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].

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.

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?

• When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women
• Simkin, Penny and Phyllis H. Klaus. Seattle: Classic Day, 2011. Print.

What are resources for my patients?

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

Tasha 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.

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

Amy 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, 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 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.

There 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.

It all became extremely clear while my little bundle of joy was on the scale being measured and weighed, when the doctor said “okay, I’m going to work on you now”. Work on me, I thought? What does that mean? The hard truth was that it meant stitching up my episiotomy and sewing a tear on the inside of my vagina. All of this, the aftermath of an hour and half of pushing out baby Isla.

The patient theme was echoed again when I made it to the mother-baby unit and my nurse said she’d be back to check on me every hour for the next three. And when she came back to check on me, boy did I need her help. I needed her help not only to get out of bed, but to go to the bathroom, and to reapply the “padsicle” of support I had in-between my legs.

The padscile was just the start of my postpartum care. The below are the six most helpful things I needed as “patient mom,” once I arrived home.

1. Mesh underwear from the hospital, your new best friend: The mesh underwear they give you really helps at home. Take all of them; ask for more if you have to. This underwear is great because they give your “parts” room to breathe while also holding in place the biggest maxi pad or padscile you have ever seen.
2. Maxi pads: For me I had to buy the large over-night ones. They filled up my underwear and covered everything front to back. Choosing the big ones helped keep them from sliding around. These were also very helpful when I was sitting in bed nursing while leaking from below.
3. Sitz bath: The idea of this did not work for me, and the contraption they sent me home with just did not fit in my toilet. So instead I used the portable showerhead. It worked marvelously. I stood in the shower and oscillated the shower head back and forth on my nether region. I felt clean and appreciated the water and other liquids running away from me into the shower drain.
4. Squirt bottle: The bottle they give you at the hospital becomes your trusted ally. Fill it with warm water and use it EVERYTIME, you have to go to the bathroom. I even continued to use it long after leaving the hospital, as many areas down there are not easily cleaned when sensitive.
5. Witch hazel pads: I was lucky enough that I didn’t get hemorrhoids but my perineum, the area between the vagina and anus, was still extremely inflamed. The cooling of the pads really helped alleviate itching and tenderness. Every time I went to the bathroom, I changed the maxi and witch hazel pads.
6. Stool softeners: The fear of going number two after pushing out a baby is real. Stool softeners really helped me to literally “smooth the way.” I continued to use them for months, as every time I had to go the pressure was an all too familiar feeling.

A combination of the above, rest, and cuddling with my newborn is really what got me through my recovery. As a mom that is finally feeling semi-back to her old self, I only wish that more people understand how long it really takes “patient mom” to feel better. Recovery is slow but if you have the tools at home to help, it will be a road less painfully traveled.

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?

The hardest moment I endured in my career, that still haunts me from time to time, happened two years ago.  I was in the middle of a three month internship at a NICU in Gothenburg, Sweden.  It was part of a required “clinical” to prove to the Swedish Board of Health that I was a competent nurse worthy of my Swedish Nursing License.

I had worked as a NICU nurse at home in the U.S. so it was familiar territory with the huge exception of having to speak another language.  I was shadowing one of the brightest nurses in the unit.  We had an assignment as well as the delivery phone.  We were near the end of an evening shift when we heard a sound on the other side of the locked door to the NICU.  It was the sound of a woman in labor screaming out.  Only a few minutes later, the delivery phone rang.  They needed us for a repeat cesarean; the indication was failure to progress with a slight indication of fetal distress.  Any nurse who has worked as the NRP nurse knows that this was just a routine cesarean.

We went in the O.R., checked the radiant warmer, suction, bag and mask, and probably started talking about something completely unrelated to the task at hand.  After all, it was maternal indications, the baby was fine.  So we thought.

We saw the baby come out, hit the APGAR timer, and the rest is a one hour blur.  The baby was pale, limp, and completely unresponsive.  We dried and stimulated the baby according to newborn resuscitation guidelines.  Nothing.  We started ventilating the baby, hooked her up to a pulse oximetry probe, and checked a heart rate.  Her heart rate was low and she wasn’t responding to ventilation.  This was about the time I had a brief out of body experience of disbelief.  I took over ventilation so my preceptor could call the attending.  Can you imagine calling a doctor in an emergency and having to speak another language?  All the while, the baby’s father stood directly behind us in quiet observation.  The baby was intubated, ventilated, given round after round of epinephrine, given blood, given every bit of life-saving effort but sadly was pronounced dead after every possible effort was made.

I can still see her little face. Her eyes were wide open.  She had a full head of hair. She was a beautiful, healthy, full term baby that didn’t make it.  This was the hardest to come to terms with.  Premature babies are not ready, not mature, we know sometimes they fight to live and it still it isn’t enough. A full term baby, though, without any defects or complications?  They are supposed to live.

I think all present that evening were shocked.   We had a debriefing in the days that followed and it was discovered that the baby had severe meconium aspiration that occurred in utero.  I must say in retrospect I have never worked with such a calm, collected, organized and respectful group of people during a code.  Each had a job and calmly, but quickly performed it.

So what advice can I offer to others that have suffered, or may in the future suffer, the same trauma?

Time

I still feel my heart skip a beat sometimes when carrying the delivery phone and it starts ringing, but it has gotten better with time.  I take deep breaths as I make my way to the operating room or labor and delivery unit.

Talk

I talked about it to anyone that would listen.  My coworkers were sympathetic, many even offering to follow me to deliveries until I felt more confidant again.  I think it is human to need to know we are not alone and are supported.

Be Kind to Yourself

It’s easy for anyone in a code situation to second guess if they did the right thing.  Doctors do it.  Nurses do it.  At some point we have to know that we did everything we could and it would not have made any difference.

Remember

The reason I say this is that it is better to be prepared for the worst and hope for the best than the latter.

Cry

I remember my preceptor crying immediately after, me attempting to console her as I left, shocked.  It didn’t hit me until long after, over dinner with my family.  I cried in my dinner.  Nurses witness more trauma and stress in a day’s work than others in a lifetime.  We are not superhuman, not robots.

The thing is that following a traumatic event, we have to pick up and assume the role of caregiver to another patient-sometimes all in the same day.  Allow space for reflection at some point.  It is necessary.  We are only human after all.

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.

Resources

Foreman, S. (2014), Developing a Process to Support Perinatal Nurses After a Critical Event. Nursing for Women’s Health, 18: 61–65. doi: 10.1111/1751-486X.12094

Puia, D. M., Lewis, L. and Beck, C. T. (2013), Experiences of Obstetric Nurses Who Are Present for a Perinatal Loss. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 42: 321–331. doi: 10.1111/1552-6909.12040

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.

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.

Living abroad over the last five years has given me a unique perspective of birth culture. I live in the second largest city in Sweden, Gothenburg. It is an international city that welcomes students and workers from all over the world. Gothenburg boasts international universities and large companies such as Volvo and Ericsson. It offers refuge to asylum-seeking immigrants from war-torn regions past and present including most recently Syria. I have met and cared for babies whose parents come from all parts of Europe, Africa, and The Middle East. One of the first questions I have always asked goes something like, “where are you from, what is your baby’s name, and what is something unique to your culture around the birth of your baby?” The answers are interesting and varied.

Join me on my journey of birth traditions around the world as I compare birth models and customs. Bear in mind is that most of the highlighted countries use a midwife model of care during pregnancy and birth. We will end our tour in the U.S. where we find that what may be the norm for us, may not be the norm everywhere else in the world.

Iran

Toktam, an engineer at Volvo, in Gothenburg, comes from Mashad, Iran. She recently gave birth to a baby girl, Hannah. She gave birth naturally and is the first in her generation of women to do so. Most women give birth by cesarean in Iran, but Toktam delivered her baby in Sweden where cesareans are reserved for emergencies and when medically indicated. When I asked her about birth traditions in Iran, she began talking about a shower. I immediately pictured the American baby shower with a group of women playing games and eating the latest Pinterest-inspired edibles. I was way off. A shower in Iran traditionally happens around 10 days after the baby is born or when the umbilical cord has fallen off. The mother’s sister, mother or aunt showers the mother. She is then massaged with special oils, given a facial, and painted with henna. It is reward for all her hard work and the pain she had to endure in labor. After the mom is showered, baby is bathed. Following the shower, friends and family are invited for a special lunch, called Valimeh (traditionally lamb). Guests bring gifts such as clothes and blankets while close relatives often bring something made of gold.

Australia

Rebecca is a nurse from Australia who has two little ones. Her first was delivered by emergency cesarean and the second by VBAC (vaginal birth after caesarean). Yay for VBAC options! Rebecca shared that in Australia it is common for family and friends to fill the new parents’ freezer with pre-made meals such as soups, casseroles, and lasagna. It gives the new sleep-deprived parents the precious time needed to rest between feedings and allows for more bonding time. She also shared a tradition new fathers share with their friends after the baby arrives. “Wetting the baby’s head,” means having a drink in honor of the new member of the family. It is a common tradition in England as well.

Italy

Amina, a postdoctoral researcher, comes from Parma, Italy. Yes, Parma where they make the most delicious cheese on the planet! She delivered her baby girl naturally. Amina shared the tradition known as “camicino della fortuna” in Italy. It is a jacket for the baby given to the mother to be after her third month of pregnancy. It is made of either silk or cotton and most commonly is white. It is worn right after birth as it is thought to bring good luck. It is usually passed on by a friend of family member whose baby wore it. Once worn, it is put away unwashed until it is time to pass it on to the next lucky mom.

Spain

One more stop in Southern Europe. We meet Astrid from Spain, mother of Sebastian. Astrid is a researcher at Ericsson, Sweden. She delivered Sebastian naturally. In Spain, it is traditional to pierce a newborn baby girl’s ears soon after birth, thus distinguishing that she is, in fact, a girl. It is very common for random strangers to approach new moms and babies in the streets to exclaim over the sweet little baby. It shouldn’t come as a surprise that these complete strangers will move in and give your baby a little peck.

Germany

Emma, a consultant, delivered her baby boy, Finn, naturally. She shared a common birth tradition after the baby arrives called Babypinkeln, which literally translates to baby pee, but is actually a party to welcome the baby. Historically, the naked baby was passed around and it was considered eternal luck to be the person that the baby peed on. It eventually became a party that occurred while mom and baby were still in the hospital to allow the mother to recover after birth. The father would get together with friends, family, and neighbors to eat, drink, and celebrate the new baby. Sometimes even cigars were passed around. These days, the party is usually planned when the mom and baby come home to join in the celebration.

Sweden

We move onward to Northern Europe to Sweden. Saga, a doula, preschool teacher, and artist, was part of a reemerging birth model in Sweden and the world for that matter, when she gave birth to both her children at home. While most Swedes give birth in the hospital with assistance of a midwife, a growing number opt to birth at home. Saga shared that it is frowned upon to bring flowers received in the hospital home after a baby is born because it is thought to be bad luck. A tradition I find most interesting and have witnessed in the years since moving to Sweden is the culture of leaving babies outside to nap. Even in the dead of winter, as far north as the Arctic Circle here in Sweden, and in minus degree temperatures, babies are bundled (Swedes know how to bundle) and their stroller is pushed outside for a nap. It is not unusual on any given day to be strolling downtown and see a line of strollers with sleeping babies outside a cafe while their moms have lunch or coffee (fika) together inside. It is thought the fresh air keeps the babies healthy and it seems to work.

U.S.

We end our tour in the U.S., my home country. Mandy (massage therapist and mother of two) recently gave birth to her baby girl, Mollie via repeat cesarean. Two traditions come to mind when it comes to having a baby in the U.S. including preparing a nursery (the baby’s room) and having a baby shower. American baby shower culture gained popularity towards the end of World War II. Women are “showered” with gifts and essentials needed in preparation for their baby. The host is usually a sister or best friend and the shower traditionally invites women only though more and more women are opting for a coed shower.

As we sum up our tour of birth models and culture, we can see that traditions vary widely. It is fascinating to hear about and share these women’s stories and learn a little about their country’s birth customs. Thank you to all who shared their special ways of celebrating mothers and babies.!! Merci! Cheers! Grazie! Gracias! Danke! Tack så mycket! Thank you!

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

“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.

As a young first time mom I was lying in a military hospital room staring at a pepto bismal pink wall and a broken television.  I was waiting for what I was pretty sure was The Best Baby Ever to be Born after The Most Painful Delivery Any Human had Ever Withstood to come back from the nursery, where a tech had taken him for his 2am vitals.  The door finally creaked open, and the young tech pushed my sweet baby back to me.  He began to leave, and then turned back.  He looked at the bassinet.  “He really is a cute little dude,” he said before closing the door.

Nine years later I can’t quite remember the exquisite pain of unmedicated childbirth or the sound of that baby’s perfect first cry...but I remember the tech—An Expert in Newborns, mind you–telling me that my baby was cute.  It affirmed every suspicion I had that my baby was the best baby ever.  And in those days of rollercoaster hormones and constant feedings and sleep deprivation, I held that gem of praise and encouragement tight.  It’s been nine years and I haven’t dropped it.

My story is one of so very many.

Jenn Osario never thinks of breastmilk without thinking of the nurse whose words encouraged her through the long days of pumping for her twins in the NICU. “When your milk comes in and you refrigerate it, you’ll see the cream settle at the top,” the nurse told Jenn.

I was totally ready to give up on pumping and I remember opening the fridge to bring what milk I had pumped that night to the NICU for the girls and there it was, the cream on the top.  It’s silly, but it really helped encourage me to keep pumping.

Allison Morgan secretly wanted an unmedicated birth, but when she arrived at the hospital she wasn’t sure she could handle the pain if the contractions got worse.

The nurse was very calming and said “You seem to be doing great and you really aren’t feeling any pain, why don’t you just wait and I will check in on you.”  She told me if I felt like pushing or my water broke to call her.  I was like, “Yeah, okay… that isn’t going to happen.”  Two minutes later my water broke and I was desperate to push.  She rushed in and checked me and I was 9.5 cm. I was totally freaking out (exactly what I was trying to avoid) and she was very good with helping me breathe and wait the few minutes for the doctor to arrive and fully dilate. Two rounds of contractions and two pushes and Dallon was born.  

I was so grateful that she was in tune with what was needed rather than just going with whatever I wanted to make her job easy.  I attribute that entire birth experience to her and every time I talk or think about his birth, she is in the forefront of my mind and I say a little thank you to her each and every time.

After a long labor Melissa Scholten-Gutierrez gave birth to a baby with low blood sugar who was more interested in sleeping than eating.  The doctor wanted to give the newborn formula, but Melissa wanted to establish breastfeeding.  The doctor threatened a NICU admission and IV feedings.  Melissa’s nurse proposed a compromise between physician and patient—allow the baby to breastfeed first and then top that off with a formula feeding.

She told me that she would try to help me find a way to do it that would really foster our breastfeeding relationship.  She spent a lot of time with us over my son’s next few feedings helping us find a way to get him to wake up enough to nurse, and then a way to get him to take the formula. At shift change, she made sure that we had another nurse that would be supportive.

Ultimately, this nurse helped me make it through a very stressful first three days, and allowed me to have confidence in my ability to breastfeed. (Of note, my son was a great nursling and still loves it at 16 months. And, I wound up having an oversupply and was able to donate to four other babies!)

Earlier this summer my sister-in-law, pediatrician Dr. Heather Henne, delivered two of the most perfect baby girls ever to be born. (I might be a tiny bit biased.  Except that they really are.)  Early in the day Heather confessed to her labor nurse at the University of Washington Medical Center that she was nervous about pushing.  The nurse had recently given birth, and shared her own experience with what effective pushing felt like.

Listening to her story made it possible for me to visualize my own experience and gave me so much confidence.  In fact, when the obstetrician asked if I wanted to try a couple of practice pushes I agreed, but felt like it wasn’t even necessary.  I felt like I’d already worked through it with the nurse by hearing her experience.  It was incredibly generous of her to share her own personal story instead of just saying “some patients find that this works” or “many patients feel this way”—making it personal made it real to me.

Heather’s positive experiences continued into the postpartum unit where her nurse’s proactive approach made her more comfortable and confident in her first days as a new mom.

My nurse knew what I needed before I needed it.  And I don’t just mean the Q6 Motrin, but things that I wasn’t even thinking about showering. She asked me if I wanted to take a shower and it hadn’t occurred to me to take one so soon after delivery, but it was amazing.  It was the best shower of my life.  It made me feel so much better.  It was incredible to have someone there who was not only with you, but two steps ahead of you.  She knew what I needed before I knew what I needed, and she was so right about it all.  I had been nursing the girls individually, but she suggested and helped me to do a tandem feed.  Never in my imagination did I think I would be tandem nursing on day one in the hospital.  That suggestion meant that when I went home I felt so much more successful and confident because I had tried tandem feeding in the hospital and wasn’t just doing it on my own.”

So as I walk into work every night, I do so with a smile.  I’ll never know what it is that sticks with a new mom, but each shift is an opportunity to pass on a kindness that will glow bright through many sleepless nights.

While pregnant with her first child and serving in the Air Force as an aircraft maintenance officer, Traci dreamed of returning to school and eventually becoming a Certified Nurse Midwife. A decade later, Traci is finally in nursing school and is delighted to be working as a CNA at the Birth Center of Penrose St Francis Hospital in Colorado Springs.