Happy belated International Day of the Midwife
Happy Nurses Day
Here is a great video on what it means to be a NICU nurse
Here’s some live action of stabilizing a preemie…
Happy belated International Day of the Midwife
Happy Nurses Day
Here is a great video on what it means to be a NICU nurse
Here’s some live action of stabilizing a preemie…
I lit my Blessingway candle in the wee hours of the morning when I saw that her labor at home was underway.
I faced the candle in a window towards her home 1500 miles away.
I like how the reflection makes it appear as though the light keeps spreading west towards her…….
sending love and support…..
Not only did she have a VBAC today–
She had a HOME VBAC !!
AND during Cesarean Awareness Month!
Gina of The Feminist Breeder is one of the most courageous women I have ever met!
Yep- I met her! She invited me … little ole me… to her Blessingway in March when I happened to be in town. I was so incredibly excited to meet her and all her fabulous birth team! Yep- I’m in that Blessingway post she did.
Here’s one of the beads I gave her for her necklace.
Congratulations Gina and John!
But it’s her story to tell……. Head over to her blog and check the coolest EVER live blog birth event. The whole thing can be read and viewed from last night thru til this morning. The audio and video clips are for QuickTime player and each clip may take a few moments to load before you can push play.
I had it on today … at work… in the NICU and took the opportunity to try to educate..
Thanks for sharing Gina!
I am so so happy for you!
Short Little Success Story
Recently had to attend a birth for a 34 weeker who had been threatening labor since 32 weeks. She had been given a regimen of steroids and antibiotics per our protocols. The parents had a beautiful birth plan. They wanted Skin to Skin at birth, baby nursing before any separation and were adamantly against formula if at all possible. Both were frightened of the preterm birth, worried for their child’s safe transition and concerned that none of their wishes would be carried out.
I had the opportunity to discuss some of these with the Neonatologist and the parents before the birth. The doc was all for doing as much as they’d wished for at birth (that we could) provided the baby did not require respiratory support…
The baby was delivered hollering at us, alert and pinked up nicely! After observing and examining him for a short period, the doc gave the go ahead for Skin to Skin as long as I could stay and observe. Happy to oblige, I had that 4 LB naked baby up on mom in no time surrounded by her warmth and love.
I did the babies first glucose check (while STS) which was at a great level. Mom proceeded to start latch attempts. The baby did nuzzle and lick the copious colostrum she offered but wasn’t able to accomplish a latch. Vitals were stable, they were snuggling… but by an hour– the Neo was getting antsy. I had to take him in to the NICU with Dad in tow. No resp symptoms. Pink stable and alert. Placed up on the warmer table and connected to all the monitors for observation, he had his second glucose check. We expect it to drop at this time which is the normal nadir. It was however 38 which meant we had to feed. I asked for 5 min. This mom had a copious colostrum flow. The baby was not symptomatic. I had another RN watch him while I scooted back to L&D with a pump and small collecting cups. I figured we may have to hand express because many moms don’t respond to a pump quickly. This mom did respond and in a few minutes we had about 10 ml !!
I took that right in to the NICU leaving mom to finish a pumping session. We syringe fed the 10 ml and a subsequent glucose check was 54. Mom sent in a container of 15 more ml
They got to have a beautiful experience with their preterm boy who never got any formula … at least not in the NICU before discharge.
I am continually working (baby steps- a little bit at a time) on improving what we do to care for the moms and babies in my little neck of the woods. Sometimes it feels exciting, positive and helpful….. but other times frustrating or futile.
Since I have been recently consumed with my newest career as a NICU nurse, I have seen some of my earlier successes of positive changes (on the mother baby unit and L&D)…. slowly. turn. back. to previous bad practices ….. I come over to the units and I see so many of the older traditional care models in place again which we had worked hard to place in a vault! You get new doctors, new nurses, new anesthesiologists etc… and they don’t give a crap about any guidelines or protocols for a natural process! However if the CDC changes their Hepatitis B, HIV or GBS protocols… they are all over it…. In. A. Heartbeat.
Why is it so hard for these professionals to relinquish control over all aspects of the birth process? Why can’t they look at any of that research? Why aren’t any of the recommendations for encouraging VBAC, discouraging scheduled CS’s without a TOL or keeping mother and baby together while delaying routine procedures taken as seriously?? Why?
I think I know why…I do. But that isn’t really what I wanted to talk about today.
I want to provide some encouraging – positive – inspirational ideas for my fellow nurses, practitioner or heathcare provider to do what is best for each mother and baby in their car. Even if you all pick just one… it can make a difference. So don’t feel overwhelmed. Just try to add at least one of these to YOUR daily practice. These suggestions are meant for situations without complications requiring urgent intervention of some kind.
Readers: Please ADD more in comments if you have them!
For some more ideas.. I have numerous previous posts about breastfeeding education, support and sited references such as the Coalition for Improving Maternity Services Ten Steps for example and other important issues.
Received this email alert and thought I’d pass on thru my blog… and encourage all to take action!
It takes 5 seconds to add your name to the list!
e-CIMS Action Alert Sept. 28, 2010
CIMS Urges ACOG to Remove Additional Barriers to VBAC
Join us in asking ACOG to take steps that will increase VBAC, reduce cesareans, and ultimately avoid unnecessary harms to mothers and infants.
In a Sept. 9, 2010, letter to Dr. Richard Waldman, president of the American College of Obstetricians and Gynecologists (ACOG), CIMS and 18 co-signing organizations urged ACOG to revise its current recommendation that VBACs (vaginal birth after cesarean) should take place in hospitals where emergency cesareans are “immediately available.”
CIMS will collect the names of additional organizations and individuals in support of this request through October 31, 2010, and will send the updated list of co-signers to Dr. Waldman. Add your name or your organization’s name now!
This request follows the March 2010 National Institutes of Health (NIH) Consensus Statement on VBAC, which found that VBAC is a reasonable choice for the majority of affected women. The NIH also reported that the “immediately available” recommendation was not based on strong support from high-quality evidence and had influenced about one-third of hospitals and one-half of physicians to stop providing care for women who wanted to plan a VBAC.
CIMS and the co-signing organizations also urged ACOG to revise its patient education publications and online consumer resources to include comprehensive information on the benefits and risks of cesarean section and VBAC. Without transparency about the short- and long-term benefits and risks of routine repeat cesarean and VBAC, women cannot make a truly informed choice about how they want to give birth.
CIMS Press Release “CIMS Responds to Promising but Conflicting Revised VBAC Guidelines”
American College of Nurse-Midwives Responds to ACOG’s 2010 VBAC Recommendations (PDF)
Take Action: Add your name or your organization’s name now!
Submitted for the Healthy Birth Blog Carnival #6: MotherBaby Edition
Skin to Skin immediately after birth is an extremely important part of the continuum of the nurturing of pregnancy, the process of birth and the transition of nurturing from inside mom to outside mom. This is the natural habitat where baby should transition and begin his own regulations of breathing, heart rate, temperature etc… This is recognized by the AAP in their changes to the Neonatal Resuscitation Algorithm back in 2000. The recommendation was to keep baby with mom and provide all initial evaluations and steps with baby on moms chest for all healthy babies! We all know that babies have an inborn innate ability to self attach and nurse right after birth. These recommendations are not just for vaginal births. Kathy Petersen has a beautiful description of the importance of STS after a Cesarean birth on her Woman to Woman Childbirth Education blog in her 5/30/10 post Skin-to-Skin in the O.R. after a C-section.
As soon as I heard about the last edition of Science and Sensibility’s Healthy Birth Blog Carnival with a theme about “keeping moms and babies together after birth”, I wanted to write about my tiny little efforts, struggles and some successes in providing moms and babies with an environment that supports and protects their need to stay together. My recent role in the protection of such an environment and subsequent privilege of watching a baby self attach in the OR 15 min after a C/S birth has re-energized my efforts to get more mother’s and nurses to speak up and make this a standard for healthy babies!
Then….. I saw a link on Laura Keegan’s Facebook fan page for her book Breastfeeding with Comfort and Joy to an awesome video and a beautiful photo posted by the author of Cesarean Parents Blog about her birth. I had heard of Laura’s search for images of STS after C/S and asking for mother’s experiences. Amy Romano from Science and Sensibility alerted Laura of the photo: Kathy blogged about STS after C/S and I was working on this post! Such uncanny timing! I am just in awe of this marvelous networking community! Head over to Laura’s facebook link and share your experience for her info gathering. Here is the fabulous video they are all talking about “Breast is Best” from Norway:
Why is it so hard for the doctors and nurses to get on board? Most of them understand the word “bonding”. But what many don’t realize is that it took a long time for the actual concept to take hold, to allow “time” for bonding to occur. It sounds silly but many times if the baby and mother are still together after 2 hours…the nurses call that “extended bonding”. I have been doing this for over 35 years now and the changes from the 70′s to now are fascinating and frustrating at the same time. To understand the process of change, we have to sometimes remember where we’ve been. I wrote about Medical Science vs Natural Childbirth a year ago because I feel history IS important to help us move forward. Often it is about control… but many times nurses and doctors are simply task oriented/focused and not patient centered. They want to complete all their procedures and charting and move on to the next task. I understand this, there is always a lot to do and document. I work there too! The environment provided to us, the health-care workers, is one in which regulations are abundant and staffing is not always optimal. Flexibility is needed. I know there is a way. This culture just has to change. And it happens in small little doses.
SO–> Skin to Skin immediately after a C/S? I have been told by coworkers, doctors and anesthesia:
“It’s impossible, “
“It can’t be done”
“There’s not enough room”
“This patient (the mom) is in the middle of major surgery!”
“The baby needs to be under the warmer, it’s too cold in the OR.”
Really? Seriously? Watch Me………
I have actually been working on this issue for the past few years…… Ever since I began staff education for World Breastfeeding Week 2007′s theme “Breastfeeding: The first hour — Welcome Baby Softly”. The focus from ILCA was: ‘Establishing a welcoming environment that keeps mothers and babies together.’ It was then that I gently tried to introduce the concepts for C-Sections as well as all vaginal births. I was getting a lot of positive response for vaginal births…not so for C/S.
Anesthesia is our biggest barrier. The chest area of the mother seems to belong to them somehow. The arms too.. I always politely ask the doctor for permission to have at least one arm released so she can touch her baby. (they are secured on armboards to her sides.) Really the OB’s didn’t mind what was happening outside of their draped domain. The Pediatrician is the next barrier because they want to finish a complete exam…. in the nursery…. before they returned to the office or whatever. So I started with the Peds… hoping they would stop expecting the baby to be quickly removed from the OR. I started with just simple requests for prolonged “bonding”… because they all get that. “Look how well this baby is transitioning.. so alert and PINK! ” “I’ll write all the measurements in your exam note…. I’m fine… I know you’re busy….” I’d say. Sometimes mom and baby got to stay together. Soon, for some of the doc’s, the expectation of baby leaving mom was gone. They got tired of waiting around and would leave. More moms and babies got to stay together…even if it was dad doing the holding. My co-workers were not always so understanding because of the work flow on the unit. It would work best when the birth happened any time other than first thing in the morning when it’s busy everywhere. Isn’t that sad? Sitting here writing this I’m thinking of ways to work on that….. another time…..
Anesthesiologists or Nurse Anesthetists are all different. There are some wonderful ones who are releasing both arms and pushing things out of the way for the baby and others who are constantly telling moms they are “under” anesthesia and can’t hold the baby, or they have given meds to mom right after baby is born so mom is now groggy. I talk to each of them respectfully and differently depending on their own approach. I have discussed my plans for STS if baby stable ahead of time. I have discussed how it is up to us to provide this protected environment for moms etc… I have used the patient satisfaction discussion, the scientific evidence discussion, the patient centered care discussion, and the increased patient numbers due to higher satisfaction talk. I have let them know that when a mother requests that–> we must do everything possible to help her experience this.
Slowly, over the last few months, I was able to facilitate some babies really getting skin to skin in the OR for short periods before going to the nursery. There were a variety of factors for why it wasn’t very long each time but at least it was happening!! It’s not a standard of care yet and I’m the only one working on it but others are getting interested… Communication has been very important to create the environment and reduce barriers. We still have a long road ahead. But we did pave a path for this mom….
She came in with an unknown double footling breech presentation in active labor and the doctors wanted to do a C/S right away. She was really upset and had a beautiful birth plan that was already getting discarded. “STS until first breastfeed accomplished” was on her plan and I was determined to help her with that! Things were happening fast. The anesthesiologist wasn’t my best STS supporter.. “oh well” I thought, “I’ll do what I can to help.” The baby was crying and pink when born and without thinking about it, the doctor, nurses and myself had him on the baby unit drying him. Mom went panicky! “Give him to me, give him to me! He has to be ON me! You just took him OUT of me, now he HAS TO BE ON ME!” She was literally trying to sit up. Anesthesia was drawing up meds for her (that was his answer). I said “OK here he comes!”. So I didn’t ask anyone’s permission this time….. just held that naked baby in one hand, snapped open her gown with the other and helped him move in. I asked for a warm blanket and looked up to see the other nurse and doctor staring at me. I said “Seriously… she’s exactly right, he does belong ON her!” Anesthesia saw the immediate transformation of his frantic patient to one with calm maternal bliss, admiration and cooing. He was then helpful to let her other hand out. This little boy stayed with mom, breastfed before he was 15 min old and went to the PACU with mom. She was so incredibly happy. I never got to see her after that since it was near the end of my shift and I wasn’t on shift the next few days. I saw that she exclusively breastfed in the hospital and without complication went home on day 3. At least part of her birth experience went according to plan!
If she hadn’t have been so vocal about what she wanted, so adamant… she would not have experienced what she did.
SPEAK UP AMERICA…. MAKE IT HAPPEN
Want to see more? This stunning video of a baby skin to skin then breastfeeding at birth in the operating room via @MothersUtopia @Laura_Keegan. What were your experiences? Please don’t forget to head on over to Breastfeeding with Comfort and Joy on FB to comment on your experience or opinion about this important topic!! Calling for women to share their experiences with skin to skin here, to help give a voice to the real need to make skin to skin in the OR routine practice in all ORs.
In the world of childbirth, Mother’s Day is a very special day. I have enjoyed years of watching a women become a mother either for the first time or again and again on this very day. It is always wonderful to share that experience with them. Fabulously Joyful!
But today, I get to be home, pampered by my hubby and just milling about… I came across some wonderful websites carrying fabulous vintage engravings and various clip art. I absolutely adore antique engravings! I have some framed and others saved for something I’ll get to one day…
This first few photos above are images courtesy of antiqueprints.com depicting mother and children. There are two WONDERFUL Antique Breastfeeding Engravings! These are all steel engravings with hand color in the first two.
The remainder of art below is from a website called “The Graphics Fairy” and all of these photos are to Karen’s credit over there. Beautiful!
This is at least a month old news to most birth junkies but….. but I find it encouraging that the news is coming thru from AWHONN (Association of Women’s Health, Obstetric and Neonatal Nurses). There are many many nurses and birth professionals out there that haven’t even heard about this conference. I know the big AWHONN convention is coming up in Nashville June 12th, and possibly this topic will be presented somewhere although late to get on agenda. Sometimes the nurses can help educate the docs…… ya think?
One topic on the Nashville Agenda is:
“SOLUTIONS FOR SURVIVAL: Working where Birth is NOT Considered NORMAL”
Boy~ would I love to go to that presentation!!!!!
“Panel Urges New Look at Caesarean Guidelines”
The New York Times, Denise Grady
A government panel recently took steps that will increase women’s ability to find doctors and hospitals that will let them attempt a normal birth after a previous caesarean section. The recommendations came from a panel at a National Institutes of Health (NIH) conference convened to assess why the rate of vaginal birth after Caesarean section (VBAC) has gone from 28.3% in 1996 to less than 10% today. The repeat surgeries are contributing to the growing rates of C-sections in the U.S., which today account for nearly a third of all deliveries. Repeat C-sections were previously deemed safer due to concerns that the uterine scar would rupture, putting both the mother and the baby at significant risk. According to the chairman of the NIH conference, “We found the use of VBAC is certainly a safe alternative for the majority of women who’ve had one prior” C-section, as long as the incision was horizontal and low on the uterus. Approximately 70% of women who have had C-sections are good candidates for attempting a normal birth, and 60% to 80% of those who try succeed. The government panel urged the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists to “reassess” their guidelines, which have rendered many clinicians and hospitals unwilling to allow VBACs. The groups’ current guidelines require that surgical and anesthesia teams be “immediately available” during labor if a women has had a prior C-section. Some institutions were unable to comply, and thus banned VBACs altogether.
Link to Article