I would like to share what an impact attending nationals has been for me over the last few years.

A few years ago I went to hear Michelle Collins present on Nitrous. She talked about bringing nitrous to Vanderbilt University Hospital. I was so inspired by her talk that I reached out to her to find out how I could do the same thing.

Michelle was very kind and gave me some great suggestions on how I might get started. After two years of research, committee meetings, writing policies, developing education materials and training staff it finally happened. Saint Joseph Mercy Hospital is one of only TWO hospitals in Michigan that offers nitrous as a form of pain relief for laboring patients.

As a pain resource nurse for our hospital, I am very committed to being able to offer patients the best pain relief options available. I am currently traveling within the state presenting on how to implement a nitrous program. I am asking hospitals to think outside of the box and look at the many applications of nitrous use within a hospital setting.

I can tell you without any reservations that I would have NEVER been able to do this without AWHONN.

I am currently a leader within the AWHONN Huron River chapter in Ann Arbor MI. I also serve on the AWHONN MI leadership team.

AWHONN has been instrumental in my professional development as a nurse.

I wanted to share this story with others in hopes that it would inspire them to follow their passion.

Learn more about the AWHONN Convention and register today!

RESOURCE ON NITROUS OXIDE FOR NURSES

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

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

When I was told my administration would be sending three of us to the AWHONN Convention, my heart skipped a beat. Actually, I squealed like a child and jumped up and down. It was a dream come true! I couldn’t help but compare Convention to a labor and delivery nurse’s Disneyland. It’s funny to me now remembering that day, as I would have had no way of possibly knowing what a tremendous impact the trip to Convention would have, both on my own nursing career as well as my unit.

AWHONN 2015 provided so much great education, but it was the passion from the speakers that truly resonated with me.

Bern Melnyk inspired me to challenge the evidence. Since hearing her speak, every policy I review and protocol I update, I scrutinize each article and ask myself, “Are we doing this because this the way we’ve always done it?  What does the latest evidence tell us?” As a clinical educator, one of my duties is to help coordinate our Nurse Residency Program. I’ve allocated an entire day in the upcoming cohort to illustrate to our new frontline nurses that we are the essential piece for recognizing nurse sensitive indicators through understanding of evidence based practices. Our goal is for new nurses to have a comprehensive knowledge of the relevant evidence in every task they perform and an understanding of how that impacts their patients’ outcomes.

Suzanne McMurtry Baird spoke on the patho of preeclampsia. I felt like I already had a pretty good understanding of this complicated disease, but she blew my mind. Listening to Suzanne was poetry. She had such command of one of the most complicated disease processes of pregnancy, breaking it down with such clarity, as if explaining how to butter a piece of toast.  Questions that had constantly crossed my mind throughout my career were addressed in the short time allotted for her session. I feverishly took notes, hoping to retain every ounce of her wisdom. I loved Suzanne’s analogy of a balloon animal from the fair being similar to the vasculature of a preeclamptic patient.  When I now borrow the same metaphor (of course giving credit where credit is due!) I love seeing that light go on for other nurses, new and experienced alike.

Twelve years ago as a new nurse, I thought I knew how to take great care of my sickest patients with preeclampsia.  I knew what to do, but I didn’t understand why we did all the things we were trained to do. This past year in our facility, we had over 200 obstetric nurses go through hypertensive emergency education and eclampsia simulations. Each time a class or a simulation was in session, I was able to confidently and comprehensively address questions or comments. Our leadership team is identifying opportunities to further improve our preeclampsia related care, enrolling our facility in a preeclampsia immersion project with the state hospital association.  What a difference a 90 minute session can make!

I also attended a session on the Maternal Fetal Triage Index. It was brilliant. Shortly after the session that very day, I met a lovely and enthusiastic woman at the AWHONN Booth, Mitty Songer.  We struck up a conversation on the MFTI and how AWHONN was looking for pilot communities. I took her card and brought it to home to the rest of our leadership team, who agreed that being part of the pilot community was an amazing opportunity. Our hospital is currently working on integrating the MFTI into our electronic medical charting. Being part of the pilot community has been extremely beneficial. We are able to collaborate with other facilities who utilize the same EMR system, bouncing questions and ideas for best practices off each other.

Another memorable session was presented by Lisa Miller. I could listen to Lisa Miller talk for days on end!  She draws you in with the statistics of liability in obstetrics, hitting on the pitfalls that can lead to litigation using real world examples.  Comparing notes and putting our heads together on our plane ride home, my manger Eva and I felt we needed to raise awareness of these issues.  Since Convention, we have integrated an obstetric liability class into our 2016 curriculum. The class is complete with an expert panel consisting of hospital legal counsel, a legal nurse consultant, a representative from our risk management team, and a couple of nurses who have firsthand experience with litigation. I also incorporated one of the articles Lisa referenced, “Intrapartum Management of Category II Fetal Heart Rate Tracings: Towards Standardization of Care”, into our mandatory interdisciplinary education for 2016. Reviewing strips and utilizing the algorithm from the article helps to take the variability out of the management. From this, we have also developed a task force focusing on opportunities for improvement in C-sections resulting from non-reassuring heart tones.

Many other sessions sparked ideas for initiatives for consideration by our leadership team. For example, we held a discussion on the potential use of Nitrous Oxide for analgesia. Nitrous is not currently used on any labor units in Kansas City. Generating dialogue and interest is the first step, and we are currently working towards getting more information to our interested providers.  Another initiative, delayed bathing, has been discussed at length within our shared governance. Though I am so excited to incorporate many of these innovative practices, I have to remind myself that any successful change in practice takes time, born through discussion and development of a well laid plan.

The sheer magnitude of information crammed into my brain in that short four days in Long Beach was overwhelming but completely invigorating. Each session I came away smarter, which has translated to my nurses and especially my new grads becoming more knowledgeable through the experiences I took away from Convention.

Out of everything I learned, the most important was gaining an understanding of who AWHONN is.  Our Kansas City AWHONN Chapter is fairly young, so my idea of AWHONN was great webinars and fetal monitoring courses. Every person I met, the bedside nurses filling the sessions, the speakers, the editors of AWHONN’s journals, every person working the booths, each of us is united by the same common thread, to make a difference in the lives of women and newborns.

It was inspiring to be back at my desk surrounded by the same text books, journals and resources, now having heard and met many of the authors. To learn from the best of the best, I felt like I was at the Top Gun of OB Nursing!

The networking opportunities at Convention are endless. In addition to a selfie with Lisa Miller, I’ve also been the benefactor of continued guidance from her. I personally met Dr. Kathleen Rice Simpson in the lobby of our hotel. I had seen her speak earlier in the day and just had to tell her how much I loved her session, I also took the opportunity to ask her for her thoughts on my contemplated return to school. She was so kind, providing her email address and telling me she would be happy to discuss it with me at greater length. A month later she graciously spoke with me on the phone, sharing her wisdom, thoughts and opinions to help guide my decision.

Inspired with gratitude and pride for the leaders within AWHONN, I am motivated to become more involved and find out ways how I can contribute. This fall I applied for the AWHONN Emerging Leader Program and was selected! I will be beginning my journey and learning more about advocacy for health care in Washington DC in March! So pumped, a cow town girl on Capitol Hill!

Just a few days in Long Beach at the AWHONN Convention changed the trajectory of my career. I am counting the days down for Grapevine and hope to see you there!

Bree 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.

I am the mother of four children, each one unique. The same can be said of their births. Because of the variety of births I have experienced, I’ve learned that for me, nitrous oxide is by far the best form of pain relief during childbirth .

My first delivery was long and painful. I labored at home for 5 hours before my water broke. I stayed at home for another 5 hours hoping for labor to smoothly progress, but upon arrival at the hospital, I was only dilated barely 1 cm. The long night in the hospital was exhausting and not beneficial to the progression of labor. Around 6 the next morning, I was drained and unable to manage pain. After discussing options with my midwife, I decided to get an epidural so my body could relax and allow me to sleep in preparation for later stages of labor and ultimately delivery. The epidural helped with the pain but I felt I didn’t have control of pushing, breathing, feeling and navigating giving birth. After 3 hours of pushing, my beautiful face-up baby girl was born. Recovery was difficult and painful. I felt sore, because I had not been able to successfully gauge how hard or soft I was pushing, and, at times, I was overdoing it. I also found out that I don’t like bladder catheters.

Ten months later, I found out I was pregnant with baby No. 2. I was anxious and focused on having an unmedicated birth. I was envisioning a much easier birth and the opportunity to see how labor and giving birth can be different without so many pokes and interventions. Luckily, my dreams came true with baby No. 2! After laboring all day at home, I decided to go to the hospital around midnight. After laboring for a few more hours with the help of my husband, midwife and sister-in-law, my water broke at 3 a.m. At 3:30 a.m. I felt like I needed to get into position. Before my husband and midwife were fully prepared, my busy baby girl pushed herself into this world without any effort on my part. My recovery was so much easier and our little girl was alert and quick to nurse.

At my 20-week ultrasound for baby No. 3, I found out I was having a boy. I had heard my mother talk about how her big boys and their collarbones were difficult to deliver. From then on, I started to imagine a huge baby boy making delivery difficult. I am naturally an over-optimistic person, so I tried to suppress negative thoughts. All this played a part in my delivery. Once again, I labored all day but this time I did not stay home. I was at my midwife’s office for monitoring since I was 4 days late. (All of my babies have been late, so no surprise here.) Since I was not at home, I was not as comfortable as I could have been. I was tired and really needed a good nap. At one point, I did fall asleep in a recliner and was awakened by a sudden gush of water. My water had broken naturally with the other two deliveries, but never this much! It gushed and gushed and gushed!

Since my last baby came 30 minutes after my water broke, my husband, midwife and I rushed to the hospital thinking the baby would come flying out any minute. Upon arrival at the hospital, I was dilated to 5 cm. I continued to labor on my own for a few hours. At that point I had not progressed, and, in fact, my contractions had started to slow down. We discussed Pitocin, which scared me because I knew that would make contractions stronger and more painful . I asked if we could try anything else. My midwife said nitrous oxide was available at the hospital, and I should give it a try. I agreed to try it, but I was not really excited about it. The anesthesiologist came to explain how nitrous is administered. It was easy to understand, and I was willing to try the mask on and take a few deep breathes. I took my first deep breath and instantly relaxed so much that I fell into a very deep sleep for a few moments.

My body was exhausted but I had not allowed it to rest up to that point. I rested, and immediately, labor picked back up. I began talking about all of my fears and deep-rooted worries about how big my little man was going to be. This talk was new to my husband and midwife who had no idea that I was nervous or even afraid about my baby’s size. I had not expressed any of this until after using nitrous and feeling completely free to be myself . I stopped fighting labor, and instead embraced the contractions and allowed them to push labor along. Within 20 minutes, I had dilated from 5 cm to 10 cm and was ready to push. With each push I could feel the pain and his little body descending, but because of the nitrous oxide, I was able to separate myself from the pain. After 5 minutes of pushing, we met our first boy and biggest baby. He was 8 pounds 6 ounces. My fear of having a bigger baby was legitimate.

Seven months ago, I gave birth to another baby girl. Her birth was fast and furious! I tried to labor at home like I always do, but these contractions went from easy early labor to hard late stages of labor very quickly. I was very nervous and afraid that I would have the baby in the car. We arrived at the hospital, and I was in so much pain. This pain was unbearable. I wanted relief, and I wanted it fast. I was already dilated to 8 cm and fully effaced. I expressed my desire to have help managing the pain and the nurse was quick to let me know that nitrous would be the easiest to administer and quickest to provide relief. She was so right! I started the nitrous and instantly received the help I needed to distance myself from the unbearable pain that normally accompanies quick labors. Just like my first child, baby No. 4 was “sunny-side up”, but I was determined to push my hardest and get her out. She was born 50 minutes after arriving at the hospital. She was by far my fastest and most painful delivery.

From my experiences with nitrous oxide, I would strongly recommend it to help provide relief and pain management. I am not the best at keeping my mind focused and distracted from the pain. Nitrous oxide gave me exactly what I needed to distance myself from the hard pains of labor while still allowing me to navigate through contractions and pushing without feeling like I was driving blindly.

Not all hospitals in the United States are offering nitrous as a form of pain management in labor, but hopefully, more will begin to see its advantages.