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


nursepicamyAmy 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.

We May Have Different Religions

By Evgeniya Larionova

“We may have different religions, different languages, different colored skin, but we all belong to one human race”. –Kofi Annan (Ghanian Diplomat, 7th UN Secretary-General, 2001 Nobel Peace Prize winner)

What is exactly childbirth? Some people compare it to a miracle, a heroic act, or a surge of love accompanied by strenuous and intense hours of labor. It’s absolutely one the most unique experiences that can happen to a woman’s body. The time when she is particularly vulnerable and in need of much support and care.

For me, a nurse practitioner student on labor and delivery floor at Massachusetts General Hospital, witnessing childbirth was something that I would never forget. Thrown into the action on a first clinical day, I had mixed feelings of joy, excitement and a slight nervousness. I felt extremely privileged and grateful to witness a natural delivery and I was hoping to help a future-to-be mom during the process.

From the morning report I found out that the woman I was assigned to follow was a recent immigrant from Guatemala who belongs to the indigenous Mayan population. Mayan was the patient’s native language but she was also able to understand Spanish. Her husband had been residing in the United States for 5 years. She moved here a year ago and the family has finally reunited.

My patient was accompanied by a traditional nurse midwife known as comadrona. Comadronas are trusted women leaders in their communities who accepted a spiritual calling. They usually don’t receive any formal training but have years of experience delivering babies. Comadronas regard birth as a natural process and rely heavily on God and prayers. The nurses established a plan of care recognizing my patient’s spirituality and personal support system. The Mayan midwife was present during labor and helped with comfort measures. The nurses also invited a qualified interpreter.

When I entered the room, a nurse and a midwife, along with the comadrona, surrounded the tiny woman. One of the nurses was checking her vital signs and the nurse-midwife was encouraging the woman to take slow deep breaths and relax. The comadrona, wearing a traditional colorful embroidered dress, was gently massaging her back. The room was dimly lit and the scent of fresh lavender floated in the air. My patient’s contractions were increasing steadily and were becoming more regular. This was active labor –she was ready to give birth.

The whole atmosphere struck me. There was no other language present in the room but the language of trust, respect and compassion between these women. I immediately wanted to become connected with what was happening- just by holding this woman’s hand and talking to her.

Reflecting back on this experience, I understood that nurses not only created the environment that made this woman feel comfortable and that was respectful of her spirituality but that the environment also had a significant impact on the labor and birth process. Although childbirth is unique and at the same time a unifying biological event for any woman; providing therapeutic communication, physical, emotional, spiritual care and comfort during the labor process is crucial.

The comadrona shared her knowledge and experience with the American nurses. It was important for my patient to have a traditional midwife near the bedside who comforted and prayed with her. There was interplay between modern and traditional medicine that contributed to the positive outcome. Nurses in this particular case were not only culturally sensitive and able to understand cultural values, beliefs and attitudes of clinicians and patients, but also culturally competent and had knowledge, capacity and skills to provide high-quality care (Jernigan et al, 2016).

It’s essential for any nurse in such a unique, heterogeneous country like the United States to be cognizant and open-minded of cultural diversity and the patient’s cultural perspectives. I will take this amazing experience to my future nursing practice and strive to always treat my patients with dignity, respect and compassion. I also hope to continue to integrate a holistic model and culturally sensitive care into our modern childbirth practices.

This woman gave birth to a beautiful baby daughter whom she named after a nurse taking care of her during her labor and birth.

Additional Resources & References
http://prontointernational.org/
https://he-he.org/en/
http://www.mayamidwifery.org/
http://midwivesformidwives.org/guatemala/
http://www.birth-institute.com/study-abroad-guatemala/
http://www.acog.org/
Jernigan, V. B. B., Hearod, J. B., Tran, K., Norris, K. C., & Buchwald, D. (2016). An Examination of Cultural Competence Training in US Medical Education Guided by the Tool for Assessing Cultural Competence Training.Journal of Health Disparities Research and Practice, 9(3), 150–167.


evgeniya-headshotEvgeniya Larionova received her Bachelors of Science in Nursing from MGH Institute of Health Professions. She is a founder and an Artistic Director of AMGITS Drama&Poetry Club at the Boston Living Center. She is a member of the student Leadership Committee of the Harvard Medical School Center for Primary Care. Evgeniya is passionate about infectious diseases, community health and integrating holistic care in modern practices.  In her spare time she plays in the Russian theater, enjoy reading, playing the guitar and hiking.

6 Tips For Postpartum Care for Mom “The Patient”

by, Kristen Wesley “The Mom”

Kristen and IslaThere is a moment after labor when you realize that not only is your sweet little baby a patient, but that you are too. At least for me, that was something that hadn’t really registered. On the day that my little baby girl Isla was born I very quickly began to understand we would both need a ton of care in the hospital and at home.

You would think from all the books I read, articles I scoured, and the numerous second hand accounts from friends I received, it would have sunk in. But it just didn’t. It literally never occurred to me that I’d be a patient too during and after labor and birth. Continue reading

Dealing with the Loss of a Tiny Patient

By Lori Boggan, RN

I have worked with babies as a neonatal nurse for nearly twelve years.  In that time I have seen countless well babies, premature babies, babies with heart defects or bowel defects, and babies born with Down syndrome or syndromes incompatible with life.  I have seen babies die.  It happens and is the sad, unfortunate part of the job. It’s sad for the parents and family that longed for this little person and lost.  It’s sad for the medical team that worked so hard to give the baby a fighting chance and lost.  So how does one overcome a particularly poignant loss? Continue reading

Birth Traditions Around the World

by, Lori Boggan

There are few things more memorable in life than the birth of a baby. No matter where in the world, what socioeconomic background she comes from, or how many times she has given birth, a woman can probably tell you every single detail surrounding her birth and the early days thereafter. She can tell you the exact moment each baby was born, how long it was and how much it weighed. I have been honored and privileged through the years of working with moms, dads, and babies to hear their birth stories and bear witness to the one of the most important moments in their lives. Continue reading

The Things You Do Make A Difference

Traciby, Traci Turchin

“But we had this for dinner LAST night” the five year old says.  My joke with the nine year old falls flat because he’s too busy sighing over his lack of clean socks.  “That’s IT!” I tell my husband with a wink, “I’m running away from home and going to work where I’m appreciated!”

I’m one of the luckiest nursing students in the world.  By day I drown in books and deadlines and elementary school paperwork and laundry, but by night I work as a CNA at the birth center of my local hospital.  I know, while the little efforts at home might go unnoticed, no small kindness is missed by our patients. 

We tuck those small kindnesses into our hearts and carry them around, forever grateful. Continue reading

Top Ten Misconceptions About the Use of Nitrous Oxide in Labor

by Michelle Collins, PhD, CNM, FACNM

The use of nitrous oxide as a labor analgesic has taken hold in the US in the past three years. It has been used widely in Europe for decades, with favorable results, along with comes educational information but all the perpetuation of myths.

10. Using nitrous oxide in labor is “just like” when you use it at the dental office. It’s not. In dental offices, the concentration of nitrous oxide to oxygen is variable, so the dentist can increase or decrease the concentration based on the patient’s needs. Dentists may use concentrations of nitrous oxide of up to 70%. The dentist also places a small mask over the patient’s nose, through which a continuous stream of nitrous oxide is delivered.

During labor nitrous oxide is only used at concentrations of 50% nitrous oxide to oxygen – no higher. And the stream of nitrous oxide is intermittently administered by the woman herself using either a mouthpiece or mask with a demand valve. The demand valve opens only when the woman inhales (breathes in) – which is when the gas is released. When the woman exhales (breathes out), the valve closes and the gas stream is stopped.10 Misconceptions about Nitrous Oxide in Labor

9. You will be confined to bed while using nitrous oxide. You will still be able to move around while using nitrous oxide during labor. About 10% of nitrous users may experience some dizziness, so your care providers will want to see you stand or move about without difficulty before they let you up on your own, but many women use nitrous oxide while standing, squatting, sitting in a rocking chair, or on a birth ball.

8. Continuous fetal monitoring will be required with nitrous oxide use. Whether you have continuous or intermittent fetal monitoring should be dictated by your obstetrical status, not because you are using nitrous oxide. In other words, if you are a candidate for intermittent monitoring, that does not have to change to continuous monitoring just because you begin using nitrous oxide.

7. If you choose to use nitrous oxide, you cannot use any other pain medications. A fair number of women who start out using nitrous go on to have an epidural placed at some later point in their labor. Using nitrous oxide earlier on allows you to maintain your mobility and stay upright, allowing the baby to move down well in your pelvis before being confined to bed with epidural anesthesia.

6. Nitrous oxide will stall your labor, or slow contractions. There has not been any research showing that nitrous slows down labor or causes contractions to be less strong or happen less often.

5. Nitrous oxide will harm the baby. Nitrous oxide is metabolized (processed) in your lung tissue, but because some of the gas passes into your blood stream, some can also pass through the placenta and go to your baby. However, studies have not shown adverse effects on babies of mothers who have used nitrous oxide in labor.

4. There is a point in labor when it is too late to use nitrous oxide. Actually, some women don’t begin using nitrous oxide until they are in the pushing stage. Other women don’t use it at all during labor, but find it very helpful if they need repair of any tears in their birth canal.

3. My family members can assist me with holding the nitrous oxide mask or mouthpiece if I get tired of holding it. As well-meaning as family members are, this is one area where they can’t help. A safety precaution for nitrous oxide use is that the laboring woman holds her own mask or mouthpiece. When she has had sufficient nitrous oxide, she won’t be able to bring her hand holding the device to her face. Allowing someone else to hold the mask/mouthpiece overrides this safety feature of nitrous oxide.

2. Nitrous oxide is offered at many hospitals and birth centers. Until 2011, there was really only one hospital in the US offering this option. Since that time, use of nitrous oxide has dramatically increased and there are currently over 100 hospitals and 50 birth centers offering nitrous oxide. Though it has come a long way, there is a long way to go to ensure that every woman who desires to use nitrous oxide in childbirth, has the opportunity.

1. Nitrous oxide makes you laugh (hence the nickname “laughing gas”). Despite the nickname, inhaling nitrous oxide doesn’t leave women laughing like hyenas! Because nitrous oxide decreases anxiety, it puts women more at ease and they may be more talkative and relaxed… but don’t count on side splitting laughter!

Michelle CollinsMichelle Collins is currently Professor of Nursing and Director of the Nurse-Midwifery education program at Vanderbilt University School of Nursing. In addition to the teaching and administrative aspects of her job, she maintains an active clinical practice as part of the Vanderbilt School of Nursing faculty nurse-midwifery practice.  Currently she is a blogger for Nashville Public Television for the popular series Call the Midwife.


Resource on Nitrous Oxide For Nurses

AWHONN has a Nurses Leading Implementation of Nitrous Oxide Use in Obstetrics webinar to describe the history of nitrous oxide use to present day and the necessary steps nurses need to take to initiate nitrous services at their institutions.

Nitrous Oxide as Labor Analgesia, Nursing for Women’s Health, Volume 16, Issue 5, pages 398–409, October / November 2012.

Our Nurse Changed Our Lives

Jessica_Familyby, Jessica Grenon

When I think back to the birth of my second child earlier this year, tears almost instantly begin to fill my eyes.

Unlike the birth of my first child three years prior, this isn’t because I am overjoyed by thoughts of holding my baby against my chest for the first time while I stare in awe at the life my husband and I created, a life that I grew in my own body and delivered into the world after many, many hours of hard labor. Instead my eyes fill with tears because I think of my labor and delivery nurse and how I believe her actions on that day affected the trajectory of my life, my son’s life, and the future of our family.

I am not a nurse, I don’t even work in the medical industry, but for the past nine years come June my work has brought me to the annual AWHONN convention, where I support the online system used by those submitting proposals and assist presenters’ presentations. Through this work I have read hundreds of abstracts and watched dozens of presentations on standard topics such as home births and skin to skin care for newborns, to more memorable subject matters like how to care for a vaginal piercing during a delivery.

My work with AWHONN does by no means make me an expert in the field of labor and delivery, but on January 30th of this year, I had gained enough knowledge from working with AWHONN to know what the possible outcomes could be when something suddenly went wrong during the birth of my son.

After 13 hours of laboring in the hospital, the time had finally come to begin pushing. Not yet knowing the gender of my child, I felt extra encouragement to push as hard so I could finally meet my baby. It took only 21 minutes of pushing to hear the words, “only one more push, Jessica, and you will be able to hold your baby!”, however, that was quickly followed by a sudden shout to stop pushing.

Stop pushing, but why? I looked down and between my legs I could see the head of my baby, turned toward my inner right thigh; he was silent and lifeless. Right away I knew that it was shoulder dystocia, and like any mother, my mind went to straight to thinking about the worst case scenarios. Was my baby getting oxygen, would he have brain damage? Is his shoulder going to be broken? I don’t care if he has broken bones, bones heal, just make sure he can breathe! Just last June at AWHONN a presenter and I had a conversation about shoulder dystocia, what was it that she said the other outcomes could be?

The next few minutes were all a blur me screaming at the doctor to help my baby, my husband kissing my head and doing the best he could to stay strong for the two of us, the student midwife attending her first delivery still holding onto my left leg waiting for someone to give her instructions and then there was a voice that I will never forget. Then the firm voice of my labor and delivery nurse as she turned to the doctor and said, “Doctor. Would you like me to call for another set of hands?” I got the sense that she wasn’t asking for permission, but rather she was politely informing the doctor of her intent to ask for assistance because she knew it was needed.

The doctor nodded as my nurse instantly took one side step closer to my head, she looked me straight in the eyes and smiled as she pushed the call button for the nurse’s station and requested another attending physician join us in my delivery room. A moment later the door swung open and the already crowded room began to fill with more people. In an instant, my nurse and another doctor were in the delivery bed with me, pushing on my low abdomen , doing all they could to change the position of my baby.

In this chaotic scene I once again heard that firm voice calmly say, “Doctor. Would you like me to call in a NICU team?”. The doctor nodded yes and soon a NICU team stormed into the room to wait for my son to be born to take over his care.

At the end of this ordeal, I was blessed with a perfectly healthy child; not one bruise on his body, no torn muscles, no broken bones, and no lack of oxygen to his brain. He did stay in the NICU for two days to be supervised for a potential infection, but otherwise all 10lbs, 5ozs of him was unscathed during his traumatic birth .

It may have been my doctor’s hands that brought my son into the world, but it was my nurse’s voice that I credit for my son’s health and our future without the need for further medical treatment.

Would my son have been fine if he were stuck during the birthing process for another couple of minutes? I don’t know. Fortunately because my labor and delivery nurse spoke up during a time of crisis, I don’t have to find out.

JessicaJessica L. Grenon is the Director of Continuing Education Services at The Conference Exchange, where she has worked with AWHONN since 2007. She, her husband, and their two young children enjoy traveling and spending time with their extended family, especially with her twelve nieces and nephews.

 


Resources on Shoulder Dystocia

Definition: Shoulder Dystocia is the impaction of the fetal anterior or posterior shoulder behind the material pubic symphysis resulting in delay in a cephalic vaginal delivery. This creates a high-risk intrapartum complication affecting both mother and baby.

For Parents: Health providers can’t always predict or prevent shoulder dystocia, but there are some risk factors you can learn about.

For Nurses: AWHONN has a Shoulder Dystocia online product to help prepare clinicians for this level of critical care event.

Beginning Breastfeeding, Breaking Down Barriers

by, Summer Hunt

You’ve heard it time and again: Breast is the best. But many moms-to-be express concerns over breastfeeding, from doubts about their abilities, to time constraints, and everything in between. However, moms who have experienced challenges and broken down breastfeeding barriers will tell you this—it’s worth it.

Same goal, different struggles

Erin Lee and her family

Pictured above: Erin and Hung Lee with Emersyn, Paxten and Mylo

Pictured above: Erin and Hung Lee with Emersyn, Paxten and Mylo

“Just because something is natural doesn’t always equal easy,” says Erin Lee, RN, BSN, IBCLC, mother of three. As a registered nurse (and now a board-certified lactation consultant), she was fully aware of all the benefits and knew that she would breastfeed. What she couldn’t predict, though, was how many bumps in the road she would encounter.

“I had a long intense labor, and they had to use some suction to get my daughter out,” she explains. “She had a strong oral aversion, and I had flat nipples, which made latching almost impossible. On top of everything else, she was extremely jaundiced. I wanted and needed to breastfeed her, and I was determined to—but it wasn’t easy to get started.”

Lindsey Grissett knew before her daughter was born that she would breastfeed. “It was just something that made enough sense to me not to question,” she says. “I was further encouraged to educate myself on it by both my doctor and my husband.” Birthing at a Baby-Friendly® hospital meant Lindsey had a lot of support. “I was signed up for breastfeeding classes well in advance, and I don’t think I had a single question go unanswered,” she says. “I felt both mentally and physically prepared.” Shortly after giving birth, baby Emma latched right on as both mom and baby got the hang of things.

Breastfeeding wasn’t without its challenges for Lindsey, though. “There were times when I would stand in the shower, stare at the wall, and wonder how it was possible for an individual to function on so little sleep,” she recalls. It felt like the baby was hungry all the time… I was exhausted.” Lindsey learned a lesson in patience and teamwork as mom and baby found their rhythm. “It’s a process—you have to use different hand movements, massaging your breast to get the milk flowing while trying to get her mouth in the right place… or else all that hard work literally just leaks away.”

Finding help when you need it

For Erin, having the support of an International Board Certified Lactation Consultant® (IBCLC) made it easier to focus on one thing at a time. “Even though I’m a nurse, she saw things I couldn’t see,” Erin says. “She realized my daughter was jaundiced. She also helped me establish smaller goals instead of worrying about getting her to latch. I pumped my milk so we could focus on feeding her and getting her to gain weight. Then we worked on overcoming her oral aversion, and then… she latched!”

Lindsey Grissett

Pictured above: Lindsey and Raymond Grissett with Emma

Lindsey agrees that a lactation consultant was a huge help. “They called a few days after being discharged, asking if everything was going okay. They set up appointments for me to come in, show them my progress, and make sure she was taking in enough.” It was a lactation consultant who recognized that Lindsey’s baby girl was also jaundiced, she adds. “Several months after I had Emma, I still received phone calls to see how I was doing. I was so well taken care of!”

An indescribable feeling

While you can read a bundle on the benefits of breast milk, there’s one thing that you can’t find in a class or a book—the physical and emotional closeness that develops between mom and baby. “The bond you feel while you’re feeding your baby… it’s incredible,” Erin says. “Until you experience it, you can’t know how powerful it is.”

“The most valuable thing about breastfeeding was definitely how close it brought me to Emma,” Lindsey says. “There so many times when I just wanted to sleep, or eat, or shower in peace… but even when I was at the end of my rope, it was such a great feeling knowing that she needed me. That was my motivation to keep going.”

Turning lemons into… breast milk?

After a difficult breastfeeding journey, Erin knew she could use her experience to help other women. “I was working in pediatrician’s office, and I shadowed the IBCLC there, seeing the moms and babies come in, some of them having the same issues I did. I wanted to help them overcome it—I became very passionate about it.” She became an IBCLC in 2013, and in 2015 she cofounded a private practice lactation business.

“Most people will encounter some sort of struggle,” she says. “For some it might be a few days or weeks, others might take months to get the hang of it. Just because the baby doesn’t latch right away, or you have a little discomfort at first doesn’t mean it’s the end. With the right support system, you can do it. It’s so empowering—being able to provide this essential need for your baby.”

For first-time moms (or first-time breastfeeding moms), Erin offers up this advice:

Educate yourself. Not just about the basics of breastfeeding, but also on normal infant development. The more you know, the more prepared you’ll be for what’s to come.

Build a support system. Find a health care provider that’s supportive of breastfeeding and understands that it’s something you want. Find an IBCLC, and attend La Leche League meetings even before you give birth. Talk to your mom if she breastfed, or your friends who did – these are the people you’ll be texting at 1am when you’re at your wit’s end and you need someone to tell you it’s going to be okay.

Be gentle with yourself. Your only job right now is to nourish your baby. The rest of it, cleaning the house, putting dinner on the table, losing baby weight… it can wait. You take care of your baby—everything else will fall into place.

 

Summer Hunt

 

Summer Hunt is the editorial coordinator for publications at AWHONN.

 

 

 


Resources for Moms

Ask Our Nurses: How Will My Baby and I Begin Breastfeeding? (video)
Ask Our Nurses: How Do I Prepare For Breastfeeding? (video)
How to Overcome the Challenges of Breastfeeding (article)
Breastfeeding Fixes (article)
Download our brand-new Breastfeeding Parent Pages here.


Erin Lee, RN, BSN, IBCLC has worked as a registered nurse in the Pediatric Intensive Care Unit at Boston Children’s Hospital, Georgetown University Hospital and All Children’s Hospital, among others. She is the cofounder of Suncoast Lactation Consultants in Bradenton, FL, where she lives with her husband and three children.

Lindsey Grissett is a mental health community court liaison in Anniston, AL, where she lives with her husband and daughter. She enjoys working out, traveling and hanging out with her family,  and watching her little girl grow.