“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.