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.

Intimate Partner Violence

Journey of Motherhood Under the Shadow of Abuse During Pregnancy

by, Ann Bianchi, PhD, RN

Intimate partner violence (IPV) has devastating effects on a pregnant woman and her unborn child.

Intimate partner violence may be more severe and more frequent during pregnancy which poses health risks to the mother and her baby. The effects on a woman’s health due to IPV during pregnancy may extend long after the pregnancy and post-partum period. One in four women are victims of IPV and 324,000 pregnant women experience IPV each year and 1600 maternal deaths each year are the result of intimate partner violence.

This blog post is part of our IPV series and covers the effects on mother-infant bonding, maternal and fetal outcomes, and our role as nurses.

The last in our blog series coming out in winter 2015 will cover screening details for nurses. Continue reading

Pregnancy test

Trying to Conceive After Miscarriage

Aimee Patrick and Charlieby Aimee Poe

My husband and I always wanted a family. The summer before I turned 29, we decided to start trying. Little did we know there would be a roller coaster of a journey ahead.

I got my first positive pregnancy test in September. I knew my life was about to change. I quit smoking, which was a huge deal for me. My husband and I were thrilled. At my first ultrasound, there was silence. The verdict was devastating: I was miscarrying due to a blighted ovum.

My doctor advised me to wait two full cycles before trying to conceive again. I didn’t track anything; I just guessed at when I was going to be ovulating. In February, I got my second positive test. Though nervous, I had a better feeling, thinking the odds were low I would have a second miscarriage.

We picked out names, I looked at birth plans, and at 8 weeks I started building a baby registry. We were cautious to share the news, waiting to tell even our parents. On March 20, one week after announcing our new addition, I went to the restroom and noticed blood. I immediately fell on the floor crying. In that split second, my dreams of our family were crushed.

When they did the ultrasound in the emergency room, they wouldn’t let me see the screen, saying only that they couldn’t detect a heartbeat. I felt like I died inside. My doctor ordered a D&C (dilation and curettage) and told us to wait two cycles.

This time, I took ovulation and trying to conceive (TTC) seriously. I continued taking prenatal vitamins, educated myself, and tracked my ovulation with digital ovulation predictor. The moment I saw the little smiley face letting me know I was ovulating, I told my husband it was go-time! The two-week waiting period after that felt even longer than the two cycles we had to wait to start trying again.

Aimee and PatrickOn July 11, I got my big fat positive! I called my husband, and then I called my mom, who was so supportive. I had a form of PTSD after dealing with two miscarriages, and I didn’t want to tell anyone I was pregnant, so as to avoid the embarrassment.

At 6 weeks, I had my first ultrasound. When we saw that tiny little heartbeat, I cried. My doctor put me on progesterone. We had our next ultrasound at 11 weeks, and there was our baby, active and wiggling around. It was amazing! I wasn’t used to seeing my ultrasounds. Every time I saw my baby felt like a miracle. We learned my due date was March 20—the date of my second miscarriage. Everything was coming full circle. Even more exciting, it was a boy!

CharlieAs badly as I wanted to meet my son, he was even more anxious: At 34 weeks and 4 days, Charles David Poe made his appearance. His birthday is February 9, the same date I had my second positive pregnancy test the year before. Tiny but strong, Charlie came into our lives so fast and has made it indescribably beautiful. It was beyond worth it to have gone through all the turmoil of TTC to get to this amazing part of my life.

Aimee and Patrick maternityAimee Poe is an experience specialist at Verizon. She loves playing video games, watching movies, hanging out with her family, and flexing her creative muscle with various projects.

 

 

Nurse expert and Healthy Mom&Baby Editorial Advisory Board member Susan Peck, MSN, APN shares her best tips for those trying to conceive.

  1. Timing is key. “Many women don’t know there is a small window of opportunity each month for conception to occur. Talk to your health care provider about how to predict ovulation based on the length of your menstrual cycle—there’s an app for that!”
  2. Quality, not quantity. “Couples may not realize that having sex multiple times a day can actually lower sperm counts. I usually recommend daily or even every other day during the few days before during and after ovulation.”
  3. Patience is a virtue. “If you don’t get pregnant right away after going off birth control, that doesn’t always mean something is wrong. Most couples will take 4-ish months or so before conception occurs.”
  4. Plan ahead. “Preconception care is so important. Talk with your health care provider about any health problems you have that could affect pregnancy as well as the safety of any medications you take.  You may need to switch medications while trying to get pregnant. You can reduce your risk of neural tube defects by beginning a prenatal vitamin which includes 0.4 mg of folic acid before getting pregnant. Now is also the time to quit smoking.”
  5. Leave the lube. “Using a lubricant during sex can make it harder for the sperm to swim the long distance to the fallopian tube. If you must, try using a sperm-friendly lubricant like Pre-Seed instead.”

Postpartum Recovery Tips for Moms from Our Nurses & Midwives

In preparation for your new arrival it is likely you will take classes, read books and get advice from friends and family on how to take care of your new baby.

What you can easily forget in all the excitement is that you take care of yourself too!

To help you focus on YOU, we recently asked our nurses and midwives what postpartum recovery advice they give their patients.

We received advice for you from over 100 nurses!

Take note of the clear themes – limit visitors to take that time to bond with your new baby, accept help from others, do skin-to-skin and sleep when the baby sleeps!

Good luck in all your new parenting adventures!


Postpartum Care Tips from Nurses and MidwivesTop 20 tips from our nurses and midwives:

  1. Absolutely choose a hospital for the care you will receive and not the new beautiful building. You’re much more likely to receive a positive birth experience and the education you receive from your postpartum nurses will make all the difference in the world.
  2. As a former postpartum nurse, I noticed how often new mothers put their needs last. It seems often families look at postpartum time as party time. I have seen c-section moms sleeping in the same room as 15-20 family members talking loudly and passing baby around for hours. My best advice is for new mothers to have 1-2 designated family helpers to be there to help care for baby while she gets much needed naps throughout those exhausting first days. Baby’s hunger cues are often missed when there are too many visitors for long stretches of time. It is difficult for new mothers to set limits.
  3. Don’t be afraid to ask people to leave. I have seen so many new mothers that are worn out from feeling like they cannot turn people away. Turn off your phone too. I wish I did for the first couple of days.
  4. Breastfeeding is an acquired skill for you and baby, be prepared to be patient and try, try again. It is a wonderful thing for you both, but needs to be learned. Do not suffer in silence, please contact your OB/midwife for lactation nurse help/referral if you are having difficulty with latching and/or very sore nipples.
  5. Sleep when baby sleeps.

  6. If you had a cesarean, take a pillow for the car ride home to support your incision for the bumps in the road.
  7. Use the Dermoplast (benzocaine topical) spray before having a bowel movement…it’ll make the process a whole lot more comfortable and a lot less scary.
  8. If someone offers to come over so you can shower, take them up on it.  For c-section moms remember not only did you have a baby, but you had major surgery.
  9. Trust yourself and your instincts. Pick and choose the advice, tips, expert advice etc. that works for you. And know that if you’re worried about being a good mom, you already are.
  10. Padsicle! Pad, ice pack, tucks, then a spray of Dermoplast.
  11. Know your body. When you get home, use a hand held mirror to look at your perineum or you cesarean section incision. This way, if you experience problems, you will have a baseline to know if something is different, for example: increased swelling, redness, tenderness, or drainage from incision. It is helpful in knowing when to contact your physician with these issues.
  12. Limit your visitors. You will not get this time back. Use it to bond as a family, seek help with breastfeeding. Skin to skin is the best bonding tool! We want to help you succeed with breastfeeding. You can press your call light for every feeding if you need to. Your baby needs your love and protection. You are your baby’s primary advocate. Not all mothers’ choose to or are able to breastfeed. How you feed your baby is your decision and your nurse will support you. Ask visitors to wait until you’ve been home for at least a couple weeks. Settle in, recover. Don’t be afraid to ask for help. If someone wants to visit, ask them to leave their little ones at home.
  13. Sleep when the baby sleeps. Keep drinking water to flush out the excess fluids and keep hydrated. Accept help from anyone willing to cook a meal, run errands or do housework so you can rest and spend more time enjoying your new baby. Get outside for a walk. Fresh air and activity help to restore and rejuvenate sleep deprived minds and bodies as well as improve the blues!
  14. While planning your new routine, ask someone to watch the baby for an hour of each day for you to spend as you please.
  15. Good nutrition is key. Have a healthy snack each time you feed baby if you don’t have an appetite. Try to get a good four hour blocks of sleep several times a week. Ask support people to change, burp, comfort baby and only bring baby to you for breast feeding to extend your sleep when tired. Have a good support system and don’t be afraid to ask them for help. Soak up the sun when you can. Have an enjoyable activity to look forward to each week. Try to get out of the house, but if you can’t do something you enjoy at home or pamper yourself. Relax and enjoy your baby. Use what works for you and don’t try to follow everyone else’s advice.
  16. Accept offers of help and assistance with meals, cleaning etc. I tell father’s to give moms one uninterrupted hour to herself each day. She can bathe, sleep, read, or anything that she wants for that hour. Daddy needs time to get to know baby too!
  17. When you get home, set visiting hours and have each visitor bring groceries or food (they’ll be thrilled to get what you need). And stay in your pajamas. Most people will be less likely to overstay their welcome.
  18. Once “settled” in with the baby reach out to a Mother’s group ( stroller club, baby sitting co-op, Mommy and me Gym or Yoga class), to get out of the house and receive and provide support to other new Mom’s.
  19. Give yourself a break. Sit at the bottom of the shower and cry if you need to every now and then, parenting is hard work. Learning to breastfeed is hard work and so is incorporating another member into your family. Sleep deprivation and shifting hormones will, in fact, make you feel crazy at times but it will get better. You will find your new norm. It’s not all cute onesies and hair bows, it’s more like poopy onesies and newborn rashes, and that’s ok.
  20. You’re stronger than you think! Don’t worry about what others might think. Enjoy every moment.  Parenthood is a beautiful experience. Allow yourself grace & room to grow.

Do you have advice for new moms as well? If so let us know. We’ll keep rolling out the advice.

For additional resources for mom visit our Healthy Mom&Baby website!

5 Q&A about Inducing Labor from our CEO

We asked moms what questions they had about inducing labor and Lynn Erdman our CEO answered back.

  1. My girlfriends told me that having labor induced is the safest, and certainly most convenient, way to have my baby, but my nurse is saying that waiting for labor to start on its own is the safest. Which is true?

Many people don’t realize that undergoing labor induction for any reason is associated with immediate and long-term health risks. Induced labor can lead to excessive postpartum bleeding (or hemorrhage), which in turn, can increase the risk for blood transfusion, longer hospital stays, hysterectomy, more hospital re-admissions and, in the worst cases, death. Induction is also associated with an increased risk for cesarean birth. Cesareans increase a woman’s  risk for infection, problems with how the placenta implants in future pregnancies, and life-long pain from abdominal adhesions.

AWHONN recommends against inducing labor at any time during pregnancy unless it is medically necessary, because a woman or her baby have problems. The medication used to induce labor is a manufactured hormone and a type of drug that bears an increased risk for causing serious patient harm when used in error. With the increasing use of labor induction and its resulting complications, it’s more apparent than ever that we must improve our understanding of the health consequences of administering artificial hormones, especially to vulnerable populations like pregnant women and infants. The short- and long-term health risks are just too serious to undergo labor induction when there is not  a medical need. Continue reading

Dangers After Delivery: Postpartum Preeclampsia

by Tanya M. Shlosman

Pregnancy is a complicated journey full of a multitude of emotions. A pregnant woman has an abundant amount of advice and resources at her disposal, but it can be overwhelming to swim through the information and decide what to take to heart and what to take with a grain of salt.

I spent my first pregnancy worried about everything. With every blood test, every ache and pain, I quickly referenced my What to Expect When You’re Expecting book to calm my concerns. When I was diagnosed with preeclampsia and my son had to be delivered almost 4 weeks early due to dangerously high blood pressure, I remember feeling afraid and uninformed. Even after I was told I had preeclampsia, I never felt my doctors did a good job of explaining the condition.

If you don’t know, as I didn’t, preeclampsia is a serious disorder occurring when women develop high blood pressure, usually in the last months of pregnancy. Preeclampsia affects as many as 1 in 12 pregnancies and can progress rapidly, resulting in seizures in its most severe form, which is called eclampsia.

Some years later, when I was pregnant with my daughter, I felt prepared and confident that I knew what to expect and what to do to keep myself healthy. I had some challenging days but made it to 40 weeks with no signs of preeclampsia.

While I had a very difficult cesarean delivery, I was relieved that my 8 pound and 15 ounce baby girl was healthy! However, within a few hours of delivery, I began to feel very sick. No matter what I did, I could not catch my breath and a cough set in. Having to cough after surgery is not a pleasant experience but I thought I had just developed a cold and was not concerned.

I soon learned that it was more than a cold. I had developed postpartum preeclampsia and this caused extra fluid to build up in my lungs—a condition called pulmonary edema.

I was not only afraid but angry—angry that I was not told that preeclampsia could happen after giving birth. Postpartum preeclampsia is a rare condition, usually occurring within the first 48 hours after birth but it can occur as late as six weeks postpartum. I endured breathing treatments and was given blood pressure medication while in the hospital and after being sent home. While my trouble breathing was the most frightening symptom, I also had severe headaches, dizziness, and blurred vision. I stayed on blood pressure medicine for almost six months.

What makes preeclampsia so frightening is that there are no tests to determine who will be afflicted with the condition. And there is no known method for preventing preeclampsia, no matter when it occurs. But there are known  risk factors. For example, women are at an increased risk to develop preeclampsia if they are obese, over age 40 or under 18, have a multiple gestation (twins or more), chronic high blood pressure or any kind of diabetes. Research shows that about twenty percent of women who had preeclampsia in a prior pregnancy will have it again with the next pregnancy. Pregnant women should talk with their nurse, midwife or doctor about preeclampsia and what their risks may be.

All pregnant and postpartum women should be aware of the symptoms of preeclampsia but especially women who have an increased risk to develop the condition. Symptoms are headache, excessive swelling, changes in vision, and upper abdominal pain. Women who have these symptoms should call their midwife or doctor right away. However, some women who develop preeclampsia will have few, if any, symptoms.

Every woman should reach out with concerns, no matter how small they may seem.

We need to talk about our experiences, support preeclampsia research and outreach to other women. I found a great source of information and comfort in the Preeclampsia Foundation, with its informational website and community forum.

May is National Preeclampsia Awareness Month and there is no better time to understand this condition and how it could affect you and your baby.

Some places you can start are Health4Mom.org and the Preeclampsia Foundation.

You can also see the 7 Symptoms Every Pregnant Woman Should Know videos in English and Spanish:


TanyaTanya earned her Bachelor’s Degree and did her master’s course work at the University of Louisiana at Monroe and work as an assistant director at a historical museum. She is a writer of non-fiction and poetry and currently working on a book discussing World War II. She is most importantly a wife and proud mother of two and several fur-babies.