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.

“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 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.

“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.

The use of nitrous oxide as a labor analgesic has taken hold in the US in the past three years. It has been used widely in Europe for decades, with favorable results, along with comes educational information but all the perpetuation of myths.

10. Using nitrous oxide in labor is “just like” when you use it at the dental office. It’s not. In dental offices, the concentration of nitrous oxide to oxygen is variable, so the dentist can increase or decrease the concentration based on the patient’s needs. Dentists may use concentrations of nitrous oxide of up to 70%. The dentist also places a small mask over the patient’s nose, through which a continuous stream of nitrous oxide is delivered.

During labor nitrous oxide is only used at concentrations of 50% nitrous oxide to oxygen – no higher. And the stream of nitrous oxide is intermittently administered by the woman herself using either a mouthpiece or mask with a demand valve. The demand valve opens only when the woman inhales (breathes in) – which is when the gas is released. When the woman exhales (breathes out), the valve closes and the gas stream is stopped.

9. You will be confined to bed while using nitrous oxide. You will still be able to move around while using nitrous oxide during labor. About 10% of nitrous users may experience some dizziness, so your care providers will want to see you stand or move about without difficulty before they let you up on your own, but many women use nitrous oxide while standing, squatting, sitting in a rocking chair, or on a birth ball.

8. Continuous fetal monitoring will be required with nitrous oxide use. Whether you have continuous or intermittent fetal monitoring should be dictated by your obstetrical status, not because you are using nitrous oxide. In other words, if you are a candidate for intermittent monitoring, that does not have to change to continuous monitoring just because you begin using nitrous oxide.

7. If you choose to use nitrous oxide, you cannot use any other pain medications. A fair number of women who start out using nitrous go on to have an epidural placed at some later point in their labor. Using nitrous oxide earlier on allows you to maintain your mobility and stay upright, allowing the baby to move down well in your pelvis before being confined to bed with epidural anesthesia.

6. Nitrous oxide will stall your labor, or slow contractions. There has not been any research showing that nitrous slows down labor or causes contractions to be less strong or happen less often.

5. Nitrous oxide will harm the baby. Nitrous oxide is metabolized (processed) in your lung tissue, but because some of the gas passes into your blood stream, some can also pass through the placenta and go to your baby. However, studies have not shown adverse effects on babies of mothers who have used nitrous oxide in labor.

4. There is a point in labor when it is too late to use nitrous oxide. Actually, some women don’t begin using nitrous oxide until they are in the pushing stage. Other women don’t use it at all during labor, but find it very helpful if they need repair of any tears in their birth canal.

3. My family members can assist me with holding the nitrous oxide mask or mouthpiece if I get tired of holding it. As well-meaning as family members are, this is one area where they can’t help. A safety precaution for nitrous oxide use is that the laboring woman holds her own mask or mouthpiece. When she has had sufficient nitrous oxide, she won’t be able to bring her hand holding the device to her face. Allowing someone else to hold the mask/mouthpiece overrides this safety feature of nitrous oxide.

2. Nitrous oxide is offered at many hospitals and birth centers. Until 2011, there was really only one hospital in the US offering this option. Since that time, use of nitrous oxide has dramatically increased and there are currently over 100 hospitals and 50 birth centers offering nitrous oxide. Though it has come a long way, there is a long way to go to ensure that every woman who desires to use nitrous oxide in childbirth, has the opportunity.

1. Nitrous oxide makes you laugh (hence the nickname “laughing gas”). Despite the nickname, inhaling nitrous oxide doesn’t leave women laughing like hyenas! Because nitrous oxide decreases anxiety, it puts women more at ease and they may be more talkative and relaxed… but don’t count on side splitting laughter!

Michelle Collins is currently Professor of Nursing and Director of the Nurse-Midwifery education program at Vanderbilt University School of Nursing. In addition to the teaching and administrative aspects of her job, she maintains an active clinical practice as part of the Vanderbilt School of Nursing faculty nurse-midwifery practice.  Currently she is a blogger for Nashville Public Television for the popular series Call the Midwife.

Resource on Nitrous Oxide For Nurses

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

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

When I think back to the birth of my second child earlier this year, tears almost instantly begin to fill my eyes.

Unlike the birth of my first child three years prior, this isn’t because I am overjoyed by thoughts of holding my baby against my chest for the first time while I stare in awe at the life my husband and I created, a life that I grew in my own body and delivered into the world after many, many hours of hard labor. Instead my eyes fill with tears because I think of my labor and delivery nurse and how I believe her actions on that day affected the trajectory of my life, my son’s life, and the future of our family.

I am not a nurse, I don’t even work in the medical industry, but for the past nine years come June my work has brought me to the annual AWHONN convention, where I support the online system used by those submitting proposals and assist presenters’ presentations. Through this work I have read hundreds of abstracts and watched dozens of presentations on standard topics such as home births and skin to skin care for newborns, to more memorable subject matters like how to care for a vaginal piercing during a delivery.

My work with AWHONN does by no means make me an expert in the field of labor and delivery, but on January 30th of this year, I had gained enough knowledge from working with AWHONN to know what the possible outcomes could be when something suddenly went wrong during the birth of my son.

After 13 hours of laboring in the hospital, the time had finally come to begin pushing. Not yet knowing the gender of my child, I felt extra encouragement to push as hard so I could finally meet my baby. It took only 21 minutes of pushing to hear the words, “only one more push, Jessica, and you will be able to hold your baby!”, however, that was quickly followed by a sudden shout to stop pushing.

Stop pushing, but why? I looked down and between my legs I could see the head of my baby, turned toward my inner right thigh; he was silent and lifeless. Right away I knew that it was shoulder dystocia, and like any mother, my mind went to straight to thinking about the worst case scenarios. Was my baby getting oxygen, would he have brain damage? Is his shoulder going to be broken? I don’t care if he has broken bones, bones heal, just make sure he can breathe! Just last June at AWHONN a presenter and I had a conversation about shoulder dystocia, what was it that she said the other outcomes could be?

The next few minutes were all a blur me screaming at the doctor to help my baby, my husband kissing my head and doing the best he could to stay strong for the two of us, the student midwife attending her first delivery still holding onto my left leg waiting for someone to give her instructions and then there was a voice that I will never forget. Then the firm voice of my labor and delivery nurse as she turned to the doctor and said, “Doctor. Would you like me to call for another set of hands?” I got the sense that she wasn’t asking for permission, but rather she was politely informing the doctor of her intent to ask for assistance because she knew it was needed.

The doctor nodded as my nurse instantly took one side step closer to my head, she looked me straight in the eyes and smiled as she pushed the call button for the nurse’s station and requested another attending physician join us in my delivery room. A moment later the door swung open and the already crowded room began to fill with more people. In an instant, my nurse and another doctor were in the delivery bed with me, pushing on my low abdomen , doing all they could to change the position of my baby.

In this chaotic scene I once again heard that firm voice calmly say, “Doctor. Would you like me to call in a NICU team?”. The doctor nodded yes and soon a NICU team stormed into the room to wait for my son to be born to take over his care.

At the end of this ordeal, I was blessed with a perfectly healthy child; not one bruise on his body, no torn muscles, no broken bones, and no lack of oxygen to his brain. He did stay in the NICU for two days to be supervised for a potential infection, but otherwise all 10lbs, 5ozs of him was unscathed during his traumatic birth .

It may have been my doctor’s hands that brought my son into the world, but it was my nurse’s voice that I credit for my son’s health and our future without the need for further medical treatment.

Would my son have been fine if he were stuck during the birthing process for another couple of minutes? I don’t know. Fortunately because my labor and delivery nurse spoke up during a time of crisis, I don’t have to find out.

Jessica L. Grenon is the Director of Continuing Education Services at The Conference Exchange, where she has worked with AWHONN since 2007. She, her husband, and their two young children enjoy traveling and spending time with their extended family, especially with her twelve nieces and nephews.

Resources on Shoulder Dystocia

Definition: Shoulder Dystocia is the impaction of the fetal anterior or posterior shoulder behind the material pubic symphysis resulting in delay in a cephalic vaginal delivery. This creates a high-risk intrapartum complication affecting both mother and baby.

For Parents: Health providers can’t always predict or prevent shoulder dystocia, but there are some risk factors you can learn about.

For Nurses: AWHONN has a Shoulder Dystocia online product to help prepare clinicians for this level of critical care event.

My husband and I always wanted a family. The summer before I turned 29, we decided to start trying. Little did we know there would be a roller coaster of a journey ahead.

I got my first positive pregnancy test in September. I knew my life was about to change. I quit smoking, which was a huge deal for me. My husband and I were thrilled. At my first ultrasound, there was silence. The verdict was devastating: I was miscarrying due to a blighted ovum.

My doctor advised me to wait two full cycles before trying to conceive again. I didn’t track anything; I just guessed at when I was going to be ovulating. In February, I got my second positive test. Though nervous, I had a better feeling, thinking the odds were low I would have a second miscarriage.

We picked out names, I looked at birth plans, and at 8 weeks I started building a baby registry. We were cautious to share the news, waiting to tell even our parents. On March 20, one week after announcing our new addition, I went to the restroom and noticed blood. I immediately fell on the floor crying. In that split second, my dreams of our family were crushed.

When they did the ultrasound in the emergency room, they wouldn’t let me see the screen, saying only that they couldn’t detect a heartbeat. I felt like I died inside. My doctor ordered a D&C (dilation and curettage) and told us to wait two cycles.

This time, I took ovulation and trying to conceive (TTC) seriously. I continued taking prenatal vitamins, educated myself, and tracked my ovulation with digital ovulation predictor. The moment I saw the little smiley face letting me know I was ovulating, I told my husband it was go-time! The two-week waiting period after that felt even longer than the two cycles we had to wait to start trying again.

On July 11, I got my big fat positive! I called my husband, and then I called my mom, who was so supportive. I had a form of PTSD after dealing with two miscarriages, and I didn’t want to tell anyone I was pregnant, so as to avoid the embarrassment.

At 6 weeks, I had my first ultrasound. When we saw that tiny little heartbeat, I cried. My doctor put me on progesterone. We had our next ultrasound at 11 weeks, and there was our baby, active and wiggling around. It was amazing! I wasn’t used to seeing my ultrasounds. Every time I saw my baby felt like a miracle. We learned my due date was March 20—the date of my second miscarriage. Everything was coming full circle. Even more exciting, it was a boy!

As badly as I wanted to meet my son, he was even more anxious: At 34 weeks and 4 days, Charles David Poe made his appearance. His birthday is February 9, the same date I had my second positive pregnancy test the year before. Tiny but strong, Charlie came into our lives so fast and has made it indescribably beautiful. It was beyond worth it to have gone through all the turmoil of TTC to get to this amazing part of my life.

Aimee Poe is an experience specialist at Verizon. She loves playing video games, watching movies, hanging out with her family, and flexing her creative muscle with various projects.

1. Newborn screening saves lives.  In the first few days after birth, clinicians screen newborns for over 30 rare but serious diseases, most of which are easy to treat with diet changes or other treatment.  This screening, along with early intervention, can save babies from death or disability. Your baby’s pediatrician works with the state health department to ensure that this screening is done.  Many professional organizations including the Association of Women’s Health, Obstetric and Neonatal Nurses support newborn screening.

2. Newborn screening is simple to do.  There are three things we generally do in the hospital before your baby goes home as part of the newborn screening – a hearing test, congenital heart defect screening (pulse oximetry), and blood sample collection on a special blood spot card. Your baby will probably sleep through the hearing test and the pulse oximetry test; however they may not like the tiny prick on their heel for the blood sample. Ask if you can hold your baby during the blood sample collection so he’s less likely to cry. To learn more about how these tests are done you can watch this video from the March of Dimes.

3. Newborn screening has to get done on time.  We need to get these screening tests done within the first two days of life, and then the results need to be reported to your pediatrician a few days after.  Please give us a working phone number and address in case we need to contact you about the results of these tests after you’ve left the hospital. In some cases, delays can be deadly and hospitals are working hard to speed results to you.

4. Remain calm.  Most screens come back negative, meaning your baby doesn’t have the condition we’re screening for, but a few come back positive and that means that we need to do more testing.  Even if the initial screening test is positive, further follow-up testing may all be negative, or normal.   And if your baby does have the condition, there are treatments.  Listen to this mom’s inspiring story about her son who was saved by newborn screening (“Growing up with Galactosemia”)

5. Everybody’s doing it!  Newborn Screening is part of routine care for all newborns across the U.S. And we’ve been doing it since the 1960’s! It’s also part of routine care in many other countries. Newborn screening is expanding all the time. To check what screening is currently done in your state check the National Newborn Screening State report .  Surveys suggest that most parents are in favor of even more newborn screening.

We want your baby to get off to a good start!  Let’s all work together to make sure your baby’s first tests (newborn screening) get done and that the results get reported to you quickly. Just ask your prenatal provider, pediatrician or nurse if you have any questions – we’re all here to help you make the best healthcare decisions for your baby.

Emily Drake is currently an Associate Professor at the University of Virginia. She focuses her teaching, practice, and research on issues of Maternal-Child Health. She currently serves as a member of the Education and Training subcommittee for the U.S. Department of Health and Human Services’ Advisory Committee on Heritable Disorders in Newborns and Children (ACHDNC).

She is the author of over 20 book chapters and journal publications and has held leadership positions in the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), Sigma Theta Tau Nursing Honor Society (STTI), and the March of Dimes.

More Information

Baby’s First Test
http://www.babysfirsttest.org

Save Babies Through Screening Foundation
http://www.savebabies.org

Parents guide to Newborn Screening
http://mchb.hrsa.gov/pregnancyandbeyond/newbornscreening/

Wikipedia on Newborn Screening
https://en.m.wikipedia.org/wiki/Newborn_screening

Newborn Screening Technical assistance and Evaluation (NewSTEPs)
https://newsteps.org/

Photo Credit: ChameleonsEye / Shutterstock.com

What you can easily forget in all the excitement is that you take care of yourself too!

To help you focus on YOU, we recently asked our nurses and midwives what postpartum recovery advice they give their patients.

We received advice for you from over 100 nurses!

Take note of the clear themes – limit visitors to take that time to bond with your new baby, accept help from others, do skin-to-skin and sleep when the baby sleeps!

Good luck in all your new parenting adventures!

Top 20 tips from our nurses and midwives:

1. Absolutely choose a hospital for the care you will receive and not the new beautiful building. You’re much more likely to receive a positive birth experience and the education you receive from your postpartum nurses will make all the difference in the world.
2. As a former postpartum nurse, I noticed how often new mothers put their needs last. It seems often families look at postpartum time as party time. I have seen c-section moms sleeping in the same room as 15-20 family members talking loudly and passing baby around for hours. My best advice is for new mothers to have 1-2 designated family helpers to be there to help care for baby while she gets much needed naps throughout those exhausting first days. Baby’s hunger cues are often missed when there are too many visitors for long stretches of time. It is difficult for new mothers to set limits.
3. Don’t be afraid to ask people to leave. I have seen so many new mothers that are worn out from feeling like they cannot turn people away. Turn off your phone too. I wish I did for the first couple of days.
4. Breastfeeding is an acquired skill for you and baby, be prepared to be patient and try, try again. It is a wonderful thing for you both, but needs to be learned. Do not suffer in silence, please contact your OB/midwife for lactation nurse help/referral if you are having difficulty with latching and/or very sore nipples.
5. Sleep when baby sleeps.

6. If you had a cesarean, take a pillow for the car ride home to support your incision for the bumps in the road.
7. Use the Dermoplast (benzocaine topical) spray before having a bowel movement…it’ll make the process a whole lot more comfortable and a lot less scary.
8. If someone offers to come over so you can shower, take them up on it.  For c-section moms remember not only did you have a baby, but you had major surgery.
9. Trust yourself and your instincts. Pick and choose the advice, tips, expert advice etc. that works for you. And know that if you’re worried about being a good mom, you already are.
10. Padsicle! Pad, ice pack, tucks, then a spray of Dermoplast.
11. Know your body. When you get home, use a hand held mirror to look at your perineum or you cesarean section incision. This way, if you experience problems, you will have a baseline to know if something is different, for example: increased swelling, redness, tenderness, or drainage from incision. It is helpful in knowing when to contact your physician with these issues.
12. Limit your visitors. You will not get this time back. Use it to bond as a family, seek help with breastfeeding. Skin to skin is the best bonding tool! We want to help you succeed with breastfeeding. You can press your call light for every feeding if you need to. Your baby needs your love and protection. You are your baby’s primary advocate. Not all mothers’ choose to or are able to breastfeed. How you feed your baby is your decision and your nurse will support you. Ask visitors to wait until you’ve been home for at least a couple weeks. Settle in, recover. Don’t be afraid to ask for help. If someone wants to visit, ask them to leave their little ones at home.
13. Sleep when the baby sleeps. Keep drinking water to flush out the excess fluids and keep hydrated. Accept help from anyone willing to cook a meal, run errands or do housework so you can rest and spend more time enjoying your new baby. Get outside for a walk. Fresh air and activity help to restore and rejuvenate sleep deprived minds and bodies as well as improve the blues!
14. While planning your new routine, ask someone to watch the baby for an hour of each day for you to spend as you please.
15. Good nutrition is key. Have a healthy snack each time you feed baby if you don’t have an appetite. Try to get a good four hour blocks of sleep several times a week. Ask support people to change, burp, comfort baby and only bring baby to you for breast feeding to extend your sleep when tired. Have a good support system and don’t be afraid to ask them for help. Soak up the sun when you can. Have an enjoyable activity to look forward to each week. Try to get out of the house, but if you can’t do something you enjoy at home or pamper yourself. Relax and enjoy your baby. Use what works for you and don’t try to follow everyone else’s advice.
16. Accept offers of help and assistance with meals, cleaning etc. I tell father’s to give moms one uninterrupted hour to herself each day. She can bathe, sleep, read, or anything that she wants for that hour. Daddy needs time to get to know baby too!
17. When you get home, set visiting hours and have each visitor bring groceries or food (they’ll be thrilled to get what you need). And stay in your pajamas. Most people will be less likely to overstay their welcome.
18. Once “settled” in with the baby reach out to a Mother’s group ( stroller club, baby sitting co-op, Mommy and me Gym or Yoga class), to get out of the house and receive and provide support to other new Mom’s.
19. Give yourself a break. Sit at the bottom of the shower and cry if you need to every now and then, parenting is hard work. Learning to breastfeed is hard work and so is incorporating another member into your family. Sleep deprivation and shifting hormones will, in fact, make you feel crazy at times but it will get better. You will find your new norm. It’s not all cute onesies and hair bows, it’s more like poopy onesies and newborn rashes, and that’s ok.
20. You’re stronger than you think! Don’t worry about what others might think. Enjoy every moment.  Parenthood is a beautiful experience. Allow yourself grace & room to grow.

Do you have advice for new moms as well? If so let us know. We’ll keep rolling out the advice.

For additional resources for mom visit our Healthy Mom&Baby website!