Have you often thought when you find out a co-worker is working on a graduate degree, “That’s not for me — I don’t have the time or the money and besides I enjoy what I am doing now”? I did not seek a graduate degree until my children were in high school and after beginning; I wish I had started on that journey earlier! Let’s address some of the myths.

• I do not have time in my life right now.
  I delayed a pursuing graduate degree because I thought I would be on campus as much as undergraduate classes require. Many graduate nursing programs offer online and on campus options or a combination. I often advise nurses, just stick your toe in the water and try one class. You can fit the assignments in your life no matter what shift you are currently working. Just trying one class a semester is “doable”

• I am not sure I can afford the tuition
  There are many options-private and public colleges. There are scholarships and some employers offer tuition reimbursement. It is an employee benefit-check it out!

• I have not been in school in years. I am not sure I am smart enough for graduate school.
  I hear this one a lot. You are smart-you are a RN and passed boards! Hands down for most nurses, our first program is the most difficult whether it was a BSN, diploma or AD program. You will be pleasantly surprised that a graduate degree builds on your existing knowledge and you will be encouraged to focus on your specialty area for assignments. You will often be able to combine an assignment with a project you wanted to do at work anyway. Plus for all of us “seasoned” nurses, when we have to use an example from practice, we have years of case studies and examples to use in assignments.

• I really enjoy being at the bedside, I don’t want to do anything different right now
  Great! We need advanced degree nurses using their expertise and practicing evidence based practice in every setting. A graduate degree will open doors that you may not even think about right now. There may be an amazing opportunity that will come your way that requires an advanced degree.

• I am not sure I can keep up with the technology now-discussion boards and on line classes.
  I was not confident either, however if you have middle or high school age children or neighbors, they will enjoy helping you. You will quickly adjust just as you have to EMRs.

I share all these myths because this is what I heard as I was working on my MSN and then a PhD. I began my MSN part time at the age of 50 when I was working about 24 hours a week and had all three children still at home. I did not intend to pursue a doctorate degree, however I became fascinated at the opportunity to influence care through research.

I started on my PhD one year after completing my MSN. I worked full-time during my PhD journey and I completed it within 4 ½ years. To add to the craziness, all three of my children got married during this time. It has now been a year since I graduated and I am an assistant professor at a university. I am able to continue to work occasionally in a clinical setting, conduct research, and teach the next generation of maternal child nurses.  I never would have dreamed that this would be my journey when I began taking that first graduate course. Therefore, if you are considering giving it a try, jump in, the water really is great. There are many others ready to encourage you along the way.

Janet Tucker is an assistant professor at the University of Memphis Loewenberg College of Nursing, where she is currently teaching maternal child nursing. She completed her MSN in 2010 and PhD in 2017. Her research interests are expectant women experiencing a fetal anomaly diagnosis.

AWHONN Resources

With generous support from individual and corporate donors, AWHONN’s Every Woman, Every Baby charitable giving program provides the opportunities to AWHONN members to apply for research grants and project grants who work in continue to improve the health of mothers, babies and their families. Additionally, AWHONN’s commitment to support emerging leaders also provides opportunities to apply to academic scholarships and enhance their professional development through attending AWHONN’s Annual Convention and information of education resources. , For more information on AWHONN scholarships and professional development opportunities visit http://www.awhonn.org/page/awards

When a mother is unable to provide enough milk for her own infant’s needs, then donor milk is the next best option. There are basically two business models for human donor milk bank operations; not-for-profit and for-profit. Both models provide safe, processed donor milk for infant consumption. One of the differences lies in the human species-specific properties retained post-processing procedures. The Human Milk Banking Association of North America (HMBANA) is a professional association that supports non profit milk banks by  providing its members with standardized guidelines to screen donors, and process and distribute human milk.⁶ The for-profit milk banks utilize different, but safe, milk processing procedures, yet the end milk product produced by each contains significantly different human bioactive milk immune and metabolic components. HMBANA milk banks utilize holder pasteurization (milk is heated to 62.5°C for 30 minutes then rapidly cooled to 4°C) whereas for-profit milk banks utilize high vat pasteurization (milk is heated to 63°C ≥ 30 minutes), and  sterilization (milk is heated to 121°C for 5 minutes at 15 pounds per square inch). This sterilization process renders significantly less human species concentrations of protein, fat, immune components, and oligosaccharides.⁷ Donor mothers will benefit from knowing  this information to make informed decisions about where to donate their milk.

Another social and commercial pressure is the monetary compensation for donating milk . Donor mothers should know the differences in processing fees between non-profit and for-profit milk banks. A mission of HMBANA milk banks is to contain processing costs so that donor milk can be equitably distributed. One mechanism to contain costs is to not offer monetary compensation for milk donations.  For-profit milk banks offer monetary compensation which is then passed on to the consumer resulting in higher prices for donor milk. Guiding principles to determine whether or not a donor of a biological product can be offered compensation is outlined in an international statement developed by the convention of the Council of Europe   ; only those products created using patents can be distributed for commercial profit.⁸ This guidance protects for-profit milk banking companies. Donor mothers have the right to know how their milk will be processed and sold.

Lastly, for-profit milk banking companies have abundant resources to promote their product using sophisticated, provocative ad campaigns. Donor mothers have the right to receive informed healthcare data regarding the value of donor milk that retains 50-90% of human milk properties post-processing-the milk provided by non-profit human milk banks- which benefits  optimal infant growth and development.

HMBANA mentors those who are developing milk banks in areas where improvement in breastfeeding support is needed. To learn more about how to become a HMBANA- developing milk bank  visit www.hmbana.org . The Mothers’ Milk Bank of Louisiana, a developing milk bank member of HMBANA, would like to express sincere gratitude for the guidance of our mentor bank, the Mothers’ Milk Bank at Austin under the leadership of Kim Updegrove, Executive Director, as well as HMBANA guidance documents. August is National Breastfeeding Month. Let’s join together to honor all donor mothers for their lifesaving donation of miracle milk and pledge to inform and enlighten them of the invaluable impact of their milk donation decisions.

References

1.            American Academy of Pediatrics Committee on Nutrition SoB, Committee on Fetus and Newborn. Donor Human Milk for the High-Risk Infant: Preparation, Safety, and Usage Options in the United States. Pediatrics. 2017;139(1):e20163440.

2.            Medicine AoB. ABM Position on Breastfeeding – Revised 2015. Breastfeeding Medicine. 2015;10(9):407-411.

3.            Agarwal S, Karmaus, W., Davis, S., & Gangur, V. Immune markers in breast milk and fetal and maternal body fluids: A systematic review of perinatal concentrations. Journal of Human Lactation. 2011;27(2):171-186.

4.            UNICEF. #breatfeeding- Breastfeeding A Smart Investment. 2017; https://www.unicef.org/breastfeeding/. Accessed August 5, 2017, 2017.

5.            Labbock ML, Clark, D. & Goldman, A. Breastfeeding: maintaning and irreplaceable immunological resource. Nature Reviews Immunology. 2004;4(7):565-572.

6.            Human Milk Banking Association of North America. Guidelines for the establishment and operation of a donor milk bank. Forth Worth, Texas: Human Milk Banking Association of North America; 2016.

7.            Meredith-Dennis L, Xu, G., Goonatilleke, E., Lebrilla, C., Underwood, M. . Composition and variation of macronutrients, immune proteins, and human milk oligosaccharides in human milk from nonprofit and commercial milk banks. Journal of Human Lactation. 2017.

8.            Council of Europe. Convention for the Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine. Treaty No.164. 1997; http://conventions.coe.int/Treaty/en/Treaties/html/164.htm. Accessed July 27th, 2017.

Shelley Thibeau, PhD, RNC, is the Director of the developing Mothers’ Milk Bank of Louisiana. As a NICU nurse for 38 years, her interest in breastmilk has expanded to exploring breastmilk immunology associated with preterm infant health.

At some point in their life, every person is called upon to lead.

As perinatal nurses, the call to lead may come from many directions. Perhaps you have a friend or loved one who needs to make an important decision about a pregnancy or birth experience and looks to you for advice. You base that advice on current evidence and your experience as a nurse; if we are honest, we acknowledge that our own birth experiences (if we have them) influence the advice given to others. Those who ask our advice look to us as leaders in nursing, even if we consider ourselves (to use a phrase I really dislike) “just a nurse”. At the bedside, we lead by advocating for our patients and families, by mentoring new nurses, and by participating in unit improvement activities.

Some nurses feel more comfortable than others with the notion that all nurses are leaders. Some nurses want to brush up or build upon their leadership skills. Did you know there are options to develop such skills tailored especially for  perinatal nurses?

AWHONN established the Emerging Leader Program (ELP) in 2008 to promote leadership development among AWHONN members. Emerging Leaders participate on AWHONN national committees, are exposed to leadership concepts and are assigned mentors along the way. I have grown as a leader myself by working alongside AWHONN’s Emerging Leaders who enthusiastically represent AWHONN in their workplaces and at the chapter, section and national levels. It is fun to watch AWHONN Emerging Leaders in action while they are in the program and in the years following their completion.  The application process for the ELP opens each September and all AWHONN members with more than one year of membership are eligible to apply. You may be asked by an Emerging Leader  to serve as their mentor.  This opportunity is well worth your time- say yes!

In my last health system role, I had the opportunity to participate in the Maternal Child Health (MCH) Leadership Academy through Sigma Theta Tau, an 18 month leadership development program. In this program, a mentor and mentee apply as a team, called a dyad, and propose a specific evidence-based project, which is presented at the Sigma Theta Tau biennial convention. Our lactation consultant decided to apply as a mentee, proposing a project to improve exclusive breastmilk feeding rates in our region, and asked me to serve as her mentor. With the support of our health system, we applied and were accepted. The MCH Leadership Academy dyads are assigned a Leadership Academy faculty member, based on the subject area of the proposed project. In our case, we worked with Diane Spatz, one of the best-known lactation experts in the United States (and an AWHONN member) who made two trips to our facility in Tennessee, giving our entire team the opportunity to learn from her expertise.

During this 10 month period my own leadership skills grew as I participated as a mentor for the MCH Leadership Academy and learned from expert faculty.

I am happy to report that exclusive breastmilk feeding rates really did increase in our institution, my mentee increased her own leadership skills and I grew along with her!

As perinatal nurses, we are lucky to have two formal programs for leadership development. Please consider learning more about AWHONN’s Emerging Leader Program (apply in Fall, 2016) and Sigma Theta Tau’s Maternal Child Health (MCH) Leadership Academy (accepting applications through Jan 3, 2016!). If you have the chance, be a mentor.

Above all, never forget that we are all leaders!

Cathy Ivory, PhD, RNC-OB
As Immediate Past President, Cathy now chairs AWHONN’s Nominating Committee and also serves on the Development Committee. Her vision for AWHONN’s future includes continuing to grow support for AWHONN’s charitable giving program, Every Woman, Every Baby; building membership and collaborations with other organizations, corporate partners, physicians and midwives; and furthering research.

As a nurse with more than 20 years of obstetrical experience, I’ve had countless opportunities to advocate for patients one-on-one in a clinical setting. Ensuring that women and infants receive the best care possible is my passion.

In an effort to expand my advocacy efforts to a larger scale, I applied for and was selected to win a scholarship offered by AWHONN to attend in the Nurse in Washington Internship (NIWI). I was thrilled when I heard the news! NIWI is a three day conference in Washington, DC that prepares nurses to influence health care through the legislative process. The conference includes meetings with Members of Congress and their staff in which nurses share solutions for preventing maternal deaths, human trafficking, injuries to nurses on the job, and more. The scholarship covered my travel to DC and all of the costs associated with attending NIWI.

Almost 80 nurses from multiple practice areas and all parts of the country attended NIWI. It began with a 1 ½ day conference packed with presentations to prepare nurses as advocates, to understand the legislative process , and have a voice at the table. Participants were then grouped by state to meet with legislators, and charged with having a UNITED NURSING VOICE.

On the last day of NIWI, my Michigan colleagues and I spent hours on Capitol Hill visiting legislators and their staff. We used our conference learnings and crafted succinctly powerful talking-points touching on “The Heart” (a personal story), “The Head” (concrete reasons for support), and “The Health” (impact on society/individuals). As the day progressed, we had meetings with Senators Debbie Stabenow and Gary Peters, Congressman Tim Walberg, meetings with five Legislative Health Aids (two were from Congressman John Conyers office), and we watched a portion of a legislative hearing.

After a day of walking to and from the Senate and House of Representative offices, our FEET were on FIRE, but we were so excited! Nurses are a trusted, powerful force. Legislators and their staff, who make decisions that impact every part of our jobs, rarely have clinical expertise. They need US to tell them what’s happening “on the ground” so they can make the best decisions possible.

During our journey, we also met interesting people/groups on missions to meet legislators to ask for support/funding. Initially, I thought asking millions of dollars to continue funding Nursing Education ($244 million) and Research ($150 million) was an astronomical amount, however I quickly learned that it was not. We met one person who casually mentioned that he was on Capitol Hill to request ONE BILLION DOLLARS in funding! After I picked up my eyes off the floor, I remembered the resounding message from the NIWI presenters which stated, “If you’re not sitting at the dinner table, then you are on the MENU”. There’s a finite number of dollars for legislators to disperse, so nurses must use USE OUR VOICE TO ADVOCATE for funding/support, or risk being left without the resources we need to do our job.

My passion for advocacy grew tremendously during the Nurse In Washington Internship. I will continue to confidently speak to legislators and others when advocating for nursing, women’s health, newborns, and beyond. I will also remember to always wear flat shoes in DC :).

Resources

• Visit AWHONN’s Legsiative Action Center for more advocacy resources that YOU can use.
• Visit AWHONN’s website to see how AWHONN is advocating on your behalf.

Cheryl Larry-Osman, RN, MS, CNM
Cheryl Larry-Osman is a Perinatal Clinical Nurse Specialist at Henry Ford Hospital in Detroit, Michigan. She has 20 years of experience in obstetrics focusing in the clinical areas of Labor and Delivery, Postpartum, High Risk Antepartum, Normal Newborn, and Women’s Health. Cheryl is an advocate for the safe delivery of care for moms and babies & has participated in legislative action at the local, state, and national level.

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.

Did you know most infant sleep-related deaths are considered preventable? This is good news worth sharing! Because most babies are born in a hospital or birthing center, nurses are uniquely positioned to interact with virtually every new parent. This means nurses play a critical role in helping prevent these deaths. We know that parents trust us (we are the most trusted profession!), watch us, and listen to us. We have a responsibility to make sure we give parents safe sleep recommendations along with the evidence behind them. We have a responsibility to problem-solve with parents about accomplishing safe sleep situations, all while simultaneously respecting their right to decide what is best for their family. The bad news is too many babies are still dying. October is SIDS Awareness month and a perfect time for nurses to spread the good news and advocate for our smallest patients!

Just for clarity, infant sleep-related deaths include Sudden Infant Death Syndrome (SIDS), Accidental Suffocation and Strangulation in Bed (ASSB), and an “Unknown” category where typically risk factors are present or the infant was in an unsafe sleep environment but ASSB is not known with certainty.

These sleep-related deaths, once generally labelled SIDS, are now more commonly referred to as Sudden Unexpected Infant Death, or SUID. In 2013 there were 3,434 SUID deaths, almost 10 per day, in the United States.

The topic of safe sleep can be tricky. There are barriers to some of the recommendations, and discussions have the potential to become controversial. Suffice to say, nurses are aware this is not always an easy topic, and some may prefer to skip it entirely. Hopefully knowing how much influence we can have will motivate us to talk to parents about this important safety issue. It could be a matter of life and death, and the majority of parents are grateful for the information.

The issues surrounding safe sleep are being discussed among healthcare experts and suggestions are emerging about how to better connect with parents. One idea is to acknowledge that parents take risks (we all do!) and adopt a more risk-reduction approach instead of a risk-elimination approach. This change might be simply rephrasing our recommendations from using terms like never and always to something like the safer or safest way for your baby to sleep. As an example, some parents, despite hearing the recommendations against these activities, will choose to continue to sleep with their baby or they might decide to continue to smoke. Our responsibility is to educate and then encourage the safest sleep situation possible, while also respecting the parents’ choices. The best comparison may be with breastfeeding: We all know that exclusive breastfeeding for the first 6 months is best, but we also know that some is better than none, and we readily help parents, if it’s what they choose. Similarly, our job is to advise and help parents do the best they can by providing safe sleep recommendations, being willing and open to discuss their unique situation, and problem-solve with them; all without being dogmatic or rigid. Our job is to educate and encourage, not coerce.

Parents who choose to sleep with their baby might be provided further information on the situations that are especially dangerous (such as with a baby less than 3 months, or with an intoxicated parent), or we can suggest other sleep options such as a co-sleeper that connects to the parent’s bed or setting a timer for moms concerned about falling asleep while breastfeeding. A parent who smokes might be open to smoking outside the home and wearing smoke-free clothes around the baby. Are these the safest ways and environments to promote safe sleep? No, but they are safer and may be what is needed to prevent a death.

ADDITIONAL INFORMATION For nurses

Common Questions/Concerns from Parents and Suggested Responses from Nurses (.pdf)
Tips for Nurses Teaching Safe Sleep in the Hospital Setting (.pdf)

Safe Sleep Strategies (.pdf)

References/Resources

Centers for Disease Control and Prevention . (2015). Sudden unexpected infant death. Retrieved August 20, 2015, from http://www.cdc.gov/sids/aboutsuidandsids.

Hitchcock, S. (2012). Endorsing safe infant sleep: a call to action. Nursing for Women’s Health, 16(5) 386-396.

Horne, R. S., Hauck, F. R., & Moon, R. Y. (2015). Sudden infant death syndrome and advice for safe sleeping. BMJ, 350:h1989. doi.org/10.1136/bmj.h1989

Moon, R. Y., & Fu, L. (2012). Sudden infant death syndrome: An update. Pediatrics in Review, 33, 314-320. doi: 10.1542/pir.33-7-314

Patton, C., Stiltner, D., Wright, K. B., & Kautz, D. D. (2015). Do nurses provide a safe sleep environment for infants in the hospital setting? An integrative review. Advances in Neonatal Care, 15, 8-22.

Shaefer, S. J. (2012). Review finds that bed sharing increases risk of sudden infant death syndrome. Evidence Based Nursing, 15, 115-116. doi.org/10.1136/ebnurs-2012-100750

Volpe, L. E., & Ball, H. L. (2015). Infant sleep-related deaths: Why do parents take risks? Arch Dis Child, 100, 603-604. doi.org/10.1136/archdischild-2014-307745

Food, water, shelter—these are all basic needs. For babies, there’s another item that tops that list: diapers. This year, Healthy Mom&Baby is partnering with the NDBN to raise awareness and to share the names, voices and stories of the families in every community who are struggling to provide for their youngest children.

As we spoke with moms affected by diaper need each one shared a similar truth: This small gesture—donating diapers, or dollars for diapers to families in need in your community—may not seem like much,but it can mean the world when you’re struggling to take care of your family.

Making Difficult CHOICES

“I think there are a lot of misconceptions about people who get help from the diaper bank. We work very hard to make ends meet… I go without a lot of things to make sure my kids are taken care of.” Lacey Cotton, mom to Hailey, Jarrod & Aurin

Lacey gave birth to her youngest son 6 weeks earlier than planned. “We knew that we would have certain expenses with the baby, but then having to bump all those payments up… we weren’t quite prepared,” she says. With her baby now 10 months old, Lacey is working long hours to support him and her 6-year-old son while her boyfriend takes care of the kids at home. “I use my car for work, and there are some days when it feels like a toss-up: Do I spend $30 on gas or $30 on diapers?”

Lacey first came in contact with her local diaper bank through her church, which frequently donates diapers. “It’s so important to give back to your community, to pull together and support one another—especially where women and children are concerned,” she says. “You never know when something is going to come along, and a family might need just a little more help. Getting support from the diaper bank has made a huge difference for my family.”

Lacey’s young son also has sensitive skin, which means she has to be careful about which diapers she uses and how frequently she changes him. “Knowing that I have enough diapers, and that I won’t have to leave him in a dirty one too long, risking him getting a rash, is such a relief,” she says. “I just want my kids to be happy and healthy.”

Finding Hope and Kindness in the Community

“Knowing I have diapers for my children means one less thing to worry about. It takes some of the stress away, and I know that there’s hope out there.” Venessa Baez, mom to John-Carlos, Raul & Natalie

When Venessa Baez’s second son was a baby, she knew something wasn’t quite right with his eating. “He was always spitting food up, and he couldn’t really consume it properly,” she says. Diagnosed withpancreatic divisum, Venessa’s son had to be a on a feeding tube to help with his chronic pancreatitis.

Already living paycheck to paycheck, Venessa was dismayed to learn that her Medicaid benefits would not be enough to help her shoulder the weight of the mounting medical costs.

Venessa found support from an Early Head Start Home Base Program. “A nurse would visit me every single week, bringing me diapers,” she explains. “I also received diapers from an organization called Welcome Baby, and I saw these stickers that said ‘Diaper Bank of North Carolina.’ These groups, with people just giving out of the goodness of their hearts… they’re truly godsends.”

There were definitely moments when times got tough, Venessa recalls. “I would be exhausted, and I didn’t want to do the home visit, but I stuck with it,” she says. “And the Early Head Start Program changed my life: They believed in me and helped me get a job with Durham Connects, where I’m able to help moms and give back to the community that was there for me when I needed it. It’s a ripple effect.”

Doing Whatever It Takes to Be a Good Parent

“I have a job to do as a parent, and that’s make sure my children have what they need.” Natasha Rivera-LaButhie, mom to Liana, Hailey & Angel

Natasha Rivera-LaButhie was overjoyed to learn she was expecting—then her doctor delivered the news that she was actually pregnant with triplets. “We were prepared for one child,” she says, “but findingout it was multiples? Say what? Needless to say, my husband and I knew there would be a lot more costs coming our way.” Additionally, Natasha did not qualify for her employer’s medical benefits as a new hire; she received state medical insurance instead.

Before entering her 3rd trimester, Natasha lost one of the babies and began having medical complications, becoming hospitalized for 75 days before giving birth. A hospital resource staff personencouraged Natasha to sign up for the diaper bank. Though she was initially hesitant about asking for help, bills were piling up. The twins’ daycare also required a full day’s supply of diapers, and she would have to leave work to bring more if they ran out. “I threw my pride out the window and signed up,” Natasha says. “It helps me to be a better parent. I have more time to tend to my kids’ needs, and I know they’re being taken care of.”

Natasha’s local organization supported her with more than just diapers: “It was actually a church. I remember coming in there sometimes, feeling tired of my job, my bills… I felt like a bad parent because I couldn’t afford these basic necessities for my kids,” she says. “But people there didn’t judge me; they would welcome me with a smile and offer to pray for me and my family—it really meant a lot to have their encouragement and support.”

These days, Natasha enjoys quality time playing outside and reading books with her family and working with the New Haven MOMS Partnership. “Sometimes I meet women who don’t want to ask for help,” she says. “To those moms I say, ‘Why would you not take advantage of a service that solely exists to help you take care of your family?’”

Summer Hunt is the editorial coordinator for publications at AWHONN.

“Your daughter has full-blown fetal alcohol syndrome.”

Those words hit me like a tsunami. I was drowning in waves of grief, disbelief, horror and remorse. For 15 years, I searched to understand why Karli wasn’t learning and growing stronger, like my other two children. Doctors told me ear infections had caused her minor delays, but she would “grow out of it.” Today, Karli is 42 years old; developmentally, she is about 6 years old.

I grew up in the 1960s in an upper middle-class suburban neighborhood. My charismatic father suffered with alcoholism, and my co-dependent mom worked hard to cover his tracks. At 16, I was already experimenting with alcohol and other drugs when I got pregnant, married and dropped out of school. I wanted to have a healthy baby so I gave up all of the drugs and drank apple wine on the weekends.

Effects of Alcohol in Pregnancy
My first child, a boy, was born with a clubbed foot, which the doctor told me was a genetic disorder. I had Karli a year later, when the research describing fetal alcohol syndrome (FAS) was published. A few years later, I gave birth to another daughter and still had never been told not to drink during pregnancy.

I divorced my high school sweetheart and remarried another man who liked to drink. My own issues with alcoholism and addiction spiraled out of control. I had two unplanned pregnancies while on methadone to treat my heroin addiction. No one at the clinic ever mentioned that it wasn’t OK to drink. My second son came prematurely and died the day he was born. After a full-term pregnancy with my third baby girl, I found her breathless in her crib at 10 weeks old: Sudden Infant Death Syndrome (SIDS). I didn’t realize how those years of addiction affected each of my children.

No Safe Amount of Alcohol
Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. Most people with FASD don’t have intellectual disabilities, but do have attention deficits, behavioral issues, learning disabilities, mental health issues, and problems with memory, judgment and reason. Each person can be affected in different ways and, often, a person with an FASD has a mix of these problems. FAS is the most severe form of FASD.

Alcohol is a leading cause of fetal brain damage, birth defects and both fetal and infant death, including SIDS. While pregnant, there is no safe amount of alcohol, no safe time to drink alcohol, and no safe type of alcohol.

Clean and sober for the last 31 years, I have dedicated my life’s work to increasing awareness and improving services for individuals with FASD and for women dealing with addiction issues. I have a beautiful marriage and 5 wonderful grandchildren. I went on to receive my Master of Human Services (MHS) degree and became a licensed clinical alcohol and drug counselor (LCADC). I know that treatment works, and by encouraging women to get help, we save their children too. Now I am that good mother I always wanted to be.

If you’re struggling or think your child may be affected by FASD, don’t hesitate to reach out to your nurse, midwife or other healthcare provider. There is no shame in asking for help—your child’s life depends on it.

Source: NOFAS.org

Kathleen is vice president of the National Organization on Fetal Alcohol Syndrome (NOFAS).

Resources

• Get Help: Circle of Hope
• Learn More: http://www.health4mom.org/alcohol_in_pregnancy_how_much_is_safe

FASD PREVENTION PROJECT

AWHONN is a national partner on the Fetal Alcohol Spectrum Disorders Prevention Project of the Arc, a non-profit advocacy organization serving people with intellectual and developmental disabilities. The goal of the FASD Prevention Project is to increase health care professional knowledge of the risks alcohol can pose to a fetus, encourage the use of FASD prevention strategies and provide educational opportunities to health care professionals, including nurses, midwives, and nurse practitioners. Learn more about this project and resources you can use. 

An open letter to all the moms, soon to be moms or family supporting moms!

On December 31st, 2011 I gave birth to a beautiful baby girl! It was something I had dreamed about for so long. I remember the day after she was born crying on the phone with my midwife because I was so overwhelmed. She was so little and I didn’t really know what to do.

Being a little overwhelmed is common, medical specialists call it the baby blues. Post-birth, most moms (as many as 85%!) experience some form of the baby blues. This could be feeling irritable, exhausted, needing to cry for no reason or worrying that you won’t be a good mom.

I did not have that. I had something that damn near sucked the life out of me.

Once we returned home from the hospital, I rarely got off of the couch for 30 days. I got up to feed the baby and change her…I didn’t even eat. I remember just feeling so weird. Everything was robotic. Must feed baby, must change baby…I don’t even remember enjoying any of it.

I remember my husband picking me off of the couch giving me a hug and saying babe, you do not smell good…I am going to take you to the shower. He literally stripped me down and put me in the shower and helped wash me. Many times with post-partum depression (PPD) the mom is too tired to notice the symptoms, and it is a husband, partner, a family member or friend that shares that something just isn’t quite right.  I am thankful for my supportive system every day.

One night I was so tired that I actually Googled how many sleeping pills I could take without dying. I didn’t want to die, but I did want to be pretty close so that at least I would sleep for a few days. I literally had a bunch of pills laid out on the ottoman. I started to down them and then I thought. What if I am unconscious and she starts crying?! Nobody will hear her. I didn’t want her to cry and not have help. So I begged God to let me fall asleep and I threw the pills away. She saved my life.

Then the paranoia set in. I started to think that something very terrible was going to happen. So I started to place emergency items around the house. Things I would need to run away with. I made sure not to be too obvious because I didn’t want my husband to be on to me. One day he left to go to the store. I remember it so clearly, “babe I’m running to the store be back in a few.”

He stepped out of the house and I threw all of my emergency items in a bag, grabbed the baby and ran.

My grandpa was staying in a nursing home at the time and I knew nobody would look for me there so I went to his house and I hid out. I had NO contact with the outside world for days. Yes, I kidnapped my own child because at this point I was pretty unstable.

My husband and best friend were texting like crazy. Finally about ten days in I received a message from best friend which said, “I love you, but right now I have to love your baby more and I will call the police because I know you need help.” I finally told her where I was but begged her not to come. She sent a family friend who is a nurse to see me.

The nurse showed up and told me I had postpartum depression. I had no idea that 15% of new moms experience PPD which is way more intense than the blues, and encompassed so many of the things I was feeling and thinking. But at the time I didn’t know any of that, all I knew is that I just wanted to disappear. I hated everything, I couldn’t function and I was mad that I wasn’t connecting with such a precious little baby.

I never wanted to hurt my baby but I know many women who suffer from PPD do, and I would be lying if I said that I never wanted to hurt myself.

I don’t even remember when I started feeling better. There is so much about that time that scares me, so much more that I could share, but even writing about it makes me feel horrible. It’s a place I NEVER want to return to, and I would NEVER wish it upon anyone.

There were periods of time where I felt that I was bordering on insanity.

Follow the rest of my story in my Part 2 post publishing October 9th – National Depression Screening Day. Take care of yourself!
Danni Starr
Danni Starr works daily as co-host of the nationally syndicated “The Kane Show.” Danni fell in love with radio at 19 and 11 years later, she still considers it her first true love. As a Mother and wife Danni is the “Den Mom” to the show & offers open, honest, opinions and advice.

The above story is adapted from Danni’s original post: https://www.facebook.com/notes/danni-starr/take-a-walk-in-my-postpartum-shoes/572481839449596

Get Support

Postpartum Support International: 1-800-994-4773 or postpartum.net
National Postpartum Depression Hotline: 1-800-PPD-MOMS

References and Learn More at

AWHONN’s Mood and Anxiety Disorders in Pregnant and Postpartum Women Position Statement