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.

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!

1. My girlfriends told me that having labor induced is the safest, and certainly most convenient, way to have my baby, but my nurse is saying that waiting for labor to start on its own is the safest. Which is true?

Many people don’t realize that undergoing labor induction for any reason is associated with immediate and long-term health risks. Induced labor can lead to excessive postpartum bleeding (or hemorrhage), which in turn, can increase the risk for blood transfusion, longer hospital stays, hysterectomy, more hospital re-admissions and, in the worst cases, death. Induction is also associated with an increased risk for cesarean birth. Cesareans increase a woman’s  risk for infection, problems with how the placenta implants in future pregnancies, and life-long pain from abdominal adhesions.

AWHONN recommends against inducing labor at any time during pregnancy unless it is medically necessary, because a woman or her baby have problems. The medication used to induce labor is a manufactured hormone and a type of drug that bears an increased risk for causing serious patient harm when used in error. With the increasing use of labor induction and its resulting complications, it’s more apparent than ever that we must improve our understanding of the health consequences of administering artificial hormones, especially to vulnerable populations like pregnant women and infants. The short- and long-term health risks are just too serious to undergo labor induction when there is not  a medical need.

2. Is it true that inducing labor does not pose any risks for a baby?

Babies face their own set of risks from labor induction, including increased fetal stress and respiratory illness, especially before 40 weeks. These issues can force a baby to be separated from his or her mother, interrupt mother/baby bonding, and result in less or no breastfeeding, which in turn increases a baby’s lifetime risks for childhood obesity and chronic illness. Worst of all, complications can mean an infant needs to be admitted to a neonatal intensive care unit, have a longer hospital stay, face more hospital re-admissions, and be separated for longer periods of time from his or her mother.

3. I’ve heard that there are no health benefits for letting labor start on its own, so why wouldn’t I want to do what is most convenient?

There are significant reasons why it’s healthier for moms and babies to complete pregnancy by waiting for labor to start on its own. Naturally occurring hormones that prepare a woman and her fetus for labor and birth typically make labor faster, easier and with less stress on the baby than an induced labor. Spontaneous labor also triggers a cascade of hormones during labor and birth that:

• provide natural pain relief, calming a woman during labor;
• help the placenta detach from the uterus;
• increase mother-baby attachment after birth;
• warm the mother’s skin at birth, which helps baby warm and hold his own body temperature;
• enhance breastfeeding;
• clear fetal lung fluid; and
• ensure that the transfer of maternal antibodies to the fetus, which makes the newborn less vulnerable to infections, has occurred prior to birth. The largest amount of these antibodies cross the placenta to the baby from 4 weeks before the estimated due date (40 completed weeks) up to 1 week after. If a woman has an induction 1 week before her due date, but would have gone into labor 1 week after had she waited, her baby will miss out on a lot of immune protection.

Additionally, researchers continue to show that a baby’s healthy development and growth benefits from a full 40 weeks of gestation. Research shows that women having their first babies, on average, will begin labor four to eight days past their due dates and women having their second or more babies will begin labor two to three days beyond their due date. Learn more about the benefits of spontaneous labor at www.GoTheFull40.com.

4. What if my labor is taking forever? Can I choose to have drugs to help stimulate contractions if I have already started labor naturally?

If labor is progressing slowly, some health care practitioners augment labor (or stimulate contractions) with the same drug used in labor inductions. While research on the risks of elective labor augmentation is limited, many of the risks associated with induction may apply because the same medication is used.

With these concerns in mind, AWHONN supports policies that limit non-medically indicated augmentation of labor and supports spontaneous labor when mother and fetus are healthy. Increasing funding for research and education about augmented labor would help improve understanding of safe labor and birthing practices.

5. I don’t understand all this concern about induced labor; women in the United States do not die of pregnancy-related causes anymore. We are more advanced than that.

Unfortunately, the number of women dying during pregnancy and childbirth continues to increase in the U.S. Two to three women die every day from complications of labor and delivery, and evidence shows about half of these deaths could be prevented. Our nation has higher death rates among birthing women than at least 46 other countries, including South Korea, and Turkey. In fact, the United States is one of the only countries where maternal deaths and injuries have increased in the last decade.

More than 50,000 women each year in the U.S.—that’s one every 10 minutes—nearly dies from a severe complication related to pregnancy or childbirth. Severe bleeding after birth, called postpartum hemorrhage (one of the risks of labor induction), is a leading cause of preventable maternal death and injury. Since investigators have demonstrated that using pharmacologic or mechanical methods to induce labor increases risks for health complications for mother and baby, AWHONN strongly recommends that women should agree to receive medications to induce labor only when there is a medical reason.

Some final thoughts from Lynn

Scheduling a baby’s birth by inducing labor with artificial hormones—rather than waiting for labor to start on its own—is now accepted as common practice. In fact, nearly 25% of U.S. births are now induced—a number that has more than doubled since 1990. Some of these inductions are needed, but others are too often performed for the convenience of busy families or obstetric providers.

What gets lost during the rush to induce labor is the fact that outside of a medical need, inducing labor can result in serious immediate and long-term medical issues for a mother and her baby. Researchers have demonstrated the potentially disastrous health consequences that can occur for women and infants with non-medically indicated inductions. Evidence shows that when a mother and baby are healthy and well in pregnancy, the mother should be encouraged, and supported, to wait for labor to start naturally—to let baby pick his or her own birthday.

Lynn Erdman is the CEO of AWHONN with more than 30 years of experience in the healthcare and nonprofit sectors. She is a highly skilled national leader in the field of nursing and previously held key national leadership positions with three global health organizations: the American Cancer Society, the American College of Surgeons, and the Susan G. Komen Global Headquarters.

For more information, please visit www.GoTheFull40.com

Also check out what our friend over at Adventures of a Labor Nurse had to say on Everything You Need to Know About Inducing Labor.

I first became a father in July, 17 years ago, with the birth of my daughter. After 39 weeks and 6 days, I was the father of a little girl. I really cannot explain how I felt. It was better than being a child on Christmas and getting everything you wanted! I fell in love with her at first sight!! Almost three years later, my son was born. I again experienced the same set of emotions, instant love and excitement for him.

I was not a nurse when my wife gave birth (it is probably very good– too much knowledge could have been a bad thing), but for the last 11 years I have been a labor and delivery nurse.

I have seen all types of births– good, bad and eventful.

During a birth, whenever possible, I try to involve the father in the delivery process, this is likely a result of me having my own children and understanding the amazing emotions and enjoyment that time can bring. When it is not possible to have the father involved during labor, I encourage them to hold the baby as soon as they can, change the baby’s’ first diaper and be involved in as many “firsts” as possible. Getting the whole family connected right from the start.

Before I had my children, I had read that children are a game changer. How right that is, but in such a very positive way. Neither child came with an instructional manual with a troubleshooting section. I have learned there are no part-time dads. For last 17 years, I have been “on duty” 24/7.

Father’s Day is celebrated to recognize the contributions fathers and father figures make in the lives of their children, it’s a day set aside to celebrate fatherhood and male parenting.

Each Father’s Day I can reflect that I have experienced it all: sickness, heartbreak, fears, joy, and sadness. I’ve been everything from a counselor, teacher, nurse, coach, dance partner and mechanic. I am a disciplinarian and avid fan. I braid hair and know too much about boy bands, all the while still throwing footballs and baseballs in the backyard or playing Xbox One.

I cannot imagine my life without my two children. Although they keep me constantly busy, financially deprived, and often dismayed, I am also overwhelmed and amazed that they are my children and so proud. I dare say that the greatest thing I will every do is be the father of my two children.

I join Naveen Jain in rejoicing, “Being a father has been, without a doubt, my greatest source of achievement, pride and inspiration. Fatherhood has taught me about unconditional love, reinforced the importance of giving back and taught me how to be a better person.”

So to all my fellow fathers, Happy Father’s Day!

Gerald has been a perinatal nurse for over ten years. As a labor and delivery nurse, he has provided care to antepartum, intrapartum and postpartum patients. He has received numerous awards including The DAISY Award for Extraordinary Nurses. He has functioned as a charge nurse, resource nurse, and a Clinical Coordinator for women’s care centers.

Currently, Gerald is a Visiting Professor for Chamberlain College of Nursing and a Clinical Instructor. Active in the Association Women’s Health Obstetric and Neonatal Nurses (AWHONN) as a chapter leader and secretary/treasurer, Gerald is the Virginia AWHONH Section Chair.

1. No one wants you to have the birth you want more than we do. Except maybe you, of course… We want to support you to stay healthy and have a healthy baby. If you end up with an unexpected birth experience, we mourn the loss of the idealized birth with you, and are here to help the experience you have be the best possible.
2. Most providers will not stay with you during labor. Many times when a woman is admitted, she’ll ask when her provider is coming. Providers have busy offices to keep up with and demanding surgical schedules. Your nurse will be the one that stays by your side. Your provider will check in on you frequently and we give them continuous updates throughout your labor.
3. We will not remember what your stretch marks looked like, how much cellulite you had, or what your vagina looked like once we walk out of your room. Guaranteed.
4. Labor is painful. Everyone thinks their labor is different than everyone else’s, that no one could have labor pains as bad as yours. But the truth is, labor hurts for (almost) everyone. The best thing you can do is take prenatal education classes so you know what to expect. A lot of fear and pain comes from the anxiety of not knowing.
5. Educate yourself on the benefits of breastfeeding. By now, everyone should know that there are a million and one reasons to breastfeed. There is so much evidence out there that supports all of the benefits of breastfeeding. No one comes to the hospital with a plan to breastfeed thinking that they may not be successful. So educate yourself prior to having your baby. Know what the most common problems are, success strategies and what to expect the first few weeks. Commit yourself to breastfeeding your baby!
6. Designate someone as your photographer. Your partner will be caught up in the moment. They’ll probably forget all about the camera. Before you go into labor, designate someone as your personal photographer or hire a professional birth photographer. You will not remember the way your partner looked at you. You may not remember how your partner looked at your baby for the first time. You want to make sure you’re able to look back and remember all of the little details you may later forget.
7. Talk to your provider. Your doctor and your midwife work for you . It’s a privilege that you’re allowing them to be a part of the birth of your baby. Don’t forget that. Discuss in advance things you would like, and ask questions. You want to know early in your pregnancy if you picked a provider who you aren’t comfortable with so you can change providers if you need to. No question is too silly. Trust me; they’ve heard it all before!
8. Don’t be afraid to speak up. Frequently, women are admitted to the hospital and they feel as if they have no say in the care that is provided. But you can speak up! You have the right to ask questions, to get those questions answered, and you have the right to say no.
9. Don’t get induced unless you have a medical reason. Even if your back hurts, and you have trouble sleeping at night, and you’re going to the bathroom 500 times a day, remember that your baby is baking in there! Every minute matters. So find methods to distract you if you’re very uncomfortable, and aim to go the full 40!
10. Take it all in and cherish the moments. Every day, nurses take care of women who can’t get pregnant, who can’t stay pregnant and we care for women who will not get to take their baby home after delivery. Having a healthy baby is a lifelong, priceless gift. Cherish every moment, because before you know it, the toddler playing with your car keys will be the 16 year old asking to borrow your car.

In the potentially fatal event below, a cord blood infusion really put into practice everything we already know about delaying cord blood clamping – the increased provision to the neonate of oxygen, red blood cells, stem cells, immune cells, iron reserves, and blood volume.

It was wonderful was seeing this baby go home with no apparent sequellae after a complete abruption at birth.

The mom was 17 years old and 27+5 weeks gestation when she arrived at our hospital for GBS bacteriuria, lower back pain and abdominal cramping. She stayed on our antepartum unit for five days due to cervical dilation 1-2 cm and received antibiotics and Betamethasone.

On day six, the mom complained of contractions around 0800. The resident checked her, she was 5 cm/80% and uncomfortable. We started her on Magnesium for neuroprotection, as ACOG recommends. We started her on a Magnesium Sulfate 6 gram loading dose and continued the Magnesium at 2 grams/hr.

At 1600 she was found to be 7 cm dilated and requesting an epidural. Four hours later, as she began to push, the baby began having prolonged decelerations. She brought the baby down quickly while experiencing tachysystole. With the last few contractions, the fetal heart rate plummeted as she pushed out her 1120 gm infant along with an abrupted placenta.

The baby’s pale, lifeless body was received by the NICU team. The physician carried both the baby and placenta to the warmer. For seven minutes, the pulsating placenta infused blood into the baby while the NICU team began to resuscitate the baby. Within the first minute, the baby gasped and cried while we watched in awe as this hypovolemic baby began to cry and turn pink as the doctor continued to hold the placenta above the baby. Baby’s APGAR scores were 7 at one minute and 8 at five minutes. CPAP and Neopuff was all the NICU team used to stabilize this neonate. Baby’s initial CBC: 10.1>15.8/46.3<272

Had we done what was “usual” and clamped the cord, would there have been enough blood cells for a successful resuscitation?

The time that it would’ve taken for them to crossmatch a sample then give adult blood with no stem cells would have been enough time for hypoxemia to occur. The baby received no blood transfusions during her hospital course of care and went home after about seven weeks of care.

Studies have also shown a reduction in newborn anemia; need for transfusion, intraventricular hemorrhage and necrotizing entercolitis. Other studies have found an increased risk for polycythemia and jaundice. In the event that hypovolemia be suspect, a cord blood infusion would be preferred and beneficial with the later treatments for possible polycythemia and jaundice provided if necessary. Based on new data and the current literature that profoundly encourages a delay in cord blood clamping, in the rare instance of a complete placental abruption this event could be modeled to save an infant’s life. This really impacted our hospital and we have since been able to do this in another case. My hope is that you’ll be able to glean wisdom from our experience.

Lisa-Marie Cook is a Labor and Delivery Nursing Preceptor in Washington, DC and teaches AWHONN Intermediate Fetal Monitoring. She is also the CEO of Birthing Basics, LLC where she teaches evidence-based birthing classes.

Resources

“Perspectives on Implementing Delayed Cord Clamping,” Nursing for Women’s Health, 19(2), 164–176.

ACOG Committee Opinion Number 543 (2012) Timing of Umbilical Cord Clamping.

Hutton, E.K., Hassan, E.S. (2007). “Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials”. Journal of the American Medical Association, 297(11): 1241-52.

McDonald, S.J. et al. (2013) Effect of timing of umbilical cord clamping of term infants on mother and baby outcomes. Cochrane Database Systematic Review, July 11. McDonald, S.J. et al. (2013) Effect of timing of umbilical cord clamping of term infants on mother and baby outcomes. Cochrane Database Systematic Review, July 11.

Rabe, H. et all. (2012) Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Systematic Review, Aug 15.