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

 

A Special Thank You to Our Preceptors

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

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

Here is a sampling of what they said:

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

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

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

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

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

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


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

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.

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

by, Jade Miles

Michelle and Corinne

Michelle Delp and daughter Corinne

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

 

Babies Have Back-to-School Needs, Too

by, Summer Hunt

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

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

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

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

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

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

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

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

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

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

Nurses Make Change Possible for Babies_1

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

Ladies on a Mission

Guatemala

by, Lori Boggan, RN

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

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

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

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

How long have you been going on missions?

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

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


Where has your mission work taken you?

Both: Guatemala


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

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


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

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

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

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

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


20140306_102410Cecille, describe your work educating midwives in Guatemala

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

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

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

How has mission work changed your practice?

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

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

How has mission work changed you as an individual?

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

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

Guatemala

What advice would you give a nurse contemplating mission work?

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

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

FullSizeRender-101Where to next?

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

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

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

Thank You Nurses

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

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

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

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

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

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

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

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

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

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

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Any mention of a product in this post or any pages linked from this blog post does not represent an endorsement or verification by AWHONN.

TOLAC and VBAC and Rupture! Oh My!

by, Bree Fallon

As a brand new labor nurse fresh out of school, I distinctly remember visiting with a seasoned traveling nurse, Pam Spivey, during an afternoon of monitoring women on the antepartum unit years ago. One of the preterm women I was caring for that afternoon was planning to attempt a vaginal birth after cesarean (VBAC) with this pregnancy when the time came.  I was pretty green and knew what the acronym stood for, and that was about it. Pam and I began to converse about VBAC and she shared a story of hers from years prior.

She told me about a woman who had been admitted to L&D. The woman had delivered her previous baby in another country by C-section and the plan for her was to allow a trial of labor after cesarean (TOLAC). Pam said her labor progressed beautifully and soon it was time for her to push. I leaned forward on the edge of my seat as Pam recounted the details. She called the provider to come for delivery. “The fetal head crowned up so nicely, and then it was gone!” I felt my eyes grow large. “Where did it go, Pam?!” I thought. She explained the next moments were a mad dash. She pulled all of the cords and plugs out of all of the devices and outlets, grabbed the nursery nurse and down the hall they went with the woman in the bed, snagging the physician on the way as they ran to the OR. Pam even remembered losing her shoe along the way to the OR, but she did not slow down. Confused, I sat in disbelief of this story. Pam recalled the team got the woman to the OR, rapidly delivered her baby via C-section, and both mom and baby survived the ordeal and did well. Still perplexed, I asked out loud this time, “Where did the head go, Pam?” The kind nurse looked at me and explained when a woman’s uterus ruptures, there is no pressure inside the uterus or on the baby anymore. The instant that the head was gone, Pam knew the woman had ruptured her uterus and the lives of both mom and baby were at stake. Horrified, I logged this story away in my brain, vowing to remember what to do when this happened while I cared for a woman.

My first year flew by. Plagued by a horrible cloud of bad luck that followed me on and off of my floor daily, whenever I saw my name assigned next to a woman attempting VBAC, I would swallow the lump in my throat, and Pam’s story would flash in my head. I would mentally prepared myself, ensuring I had my A game for this woman, should any signs or symptoms of uterine rupture arise at any point in the day. The woman would either be successful in delivering vaginally or would not be successful. The only thing that mattered to me at the end of the day was healthy baby, healthy mommy.

A couple years later, my very best friend in the world and an exceptional labor nurse, Kelsey, was pregnant with her first baby. Her baby was breech and was delivered by cesarean. I remember Kelsey laying behind the drape, asking for updates, if her baby girl was ok. Having the privilege of caring for her sweet infant in the OR that day, I swaddled her newborn up as fast as I could. Kelsey had already waited 9 months to meet her daughter, so the extra few moments it took for me to wrap the baby and hand her to Kelsey’s husband before Kelsey could even see her seemed cruel. They snuggled with their new little one while doctor finished the surgery. In the PACU, Kelsey felt pukey and could not hold her infant. Recovery was not easy, but she didn’t know any different. Still today, Kelsey remembers having a difficult time bonding with her infant, and wonders if her delivery by cesarean had anything to do with it.

IMG_6993With Kelsey’s second baby, after discussing the risks and benefits with her provider, Kelsey wanted to attempt VBAC. I was very hopeful for her, but sick to my stomach a little too. Remembering Pam’s story, I was incredible apprehensive and ultimately didn’t want anything bad to happen to Kelsey. Her pregnancy flew by and was induced at 39 weeks and 5 days. I raced to the hospital with the very important job of taking pictures. Kelsey’s labor progressed and she delivered quickly with no complications. Watching my best friend get to see her baby immediately and hold and soothe her right away is one of my most favorite memories of my career. I had taken care of many women who had successful VBAC, but did not really understand its significance until seeing first hand Kelsey and her husband experience both types of delivery.  Never having a cesarean myself, but circulating hundreds, I considered them routine. It was very powerful for me to see the difference between a vaginal birth and a cesarean for the same woman.

Just this week I was asked to review some literature to develop patient education on VBAC. Here are a few facts that stuck out to me taken from ACOG Committee Opinion 342 as well as ACOG VBAC Guidelines.

  • 60-80% of appropriate candidates who attempt VBAC will be successful. The odds are in your favor that a woman will have a vaginal birth.
  • The risks for both elective repeat cesarean and TOLAC include maternal hemorrhage, infection, operative injury, thromboembolism, hysterectomy, and death. Both have their risks.
  • Overall benefits for a VBAC is avoiding major abdominal surgery. This lowers a woman’s risk of hemorrhage and infection, and shortens postpartum recovery too.
  • The most maternal injury that happens during a TOLAC, happens when a repeat cesarean becomes necessary if the TOLAC fails. Maternal injuries can include uterine rupture, hysterectomy, or even death.
  • There are risks for baby too. Both elective repeat cesarean delivery and TOLAC neonatal complications can include admission to the NICU, hypoxic ischemic encephalopathy, and even death. One study found the composite neonatal morbidity is similar between TOLAC and elective repeat cesarean delivery for women with the greatest probability of achieving VBAC.
  • If a woman has had a prior vaginal birth or goes into labor spontaneously, she has an increased probability of successful VBAC.
  • If a woman had an indication for her initial cesarean that may reoccur with subsequent labors such as labor dystocia or arrest of descent, she has a decreased probability of successful VBAC. If a woman  is of non-white ethnicity, is more than 40 weeks gestation, is obese, has preeclampsia, has a short interval between pregnancy or increased neonatal birth weight, her probability of successful VBAC is also decreased.
  • Women pregnant with twins attempting VBAC have similar outcomes to women with singleton gestations and did not have a greater rate of rupture or perinatal morbidity. (I have never had a twin mom attempt VBAC but it can be done!)
  • On the topic of induction, one study on 20,095 women attempting VBAC found a rate of uterine rupture of 0.52% with spontaneous labor, 0.77% for labor induced without prostaglandins and 2.24% for prostaglandin-induced labor. Prostaglandins should be avoided in the third trimester in women who have had a previous cesarean section.

As years went by, I cared for more women who wanted a vaginal birth after cesarean. I cheered hard for each of them to be able to experience a vaginal birth. Any healthy birth is always a miraculous moment to have the privilege to be a part of. However, caring for women who had only experienced a cesarean before the days of skin-to-skin in the OR and then watching them birth vaginally, and being able to instantly see, touch, hold their infant, is priceless.

In my 12 years of bedside care I worked in facilities delivering on average 4,000- 5,000 babies a year, and a uterine rupture during labor had never happened to one of the women in my care  I was in charge once where one of the nurses correctly identified that the scar on her patient’s uterus was beginning to pull apart. The woman had a cesarean immediately and delivered a healthy baby without any complications. We have had cases of uterine rupture since on my floor. It can happen and if it happens, it becomes an emergent situation that must be resolved swiftly and seamlessly for a good outcome. However, it doesn’t happen very often. In fact, ACOG cites the risk for uterine rupture for woman attempting TOLAC is low, between 0.7-0.9%.

There are many indications where a cesarean delivery is absolutely necessary. In the case of an elective repeat section or a TOLAC, it is imperative that women review the risks and benefits of both with their provider to ensure they make the right choice and promote  a healthy, happy mom and a healthy, happy baby.

Bree FallonBree Fallon, BSN, RNC-OB, C-EFM
Bree Fallon is a Clinical Educator for Perinatal Services at Shawnee Mission Medical Center, the busiest delivering hospital in Kansas City. She graduated from nursing school in 2004 and started her career in a tertiary care facility, providing high risk intrapartum and antepartum care. In 2010, she moved to Children’s Mercy in Kansas City who was looking for experienced L&D nurses to help open the their new Fetal Health Center.

Nurses Save Lives

by, Christine Douglass, RN
Florida Hospital Heartland Medical Center

As a charge nurse on a busy Labor & Delivery unit I am responsible for the nurses on my team that work each day with me. On one particular day we had a patient who was scheduled for a repeat cesarean section for her second baby. Everything was going fine with her recovery in PACU, until I heard an unfamiliar alarm sounding on the unit.

I looked up at the fetal monitor board to see if the monitors indicated anything wrong. I saw that the patient in room 202, who was also in PACU, had a blood pressure of 70/40 and a heart rate of 160. I ran into the room and asked the nurse if she had seen the monitor.

She stated that she had just given the patient IV pain medication and that was why her heart rate was high and blood pressure was low. I said that is unusual for that to happen, it looks more like she is going into shock. I told her to start a second IV line and open both line wide. I checked her fundus to find out that her uterus was boggy and when massaged a mountain of clots came out.

I rang the call bell and asked OB tech to get the scale to weigh the clots and had another nurse, who had since come into the room, to call the doctor and get me an order for methergine. Methergine was given and in 15 minutes more clots were expressed and weighed. By this time we had weighed a total of 1200-1300 mls, not including the 800 mls she had lost in the OR. I asked the nurse to call the doctor back and when she did she said to prep the patient and take her to the OR, the doctor was on her way to the hospital. The patient was taken to the OR and given several units of blood and FFP.

Her uterus was saved for the time being and she was sent to the ICU for the night to be closely monitored. Two days later when she returned to our unit she told me her side of the story. She stated that while everything was happening to her she felt like she was above the room looking down and then she saw her grandparents sitting on a park bench. She told them that she wanted to stay with them and they told her she had to return to take care of her little girls. When she left she told me that we were her angels and we had saved her from death and she appreciated all we did for her and her family.

Later that day the doctor thanked me for “catching” the change in vital signs before she had gotten any worse and that I had probably saved her life. It makes be proud to be able to save someone’s life and reaffirms to me that I made the right career choice many years ago. I love what I do.