Tag: birth

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].

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.

Providing Care for Survivors of Sexual Abuse During Childbirth

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“Humiliating and Traumatic,” these are the words from a survivor of sexual abuse when asked to describe her labor and delivery. All too often, women who have been sexually abused carry their wounds into the delivery room. And, all too often, these unresolved traumas rear their ugly heads and cause complications, from labor dystocias, to full blown anxiety attacks that result in a woman completely shutting down. These are some of the more challenging labors to manage.

According to the U.S. Department of Health, one in four girls and one in five boys will be sexually abused before they turn 18. One in five women and one in 71 men will be raped at some point in their lives. This is in many ways a silent epidemic. Sometimes victims don’t disclose their abuse to their care providers. The reasons vary, and can range from  ongoing suffering of the traumatic effects of the abuse and  avoiding  reliving it, to a continuing sense of shame that victims  may have never come to grips with.

What are some possible signs of sexual abuse?

According to When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women, having a constellation of these symptoms can indicate a history of abuse. Having one or more of the following should trigger a red flag and considerations for a woman’s  care during childbirth:

  • Not able to feel fetal movement. Some women have “numbed” that part of the body
  • Hyperemesis gravidarum
  • Chronic pelvic pain
  • Missed prenatal appointments
  • Panic with vaginal exams
  • Extreme anxiety with IV starts
  • Disassociation that manifests as if she’s going into a trance

Many of these symptoms can understandably occur in women who don’t have a history of sexual abuse, but when a woman has two or more, it’s reasonable to suspect that such a history is possible. These symptoms can stem from PTSD, which is triggered by a woman’s perception of loss-of-control, as well as the physical sensations that occur during pelvic exams, labor, and birth. By rushing through procedures, and not allowing the woman time to process (if possible), understand, and consent to what is happening to her body, we can inadvertently trigger a posttraumatic reaction.

Admittedly, the discussion of sexual abuse is a tough topic for those on either end of the conversation. We often just touch on the subject while reviewing women’s admission histories, and then move on. Fortunately, we don’t need the admission of abuse to employ strategies developed for survivors. It’s actually much more common for caregivers to pick up on non-verbal cues and then tailor their care. A real tragedy is the guilt and shame survivors can feel after giving birth. So, like we would do for any woman,  it’s best to acknowledge the struggle of labor and birth, the strength a woman demonstrated, and the effort and precious reward she  achieved.

What are interventions that nurses and other caregivers can provide?

  • Explain as much as you can in advance, for example “If we run into an emergent situation there might be unfamiliar nurses coming in to help. I know this can cause anxiety, but I want to prepare you ahead of time in case it happens.”
  • Always start with asking permission. From starting an IV to turning on the overhead lights, make sure to obtain permission before doing any procedures or making changes to the environment
  • Go slowly with everything you do–this can be helpful in relation to a woman’s  fear of losing control. Fast movements can be triggers. This is especially important when uncovering a woman or assisting her with positioning.
  • Limit vaginal exams. These are especially traumatic and should be minimized. If a woman is having difficulty in relaxing enough to complete an exam, try making an agreement about when and why you can perform one. If a woman understands that the exams are being performed only when necessary, and with her consent, her anxiety is often more controllable during exams.
  • Minimize people in her room. She might have issues with nursing students or residents, especially if they are male. Obtain her permission before any new staff come into the room, unless there’s an emergent situation.

What are things not to say?

  • Intrusive interest-prying for details or descriptions of the abuse
  • Minimizing the abuse: “Well, that’s over now.”
  • Exaggerated concern
  • Shock or disgust
  • Pity

What are good things to say?

  • “I can imagine that was very hard to share that with me. It takes a lot of courage to talk about and I respect you for doing that.”
  • “Sometimes talking about these episodes can trigger strong feelings. How are you feeling right now?”
  • And, it’s always essential to assess the woman’s current well-being “Do you feel unsafe in any aspect of your life?”

Not all survivors of sexual abuse have difficulty with pregnancy or childbirth, for some it can be empowering. For those who do struggle, recognize that we have a powerful opportunity to help them. We can communicate therapeutically to help  change the woman’s focus from feeling out-of-control.  We can employ care practices to avoid the woman feeling re-traumatizatized.  And we can set the stage to promote healing and bonding with the newborn. In many instances it’s our tacit recognition and respectful and supportive care that facilitates healing, more than any words we could utter or medicines we could administer.

Where can I learn more?

What are resources for my patients?

  • National Sexual Abuse Hotline: 1800-656-HOPE
  • RAINN: Rape, Abuse, Incest National Network, www.rainn.org

Tasha-poslaniecTasha Poslaniec has been a registered nurse for 17 years. She has been working in obstetrics for over a decade and is currently a Perinatal Quality Review Nurse and Childbirth Educator.

She also writes about nursing and childbirth and has been published in the Huffington Post and the American Journal of Nursing. Pain control in childbirth has long been a topic of study and research for her.

Navigating a Labor Experience: As a Student

By Amy Smith, Student Nurse at MGH Institute of Health Professions, Boston

I could feel the excitement in the room as I entered. The couple was receptive to my questions and suggestions; and the woman was more than happy to involve me in her care.  I tried to build rapport even though I was nervous in my role as a nursing student. This was the first time I had assisted a woman in labor and, after her membranes were artificially ruptured, her contractions started to come about two minutes apart.  At one point, I had my hand on her back and her husband smiled at me across the room and signaled for to me to remove my hand!  It was a great moment in which the support person and I connected!  I remained quiet during her contractions and I asked her if she wanted me to breathe with her but she said she had it under control. I kept thinking back to my own labors and what I felt I wanted from support people so I asked her if she would like lower back counter pressure but she refused.  The family had not done a childbirth preparation course so I assumed that their interest or skills with working through labor was limited.  I thought that they would need my help more yet her prenatal yoga practice seemed to have given her the tools she needed to get through her labor. The tools I offered her personally were meditative.  I told her to focus on her favorite place, to discuss her needs and frustrations with us in between contractions and reassured her that I was there for her to breathe with her and regulate her breathing as needed.

Reflecting on the Nursing Care Women and Babies Deserve virtues I used during this experience, I believe they were humility and engagement. Humility in that I had to understand I did not know what was best for this family. I assumed they would want and need what I needed during childbirth or skills I learned from the comfort measures video I used to prepare for this clinical experience. The woman decided what she needed and I was there to support her. In respecting their wishes I could engage with the family. Before I left them for the day they commented, “We felt like we had our own doula”.  It was easy and a pleasure to engage with this couple and follow their commands and offer suggestions. I told them I had never wanted to stay at clinical so much as I did with them. I will always remember this family.

 

Additional Resources

AWHONN’s Nursing Care and Women Babies Deserve Poster –  AWHONN’s statement on ethical nursing practice, Nursing Care Women and Babies Deserve, is rooted in the American Nurses Association’s Code of Ethics for Nurses, and provides nurses with core elements of ethical nursing practice for our specialty and corresponding examples of the virtues of ethical practice in action.

Read a commentary about Nursing Care Women and Babies Deserve in AWHONN’s journal Nursing for Women’s Health. Consider submitting your own story of how you or your colleagues practice nursing care that women and babies deserve at https://www.awhonn.org/?NursingCare

nursepicamyAmy is an ABSN student at MGH Institute of Health Professions, Boston.  She was a stay at home mother for 12 years,  a community coordinator for a non profit kids running program and a volunteer at Dana Farber Cancer Institute in Boston before deciding to enter the nursing field.  With extensive volunteer experience from a camp for blind & visually impaired adults and children, to co-president of an elementary school PTO, she enjoys working with diverse groups of all ages.  Amy aims to work in labor and delivery after graduation in August 2017 but is also interested in global health and epidemiology.  She has intentions to keep making a difference in the lives of those she may never meet again.

We May Have Different Religions

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By Evgeniya Larionova

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

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

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

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

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

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

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

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

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

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

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

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

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

6 Tips For Postpartum Care for Mom “The Patient”

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by, Kristen Wesley “The Mom”

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

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

Dealing with the Loss of a Tiny Patient

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By Lori Boggan, RN

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

Birth Traditions Around the World

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by, Lori Boggan

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

The Things You Do Make a Difference

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Traciby, Traci Turchin

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

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

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