea was a literature search in Pubmed, a free national database of indexed citations and abstracts from thousands of science and healthcare journals. I also hit up Cochrane, a database that provides systematic reviews of evidence based medicine.

While it is difficult to get a good estimate on the prevalence of drug addiction in pregnancy, the National Institute on Drug Abuse published data in 2015 showing that 21,732 infants were born with Neonatal Abstinence Syndrome (NAS) in 2012. That’s equal to one baby being born every 25 minutes with this syndrome. That is a lot of potentially challenging labors to manage.

Ultimately, the most important take away from my research was “treat the pain, not the addiction”. While it’s never ideal to administer narcotics to a recovering addict without a bigger plan, it’s still superior than allowing a patient to suffer.

In an ideal world, the best plan is to have a pre-labor consultation with the patient and anesthesiologist. This can be tricky to make happen as pain control is rarely addressed (especially the kind that recovering addicts need) during the prenatal course. The opportunity for this most often occurs when women are induced, or come in for antepartum testing. I was fortunate enough that my recovering patient was having both of those.  I was able to broach the topic during an NST, and I then requested her when she came in for induction. We were both thankful that the anesthesiologist on that day was open to discussing a plan that she was comfortable with. Just talking together as a team helped her relax.

My patient at that time was taking methadone, which I learned while doing my nursing assessment. Since she had not taken a childbirth class, I gave her homework to research how methadone can both increase the body’s sensitivity to pain (hyperalgesia) as well as limit the options for other pain medications like Stadol, due to the opioid agonist therapy (OAT) she was in. By front loading her understanding of how her pain control was about more than just preventing a relapse, her expectations were set to be more informed as well as more realistic.

The plan that we all agreed upon involved several key areas:

• Set the expectation. While this falls under “patient education” it’s such a powerful tool that it bears having its own bullet point. Having a realistic and frank discussion about the realities of labor is important for any patient, and it should begin with prenatal care. As any L&D nurse can tell you, there is nothing more disheartening than a woman in labor demanding “the shot that takes all of the pain away”.
• Utilize non-pharmacological modalities as much as possible. I created a folder with childbirth information for her in which Penny Simkin figured prominently. Her free guide with illustrations of positions and easy to read mantras were the perfect shorthand for the situation. While we started her induction, we discussed the handouts together.
• Consult with anesthesia ASAP. Again, this can be difficult since you really need a doctor who is on board and .The plan that we came up with was for a labor epidural as soon as she wanted one. Thankfully, ACOG supports labor epidurals at any dilatation, and the evidence supports that receiving one “early” does not adversely affect labor outcomes. The other nuance was to administer the epidural without any opioids. No fentanyl mixed in, just Lidocaine and Bupivacaine. While the likelihood of the opioids placed in the epidural space crossing over into her circulation were pretty minimal, it was a very real concern for her, and we needed to respect that.
• Have a plan B. Should things not go according to plan go sideways, we needed to have a course of action nailed down. This included contacting the obstetrician and enlisting their support while also reminding them that a patient in OAT can require as much as 70% more opiates to manage pain (which she was willing to take should she need surgery) post-operatively. We also discussed a social services referral in this event to help provide services to prevent relapse.
• Provide continuous support. I have to say, this simple intervention was the most effective thing that I did. It helped that our census was low, and I had an understanding charge nurse.

In the end, a lot of stars aligned that day, as my patient was able to cope with the pain, receive an epidural, and ultimately give birth to a healthy baby girl.

Educating the patient, creating a team, and formulating a plan with the patient’s input, as well as providing continuous support, has guided me with the increasing number of patients that arrive in similar situations. This experience has also led me into many different discussions with other nurses and doctors.

The consensus has been that this growing population of patients is compelling enough to establish a pathway for care during labor.  Something we are working on and will hopefully provide a road paved with evidence based best practices in the near future. And while these patients are by no means representative of every person struggling with addiction (recovering or not) they allowed me to recognize a growing need, as well as to learn new ways of helping patients to cope with the dignity and compassion we all strive to provide for the patients we are caring for.

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Search for these resources available in the AWHONN Online Learning Center 

• Opioid Use in Pregnancy: Detection and Support Webinar
• Breastfeeding Implications for Women Receiving Medication Assisted Treatment for Opioid Use Disorders Webinar

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Tasha Poslaniec has been a registered nurse for 17 years. She has been working in obstetrics for over a decade and is currently a Perinatal Quality Review Nurse and Childbirth Educator.

She also writes about nursing and childbirth and has been published in the Huffington Post and the American Journal of Nursing. Pain control in childbirth has long been a topic of study and research for her.

Stress The Modern Day Predator

Holly A. Lammer, RNC-OB C-EFM

“The history of man for the nine months preceding his birth would probably be far more interesting and contain events of greater moment than for all the three score and ten years that follow it.”

~Samuel Taylor Coleridge

Decreasing the amount of stress that we encounter daily is beneficial to our health.   Stress initiates the body’s ‘emergency response system’ which activates the adrenal glands to secrete cortisol and adrenaline.  Cortisol is important for energy (glucose metabolism), blood pressure regulation, immune function and inflammatory response, but is secreted in higher levels during increased stress.  Heart disease, diabetes, autoimmune disorders, chronic inflammatory disorders, mental health issues, obesity can all in some way be linked to how the chemicals of stress wreak havoc on our bodies.   Statistics paint a grim picture:

• Preterm birth in the U.S. is higher than in other developed countries (Kaiser Family Foundation, 2015).
• Stress is associated with an increased chance of preterm birth (PLos One, 2012)
• High rates of anxiety and depression, according to WHO, the U.S. has one of the highest rate of mental disorders of any other developed country. (U.S. News, 2016)
• High rates of obesity – females affected more than males (World Obesity, 2017)
• Immune and allergy disorders, chronic diseases have increased drastically in the last few decades (overwhelming majority affecting women)(Molecular Metabolism, 2016)

One concern is how these chemicals affect a woman and her growing fetus during pregnancy.  Many pregnant women  are exposed to chronic stress;  examples are the stress of jobs, finances, family responsibilities, the expectation and drive for success, high fat and low nutrient diets, lack of time for physical activity,  lack  of community and family support, intimate partner violence, effects of racism and social marginalization.  Stress chemicals can pass to the developing baby through the placenta.

Watering the Seeds of Peace:

But pregnant women can seek to balance and reduce their stress in order to pass on positive neurological chemicals to their babies.  In particular, mindfulness practices such as yoga and meditation have profound impacts on the human brain and, when practiced in the prenatal period, can also influence the growing brain of the fetus. (PLos One, 2012)These types of practices produce changes in the neural pathways and hormonal centers that support parasympathetic response and as these neural connections are strengthened, sympathetic hypersensitivity is decreased. Mindfulness has the potential to reduce the effect of stress chemicals in the body (Journal of Obstetric, Gynecologic and Neonatal Nursing, 2009) since these chemicals are being sent directly to the fetus, through the placenta.

Mindfulness may also reduce the effects of stress chemicals in the baby.  Research shows increases in gray matter concentration in the left hippocampus, which affects learning, memory, and emotional control.  Infants  born of mothers who practice meditation have been shown to have better self-regulation and more emotional control. (Infant Behavior and Development, 2014)

Practicing mindfulness on a regular basis can also “create change in the brain that support feelings of peace, contentment, self-confidence and joy.  As these connections in the brain are strengthened, states of anxiety, worry and anger are decreased. Consequently, incidence and severity of stress related conditions are decreased and may, at the very least, become easier to manage.  Mindfulness practice has been shown to decrease anxiety, depression, insomnia, hyperactivity, substance abuse and chemical dependency.  It can also increase bonding and connection to others.

Preparation for Birth

In addition to all the above mentioned benefits, mindfulness has the added benefit of decreasing sensation of chronic and acute pain and possible subsequent psychological distress caused by pain.  This effect has been correlated to altered function and structure in somatosensory areas and an increased ability to disengage regions in the brain associated with the cognitive appraisal of pain, basically ‘reframing’ the sensation.  Most childbirth methods are based on meditative techniques (Lamaze and Bradley breathing, Hypnobirthing, etc.)  Mindfulness practices also enhance immune function – extremely important in pregnancy where it is already suppressed.  If there is a complication that is present (obesity, immune disorder, mental illness) or one that is diagnosed during the pregnancy (gestational diabetes, hypertension, multiples) or that happens during birth (prolonged labor, surgical intervention), regular meditative practices can help prime the immune system so that the effects of these events may be milder.

It’s as simple as ‘ABC’

One of the great things about mindfulness is that it can be practiced literally anytime, anywhere.

A is for Awareness:  Simply pause or stop and become AWARE of the present moment. An easy way to do this is just notice the body in space… the arrangement of the legs or arms, the overall tone in the body… the sensations in the body. Use the senses to drive your awareness:  the feel of the coffee cup in your hand, the sound of a bird chirping or the rain on the roof, the warmth of the sun on your skin.

B is for Breathing:  Bring your awareness to your breath.  The breath is always present.  Notice the inhalation and the exhalation.  Just by noticing the breath without changing it in any way, nervous system shifts to parasympathetic activity. You can enhance this shift by guiding the breath to be longer and deeper. Regulating the breath in this way also decreases blood pressure and heart rate.  Imagine your breath bringing oxygen to your growing baby. Imagine your baby listening to your deep rhythmic breaths and the slowing of your heart beat.  Calm, serene.

C is for Consciousness:   Or ‘thinking’. Now you have the space in the nervous system to examine your thoughts. Notice that they come and go like clouds on a windy day.  If there is a particular thought or sensation that is troubling you or seems uncomfortable, you have the ability to CHOOSE your reaction instead of unconsciously reacting with habitual patterns of response.

When we practice in this way, even for a few minutes a day, our nervous system slowly begins to rewire and connections of peace and joy are strengthened.  In the pregnant mom, this benefit is wiring the baby’s brain from the very beginning of development.

Helpful Resources and Links

• Antenatal mindfulness intervention to reduce depression, anxiety and stress
• Fit Pregnancy: 5 Prenatal Meditation Techniques
• Impact of stress and stress physiology during pregnancy on child metabolic function and obesity risk
• Incidence and prevalence of chronic disease
• Mindful Birthing
• Prenatal meditation influences infant behaviors
• Relaxation Response and Resiliency Training and Its Effect on Healthcare Resource Utilization
• The Association for Prenatal and Perinatal Psychology and Health
• The effects of mindfulness-based yoga during pregnancy on maternal psychological and physical distress.
  

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  Holly Lammer is an Obstetric Nurse, Clinical Educator and Childbirth Instructor for St. Luke’s Health System based in Boise, ID.  In addition to teaching credentialed courses through AWHONN and AHA,  she develops and teaches curriculum for prenatal and perinatal specialty courses offered in the St. Luke’s system.  Holly is also registered with the Yoga Alliance as a 500-hr Yoga Instructor and on faculty as a Prenatal Yoga Teacher Training Instructor. She is certified in Inpatient Obstetrics and Electronic Fetal Monitoring through NCC and is in process of obtaining her Pre and Perinatal Psychology Educator through the Association for Pre and Perinatal Psychology and Health.

  Holly has blended her experience in high volume high risk inpatient setting with her training and research in mind-body therapies to form unique educational programs for pregnant women and the providers that care for them, including Intuitive Birth – the area’s only Mindfulness-Based Childbirth Education series. A driving force for patient centered, evidence-based practice, her passion is apparent in her program content and her ability to drive changes at the policy level to improve outcomes for women and babies.

  Holly has spoken regularly at multidisciplinary local and regional conferences on the subjects of physiologic birth, prenatal psychology and health, and mindfulness-based strategies to improve health.  In addition, she provides regular educational opportunities for the public and for inpatients and care providers in her community.

When A Baby Dies

by, Debbie Haine Vijayvergiya
Stillbirth Parent Advocate • Founding Member of The Action for Stillbirth Awareness and Prevention Coalition • Founder of the 2 Degrees Foundation Fund

I won’t lie, I cringe when I think back to how frustrated and concerned I was when after two months of trying, I still wasn’t pregnant.

A friend had recently told me how she achieved pregnancy success with the help of a pricey fertility monitor so I tried that and luckily for me, I found out I was pregnant soon after.

My first pregnancy and delivery were the definition of text book. My post birth complications, which consisted of a late presentation of Group B Strep, C. difficile, and a blood clot, were not in my birth plan BUT I quickly made peace with it. I refused to allow myself to be consumed by my unexpected hospital stay or my lengthy recovery period ahead of me. I had a beautiful baby girl to focus my energies on; I would heal and get better; life was good.

I didn’t have a problem getting pregnant after that. Actually the opposite happened. When we weren’t trying; I would get pregnant. After two miscarriages, the second which occurred after a two week period of bed rest, ended in an ambulance ride, D&C, and 10 hour ER visit, I didn’t think much worse could happen. When I became pregnant for the 4th time in four years I was very anxious, but by the time I rolled into my 2nd trimester I was able to settle into the excitement of being pregnant and was finally able to feel confident that we were in for smooth sailing. At that point I had convinced myself that I had paid my dues to the pregnancy gods and nothing else could go wrong.

Unfortunately that wasn’t the case. During a routine 2nd trimester checkup my obstetrician could not detect my baby’s heartbeat. It was any expectant mom’s worst nightmare. Nothing can prepare you for the moment you find out that your baby is laying lifeless inside of you. Nothing. My life has never been the same since….

Unbeknownst to many, stillbirths cause approximately 24,000 deaths a year in the United States resulting in approximately 2000 babies dying each month – more than deaths resulting from SIDS and prematurity combined. Even with numbers like these, stillbirth remains one of the most understudied and underfunded public health issues today.

I was completely overwhelmed and unprepared to handle the unthinkable tragedy that I was facing. And I quickly learned I wasn’t alone. Soon after I was admitted to the hospital, I realized that the hospital staff – doctors, nurses, psychologists and social workers – didn’t always know what to say or how to say it. In retrospect I realized that many were lacking the tools needed to handle stillbirth. It seemed that my nurses found it difficult to switch gears between the “lively” hustle and bustle of the Labor & Delivery floor and the “barren” dark hole that my room signified. I felt neglected by my nurses. Not once did any of my nurses stop to see how were coping. I felt like a leper; as if my stillbirth was contagious.

With that being said, if I take a step back, I completely get it. The death of an unborn baby is completely out of most people’s comfort zones.

Nurses play such an integral part of the recovery process; it is critical that they are provided with the most relevant and appropriate training. In my case it would have made such a difference in my journey if the nurses were better equipped to handle the delicate nature of my experience while in their care.

There’s no such thing as one-size-fits-all advice on how to help a family suffering through a stillbirth. But what I can suggest to a nurse faced with a patient (or family member) who is struggling is to not be afraid to find the empathy and compassion that is needed to address the situation. Nurses are some of the most caring people on the planet – they went into one of the hardest and most caring professions out there. That said, even the most caring people benefit from refreshers on the effective and sensitive responses when patients have difficult circumstances. There is a lot of pressure to offer up the perfect words that will make the family “feel better” but the truth is, just being a caring presence is what is most necessary.

Stillbirth is a taboo subject across all levels of society, but if we work together to break the silence and remove the stigma around stillbirth, we will be better equipped to further the care needed to improve stillbirth outcomes for all involved.

There are many resources for nursing and parents including:

• Star Legacy Foundation
• First Candle
• The Action for Stillbirth Awareness & Prevention Coalition
• The Wintergreen Press & Babies Remembered
• 1st Breath
• Open to Hope
• Now I Lay Me Down To Sleep
• The Kelly Ryan Foundation
• The Tears Foundation
• MISS Foundation
• The Compassionate Friends
• Share Pregnancy & Infant Loss Support

Additional Resource Lists

• http://nnekahallunhinged.weebly.com/infant-loss-resources.html
• https://www.nowilaymedowntosleep.org/families/family-resources/agencies-and-organizations/
• http://www.hopeafterloss.org/support/resources/
• http://stillbirthday.com/birth-plans/

Some Helpful Tips from a Mom to Nurses

• Acknowledge their loss; tell the grieving family that you are sorry for their loss.
• Be patient with them.
• Refer to the baby by their name, if one was given.
• Make yourself available to the family if they want to talk
• And if they do want to talk, listen to the family. Don’t feel like you need to have a response.
• Let them cry, offer tissues.
• Please continue to be patient.
• Wait to talk about “arrangements” until after labor and the family has some time to let their new reality settle in.
• Continue to offer to the family the option to hold the baby, any sort of mementos, pictures such as Now I Lay Me Down To Sleep
• Please be respectfully persistent. Don’t give up. The family may say they don’t want pictures, a memory box, or to hold the baby- but that could change. There are no “do-over’s”.
• Please make sure that all hospital staff that enters the mothers room is aware of the situation and are sensitive to it.
  It’s ok to not have the answers; no one is expecting you to.
• Please don’t say- “sometimes these things just happen” or “you’re young, you can have more”.
• Please encourage them to consider a perinatal autopsy or additional extensive testing. It is in the best interest for them with regards to subsequent pregnancies and for the future understanding for us to understand why stillbirths occur and how we can begin to improve outcomes.
• Never forget to validate their feelings.
• And one of the most important things you can do is to reassure the mom that they are not at fault. I can assure you, they are blaming themselves and you have the power to take that weight off their shoulders.

Los Angeles Nurse Pledges to Fill Semitruck with Diapers to Help Families in Need

by, Jade K. Miles, BA, BSN, RN

AWHONN Member on the Move

Rosemarie Cervantes, MSN/Ed., RN has been an OB nurse for 25 years and the Los Angeles AWHONN chapter co-chair for the past three years, collaborating closely with Orange County (OC) chapter leaders. However, her AWHONN story began years earlier.

In 2009, Rosemarie was living in Nevada when she traveled to her first AWHONN national convention in San Diego. After attending informative sessions and interacting with more than 2,500 of her nurse colleagues, she returned home inspired by her experience and motivated to help build the Nevada AWHONN section.

Rosemarie’s energetic personality and reputation as a leader preceded her. Upon relocating to California in 2013, Rosemarie joined LA AWHONN and was instrumental in bringing new life to the chapter. In fact, her first event had nearly 80 attendees! She works closely between the LA and OC chapters since there is so much overlap between nurses that both work and/or live within both Orange and LA counties.

Diapers by the Dozen—and More!

By the time AWHONN announced its Healthy Mom&BabyDiaper Drive in 2015, Rosemarie was incredibly active with her fellow members in California and already making a difference in her community. But the advent of the Healthy Mom&Baby Diaper Drive brought to light an issue plaguing families that she was previously unaware of.

“The diaper drive was my first introduction to learning about the prevalence of diaper need,” says Rosemarie. “After talking to my fellow members, I realized I wasn’t the only one unaware of how much of an effect diaper need has on families.”

To help create awareness and start the conversation about diaper need, Rosemarie used resources from the Healthy Mom&Baby Diaper Drive toolkit to create a trifold with facts about diaper need to be on display for an LA/OC chapter meeting. This powerful visual aid served as a talking point and incited discussion among the nurses.

Rosemarie overheard positive feedback from members as well as an overwhelming desire to help families in need. This gave rise to a chapter diaper drive in which members were asked to bring a package of diapers to their next meeting. Rosemarie had no expectations since this was a pilot and was delighted by the generosity of her chapter members, who collected 1,765 diapers and 900 wipes.  When asked if they would do it again, the members said yes because they love giving back to their local community.

Plans to Wipe Out Diaper Need in 2016

While Rosemarie was excited to see the turnout of their first chapter drive in 2015, she set her sights on much bigger goals for 2016. Specifically, she is determined to meet or exceed the Healthy Mom&Baby Diaper Drive challenge for 2016—that’s 250,000 diapers!—by filling up a semitruck with diapers at their Fill-a-Truck Extravaganza event set for October 14 at Miller Children’s & Women’s Hospital Long Beach. Reaching that goal won’t be easy, but it will be worth it. Rosemarie has carefully crafted a plan for success that includes a powerful support system.

“First, you need to have a team that is passionate about this issue,” she explains. “Everyone has been extremely dedicated to reaching our goal. Secondly, you need a group of individuals with several skill sets to help. I have people who are excellent at acquiring donations, some with strong organizational skills, and others that can get the message out to the community. Lastly, you need to partner with the local community in order to have a successful diaper drive.”

With Diaper Need Awareness Week in mind—September 26–October for the 2016 year, when people bring awareness to diaper need in America—Rosemarie decided to aim for a fall drive for maximum impact and involvement. To get started, she met with a Long Beach City, CA council member and informed her about diaper need in the Long Beach area. She told them about plans to do a diaper drive and asked if they’d be willing to help. Long Beach said yes but that they did not have the logistics or ability to store diapers. Rosemarie took this momentary setback in stride and persevered.

“When you’re trying to work with a corporation or a large group, you have to know the right people to go to,” says Rosemarie. “Often this takes time and can be frustrating, but you just have to keep going until you get what you need.” Rosemarie contacted Baby2Baby, an LA-area diaper bank (and National Diaper Bank Network member) that helps distribute diapers to local families in need. Additionally, a local yoga studio is providing a drop-off location for diapers.

“Baby2Baby, Huggies and AWHONN have been great partners, providing necessary support to make this upcoming event a success,” Rosemarie says. “In addition to much-needed resources, manpower, marketing and other donations from Huggies we are so appreciative of local businesses and community members who have come forward to help in this event.”

Rosemarie also believes in getting the future generations involved in community service, which is why she is working with local Girl Scout troops as well as nursing students from UCLA and Long Beach City College. This is truly a group effort in which nurses are able to come together with the LA/OC communities to promote the health of women and newborns.

Confidence and Compassion: A Winning Combination

In addition to increasing the chapter’s reach and diaper donation totals, Rosemarie wanted to shed light on diaper need and the plight of low-income families. “I felt that this would be a great nurse-led community awareness campaign in our local area,” she says. “Many individuals I have spoken to are taken by surprise [when they learn] about this issue. As nurses, we need to advocate for mothers and infants by educating the medical and local community on the diaper need epidemic in our working class.”

A strong background in fundraising combined with natural instincts to care for others with which all nurses can identify have contributed to Rosemarie’s success in helping the 1 in 3 families affected by diaper need. She found her niche networking with people and not being afraid to ask for things—and that confidence is a certain asset when undertaking projects of this caliber. “I don’t give up,” she says firmly. “If the window closes, I go around and find another way to get to my goal.”

 

White House Climate and Nursing Roundtable

Wednesday, May 25th
by, Kimberly J. Angelini, WHNP-BC, RN

Today was a beautiful sunny day in D.C.

As part of Extreme Heat Week, the White House hosted representatives from leading national nursing organizations to discuss the critical importance of fighting climate change to protect public health.

Nurse leaders from across the country were convened by the Alliance of Nurses for Healthy Environments (ANHE) with hopes of establishing a relationship with decision and policy makers in Washington.

I was personally introduced to effects of environmental toxins on health through Stacy Malkan’s book Not Just a Pretty Face: The Ugly Side of the Beauty Industry. I was shocked to learn that the FDA does not regulate cosmetic products and that many contain chemicals and toxins that have been known to cause cancer and birth defects. In the book she mentions a study in which the cord blood of a newborn was found to have high levels of many of these toxins. Makes you think twice.

With this in mind I found the Skin Deep database by the Environmental Working Group (EWG.org) that lists chemicals in products and rates them as a consumer reference. I got involved and attended several lectures held by the EWG on environmental toxins as well as climate change and the effects on health. This area is critical yet remains out of the minds of the general population. The ANHE and other organizations are playing a fundamental role in bringing these health issues to the forefront and lobbying for policy change.

Nurses are on the front lines caring for America’s health.  In light of the current and predicted health threats from climate change, this historic event focused on how nursing organizations can address this public health threat through educating their members, leading research, incorporating climate change into their nursing practice, and participating at the local, state, and federal levels on climate policies like the Environmental Protection Agency (EPA)’s Clean Power Plan, which sets the first national limits on carbon pollution from power plants.

Nurses are health care professionals accustomed to looking at health holistically (telling someone to eat healthy is more complicated if the only food source in a town is fast food and gas stations.)  It is the nurse who looks at the environmental, social, and cultural aspects of an individual’s life to understand if a treatment plan will work. Nurses, as the most trusted profession, are at an opportune position to educate patients on the effects of climate change on health and anticipate the public health issues that will arise in a changing environment.

Although combustion of fossil fuel, agricultural practices, and forestry, are already causing harm and change can not be expected overnight, the harm will be less if we take prompt action. We need to both decrease the causative agents and increase our adaptations and resiliency.

Major health consequences include:

• Extreme Heat –
  • As temperatures rise, there will be an increase in heat related deaths and illnesses (particularly for vulnerable populations including pregnant women, children, elderly, and homeless)
• Air –
  • Increased temperatures decrease air quality
  • Wildfires have been increasing 5-6 fold and contribute to increased ozone and particulate matter resulting in increased cardiovascular and respiratory illnesses and death
  • Higher pollen counts contribute to longer and stronger allergy seasons
• Increased Precipitation—
  • Combination of rising sea level and increase in extreme precipitation in the form of hurricanes and storm surges can lead to flooding, alter infrastructure and result in negative health consequences before, during, and after the event, such as drowning, trauma and mental health consequences (eg PTSD)
• Water-related infections—
  • Flooding and increased water temperatures increasing contamination of water and toxic algaea growth (Vibrio vulnificus)
  • Contamination of water or shellfish
  • GI illnesses, sepsis
• Vectors –
  • Elevated temperatures and increased water breeding sites (lead to longer and larger populations)
  • Ticks and mosquitos will show earlier in season and expand northward geographically
  • Increased exposure to lyme, zika, malaria, west nile, etc.
• Food –
  • Increased temperature, humidity, and season length
  • Increased salmonella 
• Mental Health –
  • Traumatic events and natural disasters
  • Distress, grief, PTSD, social impacts, and increased stress

The impact on human health is a nonpartisan consequence of climate change that speaks to everyone globally and cannot be denied by opposition.

The need for nursing participation was clear and members of ANHE encouraged White House staff to consider electing nurses onto their committees. The role of developing committees and initiatives within each specialty nursing professional organization was addressed and the overarching importance of combining resources and efforts across nursing specialty organizations and interdisciplinary to accomplish optimal health for our nation.

Going forward, the EPA is voting on an alliance with ANHE to support continued collaboration and efforts to address this global and pressing issue.

Kimberly J. Angelini, WHNP-BC, RN is a PhD student at Boston College studying women’s health promotion. She is currently a board certified Women’s Health Nurse Practitioner and works at Dowd Medical Center Gynecology. Kim also works as a staff nurse on the in-patient transplantation unit at Massachusetts General Hospital.

What You Didn’t Know About Donor Milk

by, Diane L. Spatz, PhD, RN-BC, FAAN & Rebecca Law, MA, RN, IBCLC, ANLC ,LCCE, FACCE

Barbara’s Story

Barbara (name changed) recently became a donor due to her prenatal diagnosis with an infant whose diagnosis was fatal.  As part of prenatal care at her institution, all mothers receive a personalized, one to one, prenatal lactation consultation.

For palliative care cases, milk donation is discussed with the mother antenatally so she is aware of the possibility.  In Barbara’s case she had an older child who she breastfed for over two years.  She reported a fantastic breastfeeding experience and spoke enthusiastically about how important breastfeeding was to her as part of motherhood.  With an infant with a known fatal anomaly, Barbara wanted to have the opportunity to breastfeed and experience motherhood.  During the antenatal period, a birth plan was established so that she could hold her infant skin to skin immediately post-delivery and attempt breastfeeding.  Barbara also began the screening process to become a Human Milk Banking Association of North America (HMBANA) donor and was determined that she would pump milk and donate for the duration of her maternity leave.

At the time of delivery, Barbara was able to hold her child and the infant attempted a few suckles at the breast.  Even though the baby did not live for more than a few hours, the she was able to have her breastfeeding experience.  Following delivery, Barbara finished the HMBANA screening process and her serological testing completed.  She was approved as an HMBANA donor and expressed milk for about three months following delivery.  For Barbara donating her milk was a huge part of her grieving experience.  By being able to speak to the milk bank staff weekly, she had the opportunity to have a “mothering” and “breastfeeding experience”.  She reported that it was so meaningful to her to know that her milk was going to help other sick infants right in her own community.  She was thankful she had the little time with her daughter that she did, and felt her daughter’s short life had purpose in helping countless other children.

 

Why would mothers with extra milk donate to a human milk bank?

1. Optimistic and altruistic behaviors are the primary reasons mothers donate their extra milk to an HMBANA milk bank. Mothers may find themselves with too much milk which they do not want to discard, and by donating their milk they are giving a tangible gift that they know will benefit other infants, because they have seen the benefits of their milk to their own child.Donors report positive emotions and say they would donate again if given the opportunity.
2. Mothers who are familiar with the needs HMBANA milk banks and the infants they serve are motivated to donate their extra milk. Health care providers can influence a mother by recommending donation of her extra milk to a HMBANA milk bank.
3. Bereaved mothers, such as Barbara, also choose to become donors to HMBANA milk banks. Some mothers know in pregnancy that their infant’s diagnosis is fatal and other mothers may have an infant who dies after a long hospitalization.  Bereaved mothers report that by donating their milk they give meaning to their child’s life.  They report that by donating their milk it helps in the grieving and healing process and may help with feeling a sense of closure.

Information About Milk Banking in the United States

Pasteurized donor milk is available from both non-profit and for-profit organizations in the United States.  Non-profit milk banks are part of the Human Milk Banking Association of North America (HMBANA) and have a shared set of standardized milk banking practices.  HMBANA has an interdisciplinary board with representatives from HMBANA milk banks as well as external board members from a variety of professions.

In order to donate milk, a mother must go through a vigorous screening process.  The first step is a verbal health screening.  The mother then completes an extensive health history and lifestyle questionnaire related to her health, her infant’s health, her lifestyle and dietary practices and must have a form filled out by her health care provider reporting her health status and laboratory testing from pregnancy.  Additionally, the infant’s health care provider must complete a form stating the infant is in good health (unless in the case of fetal or infant demise). The milk bank coordinator reviews all materials and verbally reviews and confirms information with the mother.  The mother then signs consent to be a donor and at this point the mother must undergo serological testing.  The cost of the laboratory testing is $200-$300 and paid for by the milk bank.

Once a mother has passed all screening and her labs come back negative, she is approved to be a donor.  Mothers can make a one-time donation or be repeat donors.  However, if a mother continues to be a regular donor, the milk bank staff will follow-up regularly to ensure the mother has had no changes in her lifestyle or health.

Raw milk is stored frozen until ready to be prepared for pasteurization.  Raw milk is thawed, pooled, poured and then pasteurized using the Holder pasteurization method.  Each batch of milk that is pasteurized is also cultured post-pasteurization to ensure there is no bacteriological growth. Post-pasteurization, the milk is stored frozen.  Once milk culture comes back negative, milk can be dispensed to donor recipients.

In the United States, most HMBANA milk is donated to hospitals with neonatal intensive care units (NICUs).  Pasteurized donor milk is mostly used for preterm infants or other vulnerable infants.  However, there is some published literature supporting the use of donor milk for term infants or late preterm infants, if supplementation is required during the hospital stay. In the community setting, a prescription from a health professional is required for the milk bank to dispense pasteurized donor milk to a home.

Pasteurized donor milk from HMBANA is provided on a cost-recovery basis causing the milk banks to charge a processing fee of $3.00 to $5.00 per ounce.  Insurance reimbursement varies from state to state resulting in a cost to the hospitals or consumers.

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Diane 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.

 

Rebecca Law, MA, RN, IBCLC,ANLC,LCCE,FACCE is the manager of a the Lactation and Childbirth Education Departments at Texas Health Harris Methodist Hospital Fort Worth and has over 25 years experience in womens health.  She has received a Masters degree in Health and Wellness with the focus on Human Lactation and is certified as an IBCLC and Advanced Nurse Lactation Consultant. In addition she is certified as a Lamaze Childbirth Educator and has been educating patients and staff for many years.  She is part of the Baby Friendly Hospital Initiative team assisting the hospital with the designation in 2010 and is the current chair of the hospital system BFHI group. She has experience as a podium and poster presenter at several state, national and international conferences including Lamaze International, ILCA, State Breastfeeding Coalitions, and NICHQ.

Top 10 Tips for Dad’s!

From excited, to nervous, to anxious, to scared, to overwhelmed, to over-joyed; becoming a parent for the first time is a life-changing event that is filled with a wide range of emotions.

This Father’s Day we wanted to provide some tips and advice from our nurses to help ease those first-time parent jitters.

1. Congrats on this amazing journey. If you and your partner have made the decision to breastfeed your baby, congratulations! Partner support is one of the biggest long term indicators of breastfeeding success, so it is important that you support your partner as much as possible! Sign up for breastfeeding class and attend with her and learn as much as you can about how breastfeeding works. After the baby is born, many dads can feel left out because of the amount of time a breastfeeding mom spends with her newborn in the beginning while the breastfeeding relationship is being established. Support mom and get your own bonding time in by doing the diaper changes, burping the baby, bathing the baby. Encourage and support the mom when she is lacking confidence, and help her find resources if things aren’t going well. Although you can’t breastfeed the baby, there are many ways that you can be close to the baby and take part in the care of baby and mother.
2. Spend time with your baby and create a ritual or activity that is yours alone. Bonding and special time are important for you and your baby too.
3. Participate in skin-to-skin. Bring a sweatshirt with a zipper to the hospital. During skin to skin with their baby they can take off their shirt wear their sweatshirt and zip the zipper up with their baby on their chest. Also when newborns are very fussy or crying, it is almost magical to see how quickly baby calms if dad takes off his shirt and places baby skin to skin on his bare chest.
4. Your involvement is uniquely influential in the health status of your child. Each moment spent holding, bathing, feeding or reading to your baby, facilitates their growth and development. You are irreplaceable in the context of the coaching, modeling, teaching and encouragement that you instill. If you have an insecurity regarding your ability to balance work and families responsibilities or perhaps your own fathers involvement, remember that you are not alone. Forgive yourself when you make mistakes. Your contribution, point of view and playful attitude are necessary pieces of the puzzle which will guide and shape your child’s life – which cannot be replaced. A father’s love is unrivaled!
5. Ask Questions. If you are unsure of something, please don’t hesitate to ask your nurse or doctor.
6. Take Note During Discharge. You and your partner just welcomed your brand new baby in the world, and now it’s time to bring the little one home. Mom is often exhausted and overwhelmed, be sure to take note of key points when the nurse is providing discharge information that you can share with your partner when you get home after she’s had time to decompress.
7. Know When to Say No. It’s ok to stand your ground and turn away visitors if you and your partner aren’t up for it.
8. Mother’s aren’t the only ones that suffer from postpartum depression/anxiety (PPD/A). Father’s experience depression and anxiety too.  Symptoms include depressed mood; significant weight gain or loss; restlessness; fatigue; insomnia or sleeping too much; feelings of worthlessness; difficulty with decision-making; and thoughts of suicide or death. It is important to watch for changes in mood or behavior, especially since you and your partner have just had or adopted a baby. If you suspect that you or a loved one is suffering, get help and contact your doctor. You can also check out these online resources. 
9. Savor this time. It seems like the older the children get, the faster the time flies.  Slow down and treasure these moments while they are still small.
10. You are your child’s biggest hero. In your eyes, you are everything they aspire to be.  Be their best role model and biggest cheerleader.  This means more to them than anything.

 

My First AWHONN Convention So Far!

by, Melissa Strunc, RN

This was my first AWHONN Convention!

The first class I attended was on dealing with neonatal abstinence.  My hospital has a center for addiction and pregnancy and I deal with these babies almost on a daily basis, so when I saw that AWHONN offered a pre-convention seminar on shortening the length of stay for these newborns, I knew I just had to go!

The presentation by Maureen Shogan, MN, RNC, dealt with the newest changes in caring for these infants, and the latest research concerning shortening their length of stay. The first thing that stood out to me was when the Maureen said “Babies are not born addicted!” She proceeded to explain the definition of addiction, which included a pattern of compulsive behavior, impairment and behavioral control, and problems with interpersonal relationships. This certainly doesn’t sound like a newborn!

She clarified that these babies are dependent on the drugs their mothers are taking while pregnant, but are not “addicted”. The word addiction puts a negative stigma on these babies so early in their lives. The second thing that stood out to me was that these mothers, these patients who are doing this to their babies, are someone’s mother, sister, daughter, cousin. Their dysfunction is how they kept alive.

Maureen also presented information on cigarette addiction among these women who are taking other drugs and how this affects the babies’ withdrawal symptoms. She shared the latest research concerning this out of Dartmouth, where they were able to shorten the entire length of stay for these newborns when they factored in the nicotine dependence of these newborns among other slight changes to their approach.

She went on to discuss in depth the scoring system, and how to train nurses to become reliable, instruct parents prenatally and postpartum on what to expect from their babies during the hospital stay. She highlighted the importance of team training for staff in conjunction with psychiatry and finally the importance of the timing of scoring these babies so that we are not giving them unnecessary high scores when they may just be hungry.

Coming into this, I felt that my department was very good at scoring NAS babies, although I do see disparities myself from nurse to nurse. However, in this class I picked up on one specific category that we were scoring these babies higher than we should have, when one point should not have even been included in the scoring system.

I am so glad that I came to this pre-convention workshop, and I will be sharing everything that I learned with my colleagues when I return.

The second workshop I attended involved the rapidly deteriorating OB patient and how to pick up on warning signs, and follow through with the appropriate treatments, all the way through CPR (if necessary), and emergent delivery of the baby. One key point that stood out to me is to never ignore changing vital signs as these will be the earliest indicator that something is going wrong (as well as the fetal heart tracing).

I also had never heard about the importance of displacing the gravid uterus to the left during CPR! This seems so obvious after hearing it, but we do regular simulations on my unit (including the doctors), and I have never heard anyone bring this up!

My take-away quote from this workshop was “I can only control what I do”. I can’t control the doctors and other nurses, but I can take responsibility for my actions and reactions; and this will improve my patients’ safety.

The first general session had so many “ah-ha” moments for me, I don’t even know where to start. Not only was the presenter knowledgeable, but her words touched my heart and soul. It was uplifting and encouraging, at the same time challenging and convicting. As I sat there, I found myself wishing she could do the entire conference – and she’s not even an OB nurse! I left with tears in my eyes, and her presentation wasn’t even sad!! THANK YOU, Captain Beeson! I will definitely be hunting down these slides and sharing her words with my colleagues and managers concerning resilience!

One of the many quotes that stood out to me was, “Getting upset & complaining over silly, stupid things saps your energy from things that are important.” This can be translated into work, personal life, family, etc.

My favorite story she told was concerning crisis, and how there is so little complaining and negative attitudes in time of crisis. She shared a story about the time period after 9/11 when her military hospital sent a large number of their nurses to man a hospital ship off the coast of New York. She immediately started receiving calls, and was able to fill those spots in her hospital with nurses all over the area. It was such a touching story, and it really hit a chord when she said that this is the kind of nursing we need – crisis nursing without the crisis.

I know that I will start being more diligent in staying positive, speaking encouragement and positivity rather than feeding into the negativity. And, again, take responsibility for my actions in my area as well as never taking the “not my problem” attitude after attending this session.

I have already learned so much from this convention, and can’t wait to see what the next few days hold!