Category: Nursing

Legislative Update: Budget, Fiscal Year 2019 Appropriations

Yesterday, as you know, was Mother’s Day. A week earlier was the second-annual March for Moms on the National Mall in Washington, DC. The proximity of the event to Mother’s Day was intentional.

For several hours on Sunday afternoon, speakers shared their own accounts with near-death experiences or the death of a loved one due to pregnancy-related causes. Several people from AWHONN’s office attended. You may have seen some of the social media posts.

The stories are heart wrenching. I find myself wishing Congress would take action on Maternal Health Accountability Act and the Preventing Maternal Deaths Act so that we can make progress on reversing the rising maternal morality trend so no more stories of maternal deaths will have to be told on the National Mall. If you haven’t yet done so, please call your Senators and Representative and ask them to support S. 1112 and H.R. 1318. And, if they have already cosponsored these bills, a thank-you call is always appreciated. Your call can make a difference.

Sincerely,
Seth A. Chase

Updates for Monday, May 14, 2018

Budget and Appropriations
President Donald Trump’s Office of Management and Budget has sent to Congress a request to rescind $15.4 billion in appropriated funds. The request must be approved by Congress, which has 45 days to do so. Authorization for federal agencies to spend the money is on hold until either the 45 days run out or Congress takes a vote on the request. The largest single area the president asks to rescind is $7.0 billion from the Children’s Health Insurance Program–with $5.1 billion from unspent Fiscal Year 2017 funds that can no longer be spent and the remainder from a contingency account which likely will not be used.

Fiscal Year 2019 Appropriations
The Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Subcommittee unanimously approved its Fiscal Year 2019 appropriations bill last Wednesday. The bill would appropriate $6 billion for the Women, Infants and Children nutrition program.

Senate Labor, Health and Human Services, Education and Related Agencies Subcommittee Meeting
I joined other representatives of the associations in the Coalition for Health Funding last week in a meeting with the staff director for the majority (Republican) Senate Labor, Health and Human Services, Education and Related Agencies Appropriations Subcommittee. From this meeting we learned that the subcommittee hasn’t yet received an allocation for Fiscal Year 2019 from the full Appropriations Committee. The subcommittee cannot begin crafting their bill until they receive the allocation.

The staff director expressed that she does not expect large increases for public health and health research programs–especially with a $500 million hole created by the expiration of 21st Century Cures money for opioids. The Senate will be begin marking up bills at the end of this month–starting with non-controversial bills such as Subcommittee on Agriculture, Rural Development, Food and Drug Administration, and Related Agencies. The Labor, HHS, Education bill will likely be marked up toward the end of June.

Briefings and Hearings
The Senate Subcommittee on Labor, Health and Human Services, Education and Related Agencies held a hearing May 10 with Secretary Alex Azar on the Department’s the Fiscal Year 2019 budget request.

Coming Up:

  • Today and tomorrow, Jacque will be attending the Task Force meeting on Research Specific to Pregnant and Lactating Women via webinar from the National Institutes of Health. Recommendations from this meeting are used to shape and inform policy.
  • We are soliciting input from AWHONN’s Public Policy Committee and Research Advisory Panel in order to respond to comments due 5/21/18 on draft recommendations for Screening for Intimate Partner Violence, Elder Abuse and Abuse of Vulnerable Adults and Behavioral Counseling to Prevent Sexually Transmitted Infections.   Public comment can also be made at https://www.uspreventiveservicestaskforce.org/Page/Name/us-preventive-services-task-force-opportunities-for-public-comment. You can also submit your comment to us at [email protected] to be included in AWHONN’s response.
  • On Wednesday, I’ll be attending the Women’s Health Empowerment Summit.
  • On Friday, I’ll be joining Friends of Title V Maternal and Child Health Services Block Grant Program in meeting with Laura Kavanagh, the acting associate administrator for Health Resources and Services Administration’s Maternal and Child Health Bureau.

Seth A. Chase is the director of government affairs at the Association of Women’s Health, Obstetric and Neonatal Nurses.

Sign up to get AWHONN Legislative Update delivered directly to your inbox every Monday when Congress is in session by sending an email to [email protected].

 

Wellness Tips for the Busy Nurse

During Nurses Week, we honor the hard work and dedication required of every nurse. The long hours and challenging shifts can wreak havoc on the body and mind. Many nurses live in a chronic state of stress, which can manifest through headaches, insomnia, decreased immunity, hypertension, and risk for heart disease. Here are a few ways to incorporate wellness into your daily life.

Create a Routine
By establishing a wellness routine, you’ll be more likely to stick with it. Any of the following little tips can easily be added to your day—it’s not all or nothing! Most will take just a few minutes, and some can be incorporated during your commute to work. Creating a wellness routine only requires a commitment from you to take better care of yourself.

Just Breathe
The act of conscious, deep breathing can actually change your mood from tired, anxious, and unnerved to energized and calm in virtually no time. Sit tall, draw your shoulders back and down, and lengthen through the crown of your head. Eyes opened or closed, begin breathing deeply in and out through the nose. Take about 20 rounds of breath and notice how you feel.

Make a Mantra
This could be something as simple as “I am enough” or even “It’s going to be a great day.” Your mantra could even be a single word such as “peace” or “serenity.” Write it on your mirror, put it on a Post-It, say it when you first wake up or when you’re feeling stressed. There are several studies that suggest that having a personal mantra allows you to reduce stress and anxiety naturally.

Fall in Love with Lavender
Studies have shown that lavender can help with stress, depression, and anxiety. Buy pure, organic essential oil at your local health food store. Diffuse it in your home, or put three to four drops on a tissue and keep it in your car console so you can get a few whiffs during your pre-shift deep breathing. You might even consider dabbing a drop or two on your scrub top mid-shift for a little pick-me-up.

Epsom Salt Soaks
Pour a cup of Epsom salt into a warm foot bath and soak for 5-10 minutes. Your feet will thank you! Epsom salt (magnesium sulfate) relaxes the muscles and may reduce swelling. If you have a little more time, add 2 cups to a warm bath before bed. Add a few drops of lavender oil and you’ll sleep like you never have before.

Elevate Your Legs
Give swollen, aching feet a lift to reduce swelling at the end of a long shift.  You might also consider compression socks keep the blood flowing. While your legs are elevated, gently stretch your feet and calves. For a quick massage, try rolling a tennis ball (or frozen water bottle) under your foot, paying special attention to the arch.

Stretch It Out
This is good for before, during, and after work: Take 5 minutes or so to do some gentle stretches for your neck, arms, wrists, back, and legs. Try this: Grab a chair and place it in front of you. On an inhale, reach your arms up overhead, lengthening through your spine and crown of head. On an exhale, fold forward, placing your hands or forearms on the chair. Take 10 or 20 deep breaths here. Bend your knees and slowly roll back to a standing position as you inhale. Do your best to practice good posture during the day.

For when you have more than a few minutes, these tips are vital for overall health, too:

Prioritize Nutrition
Keep prepacked snacks available to grab and go, especially high-protein options like nuts, dried fruit, or protein bars. Don’t skip your lunch break, if at all possible—fill up on water and filling fruits and veggies. Look into using a slow cooker to have meals hot and ready when you get home after a long shift, or build up a stash of freezer-friendly meals. And please try not to deprive yourself of a much-needed bathroom break!

Maintain Your Mental and Emotional Health
Caring for women and babies can be stressful enough—don’t let anyone or anything else add unnecessary discomfort to your day. Find support for your challenges. Identify someone you can trust at work. Everyone deserves to know that someone has their back. If you have issues with workplace bullying, depression, or addiction, don’t let another day go by without reaching out to a trusted source of support, be that a friend, family member, employee assistance program, helpline, or spiritual community.

Keep Your Skills Sharp
Yes, part of wellness means continuing to grow and excel in your chosen field! AWHONN offers more than 40 hours of free CNE activities in the Online Learning Center on a wide variety of topics. When you just have a few minutes, check out Nursing for Women’s Health or JOGNN articles—you can even read them using the app! AWHONN members can access the full archives of these two scholarly journals online at AWHONNjournals.org.

Lori is a registered nurse with years of experience in newborn intensive care and postpartum nursing. She writes regularly for AWHONN; American Nurse Today; and her blog, Neonurse. She has also been featured in The Huffington Post. She is a 200-hour Yoga Alliance-certified yoga teacher, a certified prenatal and postnatal yoga teacher, pediatric CPR instructor, and a member of International Childbirth Educators Association (ICEA). Her passion is teaching new parents about their babies and guiding them in the process of becoming a family.

Legislative Update: Tobacco, Maternal Mortality & More

Updates for Monday, May 7, 2018

Tobacco
According to a story run by BuzzFeed News, the Food and Drug Administration is cracking down on the sale of JUUL brand e-cigarettes, which are very popular among teens and young adults. The FDA has sent warning letters to 40 retailers after federal inspectors found that they sold JUUL e-cigarettes to minors, and asked JUUL for data on its marketing of the product and any potential side effects. AWHONN supports comprehensive tobacco control initiatives. In addition, nurses should screen women for tobacco use (including e-cigarettes), counsel them about the effects of tobacco use and tobacco exposure, and have access to referral information that supports cessation efforts. In case you missed it, in September 2017 AWHONN published an updated position statement on Tobacco Use and Women’s Health which can be accessed here.

Maternal Mortality
Senate Health, Education, Labor and Pensions Committee ranking member Sen. Patty Murray (D-WA) said in a Committee hearing on April 24 that the Committee will consider S 1112, the Maternal Health Accountability Act during a hearing in May. The Committee has not yet announced a date for the hearing. AWHONN advocates for expanding research funding and opportunities to investigate and alleviate the causes of maternal morbidity and mortality and will attend the hearing if it’s scheduled.

Teen Pregnancy Prevention Program
According to a story in The Hill, the Department of Health and Human Services has announced an abstinence-focused overhaul of the Teen Pregnancy Prevention Program. The funding announcement reads that “projects will clearly communicate that teen sex is a risk behavior for both the physical consequences of pregnancy and sexual transmitted infections; as well as sociological, economic and other related risks…Both risk avoidance and risk reduction approaches can and should include skills associated with helping youth delay sex as well as skills to help those youth already engaged in sexual risk to return toward risk-free choices in the future.”

In total, tier one will award up to $61 million in funds, ranging from $200,000 to $500,000 per year. The second tier solicits applications to develop and test “new and innovative strategies” to prevent teen pregnancy while improving adolescent health and addressing “youth sexual risk holistically by focusing on protective factors.”

Health Insurance
A new Kaiser Family Foundation analysis of short-term, limited duration health plans for sale through two major national online brokers finds big gaps in the benefits they offer. Through an executive order and proposed new regulations, the Trump Administration is seeking to encourage broader use of short-term, limited duration health plans as a cheaper alternative to individual market plans that comply with the Patient Protection and Affordable Care Act’s requirements. Repeal of the individual mandate penalty – which currently applies to people buying short-term plans – is also expected to boost enrollment starting next year.

Religious Refusal
According to a story in The New York Times, the Trump administration plans to implement the proposed rule, Protecting Statutory Conscience Rights in Health Care; Delegations of Authority, which seeks to permit discrimination by providers in all aspects of health care without adequately protecting patients from discrimination in accessing health care services. This new rule would roll back an Obama Administration rule that protects transgender people from discrimination by doctors, hospitals and health insurance companies. AWHONN submitted comments opposing the rule.

This proposed rule is not necessary to protect the rights of providers. It is the position of AWHONN that the existing rule issued in 2011 adequately protects the conscience of providers and patients. AWHONN asserts that nurses have the professional responsibility to provide nonjudgmental nursing care to all patients, either directly or through appropriate and timely referrals. AWHONN recognizes that some nurses may have religious or moral objections to participating in certain reproductive health care services, research, or associated activities. Therefore, AWHONN supports the existing protections afforded under federal law for a nurse who refuses to assist in performing any health care procedure to which the nurse has a moral or religious objection so long as the nurse has given appropriate notice to his or her employer. Additional information can be found in our position statement Rights and Responsibilities of Nurses Related to Reproductive Care.

Opioids Crisis

  • The Senate Health, Education, Labor and Pensions Committee marked up S. 2680, the Opioid Crisis Response Act on April 16. The bill included measures to make it easier for opioids to be prescribed in smaller amounts, develop nonaddictive alternatives to opioids and strengthen border security to stop drug trafficking. It was passed by the subcommittee unanimously and will proceed to the full committee for a vote to go to the Senate floor. The bill also includes provisions to address treatment for pregnant and postpartum women in an effort to reduce instances of neonatal abstinence syndrome.
  • On April 25, the House Energy & Commerce Health Subcommittee approved a package of 57 bills addressing the opioids epidemic, sending it to the full committee for their consideration.
  • On April 24, the Trump administration renewed its 90-day emergency declaration regarding the ongoing opioid crisis. This is the second renewal since President Trump first declared the opioids epidemic a public health emergency in October 2017. The declaration extends the authority of federal health agencies to quickly hire more treatment specialists and reallocate resources to respond to the drug abuse epidemic.

National Guideline Clearinghouse Going Offline

The Agency for Healthcare Research and Quality National Guideline Clearinghouse web site will not be available after July 16 because federal funding through AHRQ will no longer be available to support it. The NGC is a repository of clinical practice guidelines.

Breastfeeding
On Friday, April 27, the House of Representatives voted to pass HR 4, the FAA Reauthorization Act. No, AWHONN hasn’t expanded the legislative and policy agenda to include regulating civil aviation. Rather, the FAA bill included provisions from HR 2375, the Friendly Airports for Mothers Act. This bill would direct large and medium hub airports to maintain a lactation area in each passenger terminal to provide a private and hygienic location for mothers to breastfeed their children.

AWHONN supports, protects, and promotes breastfeeding as the ideal and normative method for feeding infants, including the provision of human milk for preterm and other vulnerable newborns. Women should be encouraged and supported to exclusively breastfeed for the first six months of an infant’s life and continue to breastfeed for the first year and beyond. AWHONN partners with other maternal‐child health organization to improve cultural, institutional, and socioeconomic systems so that more women and newborns can experience the numerous physiologic and psychosocial benefits of breastfeeding. Our breastfeeding position statement can be reviewed here.

Abortion Care
According to a story in The Hill, Iowa lawmakers passed a bill on May 2 that would ban abortions once a heartbeat is detected in the fetus, effectively prohibiting the procedure by the sixth week of pregnancy. Gov. Kim Reynolds (R) has signed the bill. AWHONN’s position is that any woman’s reproductive health care decisions are best made by the informed woman in consultation with her health care provider. AWHONN believes these personal and private decisions are best made within a health care system whose providers respect the woman’s right to make her own decisions according to her personal values and preferences and to do so confidentially.

Therefore, AWHONN supports and promotes a woman’s right to evidence-based, accurate, and complete information and access to the full range of reproductive health care services. AWHONN opposes legislation and policies that limit a health care provider’s ability to counsel women as to the full range of options and to provide treatment and/or referrals, if necessary.

Title X Family Planning Programs
According to a story from Reuters, Planned Parenthood and the National Family Planning and Reproductive Health Association have filed lawsuits against the Trump administration to prevent the Title X Family Planning grant program from favoring groups that are faith-based and that promote abstinence. The lawsuits, which were filed in federal court in Washington, take aim at the guidelines the Department of Health and Human Services issued in February, which provided new criteria in evaluating applications for grants under the Title X family planning program.

Seth A. Chase is the director of government affairs at the Association of Women’s Health, Obstetric and Neonatal Nurses.

Sign up to get AWHONN Legislative Update delivered directly to your inbox every Monday when Congress is in session by sending an email to [email protected].

Saving Women’s Lives

by Jennifer Doyle

As we close out Women’s History Month, and I want to take this moment to discuss an issue that is not only dear to my heart but also takes the lives of more than 700 women each year—maternal mortality.

A maternal death is defined as the death of a woman during pregnancy or within one year of the end of pregnancy. The death is determined to be pregnancy-related if the cause of death is related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

Of the 5,259 deaths within a year of pregnancy completion that occurred during 2011–2013 and were reported to the Centers for Disease Control and Prevention (CDC), 38.2% were found to be pregnancy-related. In the United States, more than half of all maternal deaths occur after birth—often after discharge from the hospital. This doesn’t have to happen. In fact, at least half of all pregnancy-related deaths are preventable when the warning signs of pregnancy or childbirth complications emerge and a mom can get the timely care she needs from her healthcare providers. The reality is that many women do not receive consistent messages or adequate guidance on identifying the warning signs of complications, or instructions about when, and where to obtain necessary medical attention.

AWHONN has created specific instructions for acting on these warning signs called “SAVE YOUR LIFE: Get Care for These POST-BIRTH Warning Signs.” Here are the specific signs you should watch for and act on during the first year after birth:

  • Pain in your chest
  • Obstructed breathing or shortness of breath
  • Seizures
  • Thoughts of hurting yourself or your baby
  • Bleeding that is soaking through one pad/hour, or blood clots the size of an egg or bigger
  • Incision that is not healing
  • Red or swollen leg that is painful or warm to touch
  • Temperature of 100.4 °F or higher
  • Headache that does not improve, even after taking medicine, or a bad headache with vision changes

For moms: If you are experiencing any of these post-birth warning signs, contact your health care provider or go to the nearest urgent care or hospital as soon as possible. For serious and potentially life threatening warning signs like pain in your chest, obstructed breathing, seizures, or if you have thoughts of hurting yourself or your baby, call 911. Let all responders know that you gave birth within the past year.

Recognizing and acting on these warning signs and complications that can lead to a mom’s death or injury is essential to reducing maternal deaths in the United States. Share this information with pregnant women you care for. AWHONN is committed to working together with nurses and moms to reduce maternal mortality rates. Let’s help women to be aware and to recognize the signs of post-birth complications in order to begin reversing this alarming trend.

Additional resources:

Jennifer Doyle is the 2018 AWHONN President and a women’s health nurse practitioner with nearly 25 years of experience in obstetrics. She is the APN of the Women’s Service Line at Summa Health in Akron, OH, as well as faculty and coordinator of the WHNP program at Kent State University in Kent, OH.

Disparities in Maternal Mortality

Black women are 243% more likely than white women to die from complications of pregnancy or childbirth, according to the latest data from the Centers for Disease Control and Prevention and Propublica, a collaborative of investigative journalists. One national study of 5 medical complications that commonly cause maternal death and injury determined black women were 2-3 times more likely to die than white women who had the same complications.

These truly alarming numbers are why during Black History Month and beyond the nurses of AWHONN want healthcare providers and moms alike to learn and share post-birth warning signs that have been shown to help new moms and their caregivers recognize potential problems and get the help they need—perhaps even saving their lives.

AWHONN has created specific instructions for acting on these warning signs called “SAVE YOUR LIFE: Get Care for these POST-BIRTH Warning Signs.” Here are the specific signs women should watch for and act on during the first year after birth:

  • Pain in your chest
  • Obstructed breathing or shortness of breath
  • Seizures
  • Thoughts of hurting yourself or your baby
  • Bleeding that is soaking through one pad/hour, or blood clots the size of an egg or bigger
  • Incision that is not healing
  • Red or swollen leg that is painful or warm to touch
  • Temperature of 100.4 °F or higher
  • Headache that does not improve, even after taking medicine, or bad headache with vision changes

If you are experiencing any of these post-birth warning signs, contact your healthcare provider or go to the nearest urgent care or hospital as soon as possible. For serious and potentially life-threatening warning signs like pain in your chest, obstructed breathing, or seizures, or if you have thoughts of hurting yourself or your baby, call 911. Let all responders know that you’ve just given birth within the past year.

Recognizing and acting on these warning signs and complications that can lead to a mom’s death or injury is essential to reducing maternal deaths in the United States. Currently, maternal mortality rates—the number of women dying during or within 1 year of childbirth—are increasing, climbing 27% to 24 maternal deaths per 100,000 births since 2000. In the United States, more than half of all maternal deaths occur after birth—often after discharge from the hospital. This doesn’t have to happen.

For black moms, it’s even bleaker. Black mothers in the United States die during or within 1 year of giving birth at 3-4 times the rate of white mothers. This difference in maternal deaths and injury among black women is a serious issue that needs our action. At least half of all pregnancy-related deaths are preventable when the warning signs of pregnancy or childbirth complications emerge and a mom can get the timely care she needs from her healthcare providers.

Share this information with other nurses and pregnant women you care for so that moms and nurses can work to reduce maternal mortality rates, especially the higher rates among black women. Together, we can help women recognize the signs of a post-birth problem to prevent unnecessary injury or death.

Mary Elizabeth Elkordy is the Communications and Public Relations Manager for the Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN).

From Care Provider to Patient: My Experiences in the NICU

By April Farmer, CRNP, NNP-BC

The author in her natural habitat.

As far back as I can remember, I’ve wanted to be a nurse—I had no intentions of doing anything else! I always thought nursing was the field for me because I could care for others and be a teacher and counselor, all at the same time. I originally thought I was going to work in the emergency department; I had no idea that the NICU existed. One day, our class took a tour of one of the largest hospitals in Alabama, and one of the units we visited was the NICU. I was immediately drawn to these tiny babies.

After that tour, I decided to do my preceptorship in the NICU, and it was then that I fell in love with neonatal nursing. I was very fortunate after nursing school to be offered a position in the NICU. I could not imagine working in any other area of nursing—and that’s where I’ve been since January 2004. I initially worked as a bedside nurse and then decided to further my education and become a neonatal nurse practitioner (NNP), a role I’ve had for the past 5 years of my career.

What I love about the NICU is that premature infants are fighters. I see them defy the odds every day. If you don’t believe in miracles, come visit the NICU. I also love that from the beginning, each one of these little babies has their own personality. They cannot tell you when something is wrong; you have to depend on your assessment skills and their cues to figure out what they need. It’s such a joy to see these infants grow and thrive. What I love most, though, is watching the parents get more and more comfortable caring for their child.

I’ve met so many wonderful families during my years in the NICU. They entrust you with their most precious possession, their child. It’s hard not to bond or connect with these people who spend weeks and months in the unit. When I’d been a NICU nurse for about a year, there was a baby I cared for who was born at 23 weeks and spent months in our unit. As I cared for this infant on a regular basis, I really bonded with the family. I remember many times over the months thinking that this patient was not going to survive. This family had the strongest faith I’ve ever seen, and eventually they did go home with their baby. Years later, they brought that child up to the NICU to see me. I was shocked that I touched their lives that much! They recalled specific things I had said or did, and it was one of those moments when I realized that my job makes a difference. I don’t do this job for recognition, but it’s nice to know I made such an impact.

Shortly before Rilee’s birth.

After spending so much of my time around other people’s babies, I was excited when I found out my husband and I would be welcoming our own child into the world. I had no complications during my pregnancy, and my only risk factor was advanced maternal age, as I would be 35 years when my son was due to be born. However, Rilee had different plans—I went into labor at 29 weeks and 4 days, and just like that, I went from NICU nurse to the mother of one of those tiny, vulnerable babies.

My labor happened so quickly that there wasn’t much time to process it. I didn’t sleep well the night before. I just could not get comfortable but assumed it was normal. I was scheduled to work, so I decided to go ahead and get up early since I wasn’t sleeping anyway. While in the shower, I began to hurt and feel nauseated. Even then, I still didn’t process that I might be in labor. I figured if I was still hurting when I got to work, I would go to Labor & Delivery and get checked out.

Rilee made his appearance more than 10 weeks early.

While trying to get dressed and ready for work, the pain was worsening. I began to vomit and feel the urge to go to the bathroom. That’s when it finally hit me that I might be in labor. I woke my husband up, and he drove us as fast as possible the 75 miles to the hospital. About halfway there, my water broke in the car. The contractions were coming every 2 minutes, and I was focusing on trying to keep my legs crossed because I could feel the baby’s head. When we arrived at the hospital at 6:15 a.m., I was completely dilated. There was no time for any medications or an epidural; I pushed twice, and Rilee was born at 6:30 a.m. I was in complete shock, and it took a little while for me to really process the fact that I had given birth more than 10 weeks ahead of schedule.

Having worked in the NICU for so long, I had some idea of what would happen next. I knew he would require oxygen and have apnea/bradycardia episodes, and I was prepared for him to not be a great PO feeder. What I was not ready for was the pain I felt as he struggled to breathe and had episodes. As a nurse, I knew it was totally normal, but as a mom, I was disappointed every time he took a step back and that he was not progressing at the pace I wanted him to.

April and husband Thomas visiting with their son, Rilee.

Working in the NICU may have prepared me for what to expect medically, but it did not prepare me for what I was going to experience emotionally. I had no idea the guilt I would have for not carrying Rilee to term. I felt my body had failed me, and I had failed my child. I mourned those last 2.5 months I missed out on and my lost chance at a full-term pregnancy. It may sound silly, but I felt cheated out of normal experiences like maternity pictures or being pregnant at my two wonderful baby showers.

One of the hardest things I had to do was to leave my baby. When I was discharged and had to leave Rilee for the first time, I sobbed the entire ride home. It’s just not natural to leave your child. I had envisioned giving birth and leaving the hospital with my baby in my arms. It’s also difficult letting others care for your child. As an NNP, I’m used to making the decisions and caring for the patient. It’s hard to just sit back and feel so helpless. I felt like I had to put on a brave face because I worked in the NICU, but there were days I felt like I was falling apart. I was stressed, exhausted, and anxious.

I went back to work when Rilee was 9 days old. That may sound quick, but I wanted to save my maternity leave for when he was discharged. My hospital was great, and I was allowed to come back even though Rilee was a patient in my unit. I did not care for, round or make decisions on my son, but it was nice to be able to go back to work and visit him on my breaks and during my downtime.

April checking in on Rilee’s progress in the NICU.

My sweet coworkers were wonderful to Rilee, as well as to my husband and me. We both felt like my son was given extra-special care and attention. The nurses celebrated his accomplishments and milestones with us; they also let me cry and vent to them. A few of my coworkers have had premature infants, and they understood exactly how I was feeling.

One particular experience with my nurses will always stick with me: When Rilee was about 3 or 4 weeks old, the night shift nurse asked me if I wanted to help bathe him. I know this may sound silly to some, but I appreciated it so much. Working in the NICU, I have bathed many babies—but this time, I got to bathe MY baby. This little thing really meant a lot to me.

Knowing what to expect as a NICU nurse was a blessing and a curse. I knew Rilee was doing well for 29 weeks, but I also knew all of the things that could go wrong. I was constantly waiting on something bad to happen. I had a hard time enjoying my baby and how well he was doing for the fear of the “what ifs.” I remember saying multiple times during his NICU course that I couldn’t believe how well he was doing, but that I didn’t trust him. I also got anxiety when it was time for a test, such as a head or cardiac ultrasound. When all was said and done, Rilee was in the NICU for 50 days. He was discharged home at 36 weeks and 5 days.

Finally going home!

Being a NICU mom has definitely made me change my way of thinking when it comes to talking to parents. I know each and every mother’s experience is different, but I feel like I can empathize now. Sometimes when mothers are having a hard time or feel like no one understands them or their situation, I just sit down and talk to them. I let them vent and tell them I understand. My experience may be different, but I do understand. Sometimes I do share my experience with a mother if I feel led to or if I think it will help.

Skin-to-skin care is good for baby and mommy.

I’m also quick to make sure mothers are holding their babies or doing skin-to-skin as soon as medically possible. I felt like this helped me to bond with Rilee and with my breast milk production. I also encourage moms to start pumping right away. I think pumping made me feel like I was actually doing something for my son at a time when I was virtually helpless—I was unable to care for him, so making milk was my contribution. It was the one thing that only I could do for him.

To women who find themselves in the NICU, I would say to take it one day at a time. Your baby will have good and bad days—you will have good and bad days. It truly is a roller coaster ride. Lean on friends and family for support. Find a NICU support group, which is great for parents to bond and share their experiences with one another. Don’t be afraid to ask questions or voice your concerns. You are the voice for your child; you are their advocate.

For fellow NICU nurses: Talk to the parents of these tiny, vulnerable babies. Listen to their concerns, and ask them how they’re doing. Sometimes they just need someone to talk to. Also, get them involved wherever possible. Encourage touching and holding. Ask them if they would like to help you take a temperature or change a diaper. It’s their baby, and they would like to feel like they are contributing. I will always remember when I got to bathe my son while he was in the NICU. Small gestures like this will mean more than you will ever know.

April Farmer, CRNP, NNP-BC, is a neonatal nurse practitioner in Birmingham, AL.

5 Myths About Working on a Graduate Degree

By Janet Tucker, PhD, RNC-OB

Have you often thought when you find out a co-worker is working on a graduate degree, “That’s not for me — I don’t have the time or the money and besides I enjoy what I am doing now”? I did not seek a graduate degree until my children were in high school and after beginning; I wish I had started on that journey earlier! Let’s address some of the myths.

  • I do not have time in my life right now.
    I delayed a pursuing graduate degree because I thought I would be on campus as much as undergraduate classes require. Many graduate nursing programs offer online and on campus options or a combination. I often advise nurses, just stick your toe in the water and try one class. You can fit the assignments in your life no matter what shift you are currently working. Just trying one class a semester is “doable”
  • I am not sure I can afford the tuition
    There are many options-private and public colleges. There are scholarships and some employers offer tuition reimbursement. It is an employee benefit-check it out!
  • I have not been in school in years. I am not sure I am smart enough for graduate school.
    I hear this one a lot. You are smart-you are a RN and passed boards! Hands down for most nurses, our first program is the most difficult whether it was a BSN, diploma or AD program. You will be pleasantly surprised that a graduate degree builds on your existing knowledge and you will be encouraged to focus on your specialty area for assignments. You will often be able to combine an assignment with a project you wanted to do at work anyway. Plus for all of us “seasoned” nurses, when we have to use an example from practice, we have years of case studies and examples to use in assignments.
  • I really enjoy being at the bedside, I don’t want to do anything different right now
    Great! We need advanced degree nurses using their expertise and practicing evidence based practice in every setting. A graduate degree will open doors that you may not even think about right now. There may be an amazing opportunity that will come your way that requires an advanced degree.
  • I am not sure I can keep up with the technology now-discussion boards and on line classes.
    I was not confident either, however if you have middle or high school age children or neighbors, they will enjoy helping you. You will quickly adjust just as you have to EMRs.

I share all these myths because this is what I heard as I was working on my MSN and then a PhD. I began my MSN part time at the age of 50 when I was working about 24 hours a week and had all three children still at home. I did not intend to pursue a doctorate degree, however I became fascinated at the opportunity to influence care through research.

I started on my PhD one year after completing my MSN. I worked full-time during my PhD journey and I completed it within 4 ½ years. To add to the craziness, all three of my children got married during this time. It has now been a year since I graduated and I am an assistant professor at a university. I am able to continue to work occasionally in a clinical setting, conduct research, and teach the next generation of maternal child nurses.  I never would have dreamed that this would be my journey when I began taking that first graduate course. Therefore, if you are considering giving it a try, jump in, the water really is great. There are many others ready to encourage you along the way.

Janet Tucker is an assistant professor at the University of Memphis Loewenberg College of Nursing, where she is currently teaching maternal child nursing. She completed her MSN in 2010 and PhD in 2017. Her research interests are expectant women experiencing a fetal anomaly diagnosis.

 

AWHONN Resources

With generous support from individual and corporate donors, AWHONN’s Every Woman, Every Baby charitable giving program provides the opportunities to AWHONN members to apply for research grants and project grants who work in continue to improve the health of mothers, babies and their families. Additionally, AWHONN’s commitment to support emerging leaders also provides opportunities to apply to academic scholarships and enhance their professional development through attending AWHONN’s Annual Convention and information of education resources. , For more information on AWHONN scholarships and professional development opportunities visit http://www.awhonn.org/page/awards

 

Safe Sleep Advice from Real Moms

By Courtney Duggan

When I became pregnant with my first child, I did everything I could to prepare—from research on cribs, bottles, breastfeeding, you name it. Having suffered miscarriages in the past, I was very concerned and anxious about SIDS. I made sure that my daughter’s crib had nothing but the mattress and sheet. I even contemplated buying one of those boards that detects movement and alerts you when a baby stops moving.

Once my daughter was born, she slept in the bassinet in our bedroom. I was still recovering from my cesarean, so my husband was there to help put her in and take her out of her bassinet when it was time to nurse. I was very good about following the safe sleep guidelines, but we would sometimes take naps together while I nursed on my side. I knew in the back of my mind it wasn’t the best option, but we were both able to get rest.

Fast forward 2 years, and my son is born. Again, I was cautious as I prepared for a new baby: I purchased a firm mattress and was sure not to have any toys, bumpers, or blankets in his crib. I told myself I was going to be much better with following safe sleep guidelines than I was with my daughter.

He, too, was born via cesarean, and in the beginning I was very good about not allowing him in bed and always putting him back in his bassinet. When he was about 3 months old, it became harder and harder to follow the guidelines. My son wasn’t sleeping at night, he refused any kind of pacifier (I tried six different brands), and the only thing that soothed him was nursing.

Baby Maxwell in his sleepsuit

Around this time, I returned to my full-time job. I found it easier to nurse him while lying down and returning to sleep. He also seemed to sleep better when he was next to me. I knew it wasn’t right, but I just wanted him to sleep—and I wanted to sleep myself. I tried swaddling, sleep suits, white noise… everything. It’s not supposed to be this hard the second time around, I thought. I’d already been through this; they say the second kid is easier!

When he was about 8 months old, I woke up to a boom and a baby screaming: He had fallen out of the bed, and I felt like the world’s worst mother. Luckily he was ok, but it could have been worse. He could have really gotten injured, or worse, I could have lost him. I knew the rules, I knew that babies were supposed to sleep in their own space, but I ignored them because I wanted my baby to sleep during the night and I was exhausted.

After my son’s fall, I knew something had to change; my son could no longer sleep in my bed at night. I decided to move his crib from our room into another room, and I gave the pacifier another shot. While sleep training hasn’t been successful, he is now taking a pacifier. Instead of bringing him into my bed when he wakes up at night, I offer him his pacifier if it’s before 3 a.m. If he wakes up again, I stay in his room to nurse him and then place him back in his crib. In addition, I had to make the decision to go to sleep earlier to ensure that I got my rest, too.

This got me thinking: What are some ways to help moms follow safe sleep practices after the baby is home? I enlisted the help of nurse Sharon Hitchcock, DNP, RN-C and some fellow moms.

Sharon is an obstetrics nurse and teaches at the University of Arizona. She is quite passionate about the topic of SIDS and safe infant sleep as she now knows why most of these deaths occur and, more importantly, how to prevent them (at least most of them).

She routinely talks about the American Academy of Pediatrics (AAP) safe sleep recommendations to students as well as parents and nurses. She’s also gotten a recent taste of some of the struggles, as she’s the happy grandma of a 9-month-old!

Naomi is mom of 9-month-old Samuel and became a safe sleep advocate long before having her baby. Heidi is almost finished with nursing school and has two kids, 3-month-old Eli and 4-year-old Sophia. Melanie, a mom of three, teaches obstetrics at the University of Arizona and is a childbirth educator at the local hospitals.

I shared with them my struggles of following safe sleep practices with my son and asked several questions about how parents can better follow safe sleep guidelines. Here’s what they had to say:

  1. Night feedings can be exhausting, especially when breastfeeding. What are some best practices to help resist the urge to nurse while lying down?  

NAOMI: I resisted the urge to nurse while lying down simply because I didn’t want to bring the baby into bed with me. There were some times when I nursed while sitting up in bed, but I also nursed in a rocking chair in my son’s room, just next to his crib, so I could immediately put him back to bed when he finished eating. I’m a light sleeper and didn’t worry much about falling asleep while feeding him, but I’ve heard it’s a good idea to use a timer, like the one on your phone, if you’re worried about falling asleep.

HEIDI: I was aware of the risks of breastfeeding while lying down from my OB classes in nursing school and had heard the horror stories of parents falling asleep with their infants and accidently suffocating them during their sleep. This was enough to make me take precautions the majority of the time that I was breastfeeding at night. I would feed him in my bed, sitting up, with him in the cross cradle position. I would set alarms just in case I did fall asleep with him, as studies have shown that the longer you are asleep with your infant, the greater the risk of SIDS. If mothers are truly so exhausted that they feel like they need to lie down while nursing, they should remove all pillows and blankets from around the baby and set alarms that will wake them should they fall asleep

  1. What are some ways to keep baby warm at night without using blankets?

NAOMI: Our son was born at the end of November, just when it really started to cool down here in southern Arizona. We kept the room warm and comfortable, and he wore footed pajamas.

HEIDI: For both of my children, I used sleep sacks that are available to buy online or in any baby store. They have worked well for me both times. I made sure the house was kept warm enough that they would be comfortable throughout the night.

MELANIE: It is recommended to keep the bedroom at a temperature that is comfortable for a lightly clothed adult. Overheating a baby is very dangerous, as they cannot just push the covers off.

  1. The risk of SIDS goes down once a baby turns 6 months—is it okay to bed-share then?

HEIDI: No. The baby can still roll over and suffocate on the softer mattress, pillows, and thick blankets that we have. In addition to the suffocation risks, I believe that getting the baby into a routine of sleeping in their parents’ bed will be one that is hard to break. Neither of my children have been able to sleep in my bed with me, mostly due to my concern for their safety. I am a hard sleeper and would not wake up if I rolled onto them. I also always wanted them to be able to sleep in their own rooms, once old enough.

MELANIE: It is true that most SIDS deaths occur before 6 months, but the infant is still at risk for SIDS until 12 months of age, and adult beds are not designed for infants. Most babies are rolling over by 6 months, and adult beds are usually too soft and have too many blankets and pillows. The other risks include the parents rolling onto the infant or the infant falling out of the bed.

  1. My baby has reflux and spits up during the night. Can I place a wedge or pillow in his crib?

HEIDI: No. This is another thing that infants could suffocate on if they rolled over. My son spits up a lot, too, but thankfully I knew from my OB class that it was safer for him to be on his back when he sleeps than on his stomach or wedged if he spits up. A baby is less likely to choke when on their back if they spit up because their airway sits above their esophagus (the tube going to their stomach), making it easier for the fluid to stay away from the airway and easier to swallow.

MELANIE: The AAP recommends that infants are always placed on their backs and not on their sides. Infants are quite good at protecting their airways while on their backs (unless they have a swallowing impairment, which your doctor would tell you). The U.S. FDA has stated that infant sleep positioners are not recommended as there have been several cases of infant deaths from the use of side positioners after the baby rolled to the stomach position or when their face got wedged into the positioner. Keeping the infant upright on a parent’s shoulder for 20–30 minutes after a feeding can decrease reflux.

SHARON: Some parents may think it’s a good idea to elevate the head of the crib to help with the reflux. However, multiple studies have shown this does not help and actually puts the baby at risk for sliding down to the foot of the bed and getting into an unsafe sleeping position.

  1. If I nurse while lying down, should I remove everything from my bed in case we fall asleep?  

NAOMI: This is what the newest recommendations advise you to do. Make sure all the blankets, pillows, etc., are moved out of the way, so that in the event you fall asleep, the bed will be a little bit safer.

HEIDI: Absolutely. This is the safest practice if you must nurse while lying down. This is what I did. I also asked my husband to adjust his pillow, and if possible, stay awake with me to ensure that I didn’t fall asleep with the baby. We aren’t perfect, though, and there were a couple of times where we dozed off with him, but fortunately I had alarms set to wake me within 15 minutes of beginning nursing. Once I knew he was full and had a clean diaper on, I set him back down in his crib and went to sleep.

  1. Sometimes the baby falls asleep on my chest. It’s recommended that babies sleep on their backs, but since he’s on my chest is it okay?

HEIDI: I believe so, as long as you are rested enough that there is no risk of you falling asleep and you are able to monitor the baby while he is asleep on his tummy. I did this a lot with both of my children during the day and think it is the perfect opportunity for skin-to-skin time.

SHARON: Make sure you can see your baby’s face (to make sure it is not covered or does not become wedged into your breasts) and you are awake and attentive to him.

  1. The only way to get my baby to sleep is if I nurse him; when I go to transfer him into his own bed, he wakes up and cries. Is it okay to let him cry it out?

NAOMI: This is a hard topic. There are so many opinions out there, and it’s hard not to get discouraged by all the articles in my Facebook newsfeed that highlight how awful it is to let your baby “cry it out.” It became important for me to consider our circumstances and the fact that every baby is different. I didn’t use the formal “cry-it-out” method for sleep training, but there were, and still are, so many times when I have to let my son cry for a while before he’ll give in and go to sleep. He’s fed. His diaper is clean. He has burped. He’s still crying. He’s not comforted by me holding him close. I’m starting to go a little crazy, and my left ear is ringing from his screams. I know he’s exhausted. What he needs is sleep. It’s okay to place him in his crib and walk away. It’s OKAY to let him cry. I had to learn this early on. It’s made a huge difference.

MELANIE: Crying is a baby’s language and the only way they have to communicate. They cry because they are hungry, tired, uncomfortable, and sometimes just because they are fussy and need to get rid of excess energy. If they have burped and their diaper is clean, you can try to console them with rhythmic noise, music, or gently stroking their head. If the baby is tired, they will usually fall asleep quickly.

Safe sleep is harder than it appears, at least for some of the recommendations. This is an extraordinarily complex topic, and we know it’s hard. In order to keep your baby  as safe as possible, learn  the recommendations, start them at birth, do the best you can, and know that you are not alone in your struggle.

Do you have safe sleep tips/advice you want to share with parents? Share them at www.awhonn.org/SafeSleepTips

Resources

References

American Academy of Pediatrics. (2016). SIDS and other sleep-related infant deaths: Updated 2016 recommendations for a safe infant sleeping environment. Pediatrics, 138(5), 1–12. doi:10.1542/peds.2016-2938

Centers for Disease Control and Prevention. (2017). Sudden unexpected infant death and sudden infant death syndrome. Retrieved from https://www.cdc.gov/sids/data.htm

Gradisar, M., Jackson, K., Spurrier, N. J., Gibson, J., Whitman, J., Williams, A. S., . . . Kennaway, D. J. (2016). Behavioral interventions for infant sleep problems: A randomized controlled trial. Pediatrics, 137(6), 1–10. doi:10.1542/peds.2015-1486

Hitchcock, S. C. (2017). An update on safe infant sleep. Nursing for Women’s Health, 21(4), 307–311. doi:10.1016/j.nwh.2017.06.007

Moon, R. Y., & Task Force on Sudden Infant Death Syndrome (2016). SIDS and other sleep-related infant deaths: Evidence base for 2016 updated recommendations for a safe infant sleep environment. Pediatrics, 138(5), e1–e29. doi.org:10.1542/peds.2016-2940

Storrs, C. (2016). It’s OK to let your baby cry himself to sleep, study finds. Retrieved from http://www.cnn.com/2016/05/24/health/cry-it-out-sleep-training-ok/index.html

Courtney Duggan is a digital marketing manager in the Washington, D.C. area and is a mother of 2.

Life Entangled in Pink Ribbon

 *This blog was previously published at www.summahealth.org

My name is Jennifer Doyle.  As women’s health nurse practitioner and breast cancer survivor, I was asked to share excerpts from a 4-part blog that was published as part of my Health System’s ‘Flourish’ series in 2013.  Only 5 days ago, I passed the ‘5 year mark’ from diagnosis.  Thank you for allowing me to share my story, which I hope may help others who face breast cancer.

Diagnosis: “I am NOT a pink ribbon”

I was diagnosed with breast cancer on Sept. 24, 2012. I was not necessarily shocked, as all three of my father’s sisters had been diagnosed with breast cancer by the age of 50. I found a lump through a self-breast exam, and within a week had my diagnosis. I noticed the lump a few months prior, but it was very small and very hard.  I figured it was just my monthly cycle. However, when I re-checked my breast in the shower, it was much, much larger and hard as a rock. I could not move it. I could not find the edges of the mass on palpation. When I got out of the shower and looked in the mirror, I saw the orange peel affect, or dimpling of the skin around the area, and instantly knew that I had breast cancer.

When it came to the actual diagnostic process, it was quite memorable. I recall going in for the mammogram, already believing in some part of my brain that I had breast cancer. I thought to myself, “Hey, if I get my mammogram and get out of here, I’m good. If they keep me for an ultrasound, I’m screwed.” I had the mammogram, and wouldn’t you know it, I needed to stay for an ultrasound. As I sat waiting for the ultrasound, and again waiting for the ultrasound results, I watched women come and go from the breast center. They came in talking on their phones, making lunch plans; in and out. I was jealous. I wanted to just get up and go on with my life, too. Yet, I already knew that I could not.

Then came the inevitable. I was taken into a room with a tech and a physician, and informed that I needed a biopsy – today if possible. I was told that I had a mass in my right breast and that it was “very suspicious.” When the staff members left the room, I sat somewhat stunned. I looked around and realized I was surrounded by pink ribbons. There were quilts and pictures all hailing the pink ribbon. I instantly hated the color pink. Everything in me rebelled against the pink ribbon. I thought, “I want nothing to do with any of this. I am NOT a pink ribbon. I will not be defined by this!”

My formal diagnosis came via a phone call from my OB/GYN. Despite being a Women’s Health Nurse Practitioner, I said “I work in OB; I don’t know anything about breast cancer! What does this mean?” He informed me that it was the most common type of breast cancer, invasive ductal carcinoma, and that he was referring me to a general surgeon. My path was laid out before me, and I began my journey….

Treatment-“Wow, you look like GI Jane!”

My husband, Tim was with me for the biopsy and the diagnosis. One of the most challenging days was the day I had to tell my parents and our 13-year-old daughter, Claire, Someone wisely told me that the most difficult part of dealing with cancer is dealing with others’ reactions and emotions. It is so true. I rarely worry, but I hate being the cause for worry in the people I love. What I would say about Claire and my recovery is simple: She was ALL of my reasons.

After I broke the news to my family, my Breast Care Coordinator Heidi Eve Cahoon, MSN, CNP, of Summa’s Jean and Milton Cooper Cancer Center in Akron, met with myself, my husband, and my parents. She explained the pathology report and typical course for the breast cancer patient. We all felt more informed and educated after meeting with her. If you’re coping with the same diagnosis, it’s worth reading more about how breast cancer navigators can help you through treatment.

I opted for chemotherapy prior to any surgery. This was due in part to medical recommendations, but it appealed to me because it bought me time to assess my options for surgery and/or radiation. My four rounds of chemotherapy included “AC,”which stands for Adriamycin and Cytotoxin (sounds so lovely). The very first round of chemo came with a side of the vomits. I began vomiting within four hours of leaving treatment, and this continued for a couple of days. Thankfully Dr. R. Douglas Trochelman (my oncologist) and the nurses changed up my antiemetic medications, and I did not experience any vomiting during the last three rounds.

Chemotherapy is quite interesting. The ‘chemical menopause’ ceased periods and brought on hot flashes. The nausea, the vomiting, mouth sores, and the utter exhaustion were novel and unwanted companions. Hair loss seemed to be the most focused-on side effect by nearly everyone. I followed the advice given to me: Buy a wig. Buy two wigs. Be prepared. I spent $400 on wigs. When the time came and the hair began to fall, my husband and I went into the bathroom. Clippers in hand, my remaining blonde locks fell all around. A tear or two did escape. But then my husband looked at me with wide eyes and said, “Wow, you look like GI Jane!” I regarded myself in the mirror for some time and decided I didn’t mind the bald chick look. I briefly tried wigs but found them intolerable. I decided to rock the new look and traded up the wigs for bandanas, ball caps, and very often, nothing at all!

I underwent a double mastectomy at Summa Health Akron in early February 2013. I chose to have this, despite being a “good candidate” for a lumpectomy. I did not have either of the BRCA genes. However, I wonder how many genes are there out there that we do not know about yet? Part of my reasoning was a desire to avoid radiation. The other was family history. My general surgeon performed the double mastectomy and my plastic surgeon placed tissue expanders. I took the Scarlett O’Hara approach to the double mastectomy. I did not think about it. I thought, “I will think about it when it is over.” I woke up after surgery and a funny thing happened. I actually was OK. I did not mourn my breasts. The pain was tolerable. I thought I was over halfway through my journey, when the road took an unexpected turn. My lymph nodes removed during surgery tested positive for cancer.

Somewhere in the back of my mind I heard a game show announcer: “Jennifer Doyle, guess what YOU’VE won?! Four more rounds of chemotherapy!” I endured four more rounds of chemotherapy with the drug Taxol. No nausea, vomiting, or mouth sores, but the exhaustion persisted, and I experienced exquisite bone pain.

Breast reconstruction following mastectomy is quite novel and interesting. There are many options, from flaps to implants to prosthetics. Would you like a nipple created? Did you keep your own? Or would you like a nipple tattooed on? I chose to go with implants. What I would choose for nipples; Stars? Flowers? This was one of amusing things I thought about while going through the process.

It wasn’t easy as it seemed. In order to get implants, one must first endure the tissue expanders. The tissue expanders are like balloons made of tire tread. They are placed during mastectomy. A series of injections expands the balloon. The skin expands and stretches, giving the plastic surgeon a pocket, or space to place the implant, and adequate skin to cover the new implant. I began going to my plastic surgeon’s office for weekly expansion. I referred to them as my “pump me up” sessions.

The first time the nurse came in with the two large 60 cc syringes and extra-long needles, my husband swore and exclaimed, “Are you going to hit her heart with that?!” This was the expansion process. For me, it was one of the most painful processes of breast cancer. My husband went with me to nearly every expansion. When he could not go, my parents went. I always had Tim or my mom there to hold my hand during the expansion. I know it sounds wimpy. But, hey, it helped!

As I waited for my final surgery, a combination of breast reconstruction and oophorectomy (ovary removal), life went on. I went back to work at Summa Health’s Women’s Health Services Department once chemo was over.

A Successful Journey: “There is a lesson in every joy and every sorrow.”

I believe three factors have made my journey a success, even though the ending yet eludes me, and the outcome is not set in stone. First, is the seemingly endless support I have received from my family and friends. The care and outpouring has been humbling and heartwarming, to say the least. I am glad it was me who has breast cancer, and not my mom or sisters, though I know they would trade places with me. You see, as a baby, I was born with multiple birth defects and spent a large part of my childhood sick, undergoing surgery, or admitted to the hospital. So for me, medical issues are nothing new. I’m not Superwoman. It’s just that I take such things in stride; that is the second factor. The third factor is faith. From the diagnosis until now, my faith has held fast. I have always believed that everything has purpose. If it were not for my childhood challenges, I probably would not have become a nurse. There is a lesson in every joy and every sorrow. It may sound hard to believe, but I have never asked God “Why?”I have also never asked God to cure me. I have simply prayed for two things:

One, that God grants me the strength to endure this with dignity and grace, no matter what, and two, “Thy will be done.”

On July 8, I underwent my final two surgeries. The surgeries included reconstruction and an oophorectomy (ovary removal). You may recall that my reconstruction choice was tissue expansion followed by silicone breast implants. Both surgeries went very well. I actually woke up feeling a bit more comfortable than I did going into surgery. The implants are much better than tissue expanders! I consider myself lucky to have had such a fabulous care team of Summa Akron City Hospital nurses and surgeons!

Survivorship

Fast forward five years.  It is hard to believe all that has happened since Sept., 2012.  Now it is Sept, 2017 and I am President-Elect of AWHONN!  Claire is now a senior in high school and will leave for college next summer.  I am grateful every day for the opportunity to contribute in a meaningful way both in my personal and professional life.  For now, I have defeated cancer.  However, cancer and I have each left our mark on the other. I still experience some discomfort most every day in my right chest and axillary region.  Not exactly sure why that is, but it is most likely related to scarring and adhesions.  I still cannot lift my right hand very far above my head unless manually assisted.  Opening a can or bottle comes with significant difficulty that offers a regular reminder. I continue to experience aphasia from time to time; this peaked during chemotherapy and has not completely left.  Finally, the neuropathy in my feet remains profound.  I have very little feeling in my feet and most of the time; they just feel ‘asleep’.  That can be really annoying, to say the least.  Despite some of these physical effects, I am overall quite healthy and physically active.

Once cancer has personally impacted your life, there may always be some small measure of worry in the deep (or not so deep) recesses of your brain.  Cancer can become a lifelong resident in your mind:  What if it comes back?  Is that a lump or just scar tissue?  I cannot believe that anyone is immune to these doubts that come to call on occasion. What I think is important is to own your thoughts and where you allow those thoughts to go.  Of course I have fears, but I remind myself to center and to refocus my thoughts and efforts in another direction.  Sometimes this takes specific intention. In every story, there is meaning.  While I still have not fully come to understand the meaning of my breast cancer, perhaps it will be made clear to me one day.  Lessons learned via a renewed appreciation for life’s small moments are perhaps what I take from this part of my journey.  Every person has a unique story and must come to their own point of resolution and peace.  I thank you for allowing me this opportunity to share some of my experiences.

My life was certainly entangled in the pink ribbon for some time.  Now, that has come full circle.  Today I embrace that ribbon and am proud to wear it as a banner symbolizing survival.

Jennifer Doyle is a WHNP with nearly 25 years of experience in obstetrics. She is the APN of the Women’s Service Line at Summa Health in Akron, Ohio as well as Faculty and Coordinator of the WHNP program at Kent State University in Kent, OH. She is AWHONN’s President elect in 2017 and is happy to share her personal story from the perspective of a breast cancer patient.

Alcohol and Pregnancy – An Approach Nurses Can Use to Prevent Fetal Alcohol Spectrum Disorders

By: Ann M. Mitchell, Holly Hagle, and Brayden Kameg

Prenatal exposure to alcohol can lead to a range of physical, mental, behavioral, learning, and developmental disabilities, with possible lifelong effects for the child exposed in utero. This range is commonly known as fetal alcohol spectrum disorder or FASD. FASDs are 100% preventable when a baby is not  exposed to alcohol during pregnancy.

Healthcare professionals may tell women that it’s OK to drink alcohol on occasion or even in moderation, when they are pregnant. However, evidence shows that there is no known safe type, safe amount, or safe time to consume alcohol while pregnant.

Additionally, it’s important for healthcare professionals to broach the subject of alcohol consumption, not only with their pregnant patients, but with all women of reproductive age. Women who are sexually active and not using effective contraception may be at an increased risk for alcohol exposed pregnancies, as nearly half of all pregnancies within the United States are unplanned.

It is critical that healthcare professionals educate all women of reproductive age about alcohol use and pregnancy. Alcohol screening and brief intervention (alcohol SBI) is one evidence-based approach to assessing patients for at-risk alcohol use. Screening includes use of a validated tool, such as the Alcohol Use Disorders Identification Test (AUDIT). The AUDIT is a clinically reliable and valid instrument (Bohn, Babor & Kranzler, 1995). The AUDIT has been consistently found to screen and detect alcohol use across a spectrum of low, moderate, and high risk consumption (Reinert & Allen, 2007).  The AUDIT has been found to be valid and reliable with diverse populations and in a variety of settings.

When a patient screens positive for at-risk use, a non-judgmental discussion, called a “brief intervention” occurs with the use of motivational interviewing techniques. For example, the patient is provided with the score on the AUDIT during the health care visit. If a patient scores between an 8 and 15, this score is discussed in relation to their current health condition and presented objectively to the patient as moderate alcohol consumption. If the AUDIT score is between 16 and 19, then brief counseling and continued monitoring are suggested. With a score of 20+ a referral for further assessment is indicated (Babor & Higgins-Biddle, 2001). The main goals of the brief intervention are to increase a patient’s awareness of their alcohol consumption patterns, understand the associated risks and options for reducing or eliminating those risks, and to increase their motivation to make healthy choices.

As nurses, it is our obligation to ensure that women are provided with the knowledge needed to make informed choices regarding their health. For example, giving the patient objective feedback about their score on the AUIDT and then asking them “What are your thoughts about this score?” is a way to elicit their thoughts and feelings about their alcohol consumption in relation to their health and wellness. Further, exploring the pros and cons of the patients current level of alcohol consumption is an excellent technique to elicit the patients thoughts and provides an opportunity for the health professional to provide feedback and health education.  Patients have high trust in confiding to their healthcare provider and in particular nurses.

Additional Resources

Dr. Ann M. Mitchell is professor of nursing and psychiatry at the University of Pittsburgh School of Nursing. She is principal investigator on a CDC-funded project for the implementation of alcohol screening and brief intervention with the ultimate goal of preventing FASDs.

Dr. Holly Hagle is Director of Education for the Institute for Research, Education and Training in Addiction (IRETA) and a partner in the CDC-funded FASD project.

Brayden Kameg is a graduate student in the psychiatric-mental health nurse practitioner DNP program at the University Of Pittsburgh School Of Nursing. She is actively participating in grant-related activities on Dr. Mitchell’s projects.