Labor Day

Labor Day.... a day in September..... but to Perinatal Nurses, every day is Labor Day.  I come from a very big family and when I was in the ninth grade my mother went into labor on Labor Day with my youngest sister.  I was supposed to go to a babysitting job that evening so Mom was grilling me some pork chops before I went.  I remember her calling to me and I went along hurrying to follow her into the house and saw so much blood..... I was very scared.  

This would be my mother's seventh child.  As I know now, she was a grand multiparous, elderly, advanced maternal age with a history of hemorrhage with every delivery.   The only thing that probably would have been worse for me at this point was if she had the baby at home!

My Dad was summoned after I helped clean my mother up.  I canceled my babysitting job because I would be babysitting my own brothers and sisters while dad took mom to the hospital.  Dad knew the drill and got my mother promptly to the hospital.

A few hours later, Dad returned and told us we had a new baby sister.  My parents had given up on naming babies and told us we could name her.  There was a show back then called My Favorite Martian.  My siblings and I loved that show and one of the characters had a girlfriend named Laura Lee so that is what we suggested they name the baby and they did!   Although in looking up the show for this picture, I found on Wikipedia that her name was spelled, Lorelei.  <so sorry Laura, we misspelled your name!>

Back then, dads did not stay at the hospital with the moms and the older siblings definitely did not get to go to the hospital to see the baby sisters and brothers.  So we stayed home and waited for our mother and baby sister to come home!  My mother did have to have blood transfusion after Laura was born.  But, Laura was perfect and Mom was soon back to normal.  

Every Labor Day, I think back to this story, pork chops, BBQ, being scared, and of course, My Favorite Martian! I also wonder if this was the exact moment I decided to be a Perinatal Nurse.

What is happening to all the pregnant women?

There has been a lot in the media and medical journals about the rising morbidity of pregnant women in the United States.  What is going on?  I have been working in maternal child nursing for my whole career of almost 40 years.   I currently work in a Level 1 obstetrical unit.  This means we should be seeing the healthiest of pregnant women delivering at our hospital and yet, as I sat down with a few colleagues on my unit this week, we were discussing the probability of needing to consider having telemetry on our unit to monitor our patient's cardiac status.  This is something we never would have thought before.

This year when we were considering the purchase of a fetal monitor attachment that would give us the capability to monitor obese patients more easily, I started to track the numbers of women who would actually need this for their labors and it was shocking.  I thought the number of women with a BMI greater than 30 would be about 30%.  However, the number turned out to be over 60%.  Obesity causes many complications we are seeing in our patient population:  gestational diabetes, hypertension in pregnancy, shoulder dystocia, obstetrical hemorrhage, cesarean sections, poor healing after birth..... and on and on...

The risks of the things we see on the OB Floors these days has necessitated that the staff become more aware of the early warning signs for many different disease processes.  We have to be aware to keep all patients safe.  This is done with drills and training with the staff,   shift huddles to discuss challenging patients, debriefing after an event occurs.  It also involves reaching out to our partners inside the hospital.  The Emergency Department is an important partner, because the pregnancy period not only includes when the mother is actually pregnant but also the time in the weeks immediately following birth.  Today our OB Educator participated in the Emergency Department skills fair to bring their team additional knowledge on obstetrical emergencies.  

It is important to work together as a team and to share information with our partners so we can best work together in emergent situations.  Obstetrics should be considered a high risk environment because we never know what is going to happen.  It isn't rocking babies and dealing with happy, healthy, easy patients any more.  We have to be ready for anything in our population especially as they present to us sicker than they ever have.  

It is also important to work on the pre-pregnancy health status of women.  We need to work together to solve the issue of obesity in women and the overall health of women prior to when they get pregnant.  Exercise, good food, and good mental status are important prior to getting pregnant.  Women should plan on seeing their OB/GYN provider prior to conception to discuss overall health.  

State Perinatal Collaboratives

In 2006 the California Maternal Quality Care Collaborative (CMQCC) was formed.  I am not sure if it was the first, but it was one of the first.  What is a state quality care collaborative?  It is when a group of people gather together to help improve the health of a population.  In the case of my specialty, that would be mothers and newborns.  

In Florida, we have our own quality collaborative, Florida Perinatal Quality Collaborative or FPQC.  The FPQC was formed in June 2010 when a meeting was held in Gainesville Florida.  The meeting included the top minds in maternal and neonatal care throughout the state of Florida and FPQC was born.   The vision of the FPQC:

All of Florida’s mothers and infants will have the best health outcomes possible through receiving high quality evidence-based perinatal care.

The mission of the FPQC is to advance perinatal health care quality and patient safety for all of Florida's mothers and infants through the collaboration of all FPQC stakeholders in the development of joint quality improvement initiatives, the advancement of data-driven best practices and the promotion of education and training.  So who are these stakeholders?  They are perinatal health-related practitioners from a  variety of professions and specialties, statewide organizations, individuals, advocates, educators, policymakers, hospitals and payers as well as involved families.  

My hospital has been involved with the FPQC from very early on in the first initiative, Eliminating Early Elective Deliveries.  It was not until I was asked to be a representative to the Hypertension in Pregnancy workgroup for the Florida AWHONN section that I got to really experience what it means to be a part of FPQC.  What was so unique about this experience is how all groups that participated in the development of the Florida Hypertension in Pregnancy tool kit worked together.  They included academic obstetricians, private practice obstetricians, ACOG District XII,  Preeclampsia Foundation, Florida Hospital Association, Healthy Start, March of Dimes, Florida Department of Health, AWHONN Florida Section, Maternal Fetal Medicine physicians, anesthesiologists, Florida Affiliate of American College of Nurse Midwives, Agency for Health Care Administration, and insurance providers.   Everyone was around the same table and worked together to make a plan that would roll out to the entire state of Florida.  We were able to use the CMQCC Hypertension in Pregnancy initiative and adapt it to make it an initiative for the State of Florida because CMQCC willingly shares.   Everyone had a voice.  The initiative has been rolled out to participating hospitals who are now working on incorporating the FPQC Hypertension in Pregnancy toolkit into their own organizations.  What is great is there is support from FPQC all along the way.  First there was a kick off in person meeting where all participating hospitals travel to learn about the initiative.  Participants were able to interact with other hospitals throughout the state.   The next support comes with monthly webinars where topics of interest are discussed and implementation problems are solved.  This is a time to ask questions and get answers from others going through the same thing in their organizations.  FPQC also offers grand rounds that can be held in your own facility.  

The thing is, this happens with ALL of the initiatives!!  The state quality collaboratives are working with the Council on Patient Safety in Women's Health Care, Alliance for Innovation on Maternal Health or AIM, on a national level.  Initiatives are shared.  No one has to work alone.  It is much better when we work together.  Through the initiatives or bundles, we are striving for Readiness on every unit, Recognition/Prevention for every patient, Response for every case, and Reporting or systems learning for every unit.

Here are the initiatives that have been worked on or are in progress by FPQC:  

• Early Elective Delivery
• Neonatal Catheter Infections
• Obstetrical Hemorrhage
• Golden Hour
• Antenatal Steroids
• Hypertension in Pregnancy
• Mother's Own Milk
• Perinatal QI Indicators

What can you do?  Join your state collaborative.  Look at the toolkits available through CMQCC, FPQC, and AIM!  Together, we can work to decrease maternal and neonatal morbidity and mortality.  We can make a change for the future!

California Maternal Quality Care Collaborative:  https://www.cmqcc.org

Florida Perinatal Quality Collaborative:  http://fpqc.org

Council on Patient Safety in Women's Health Care AIM:  http://www.safehealthcareforeverywoman.org/aim.php

World Breastfeeding Week!

Yesterday we hosted the Big Latch On at our facility.  It was our fourth year participating and our third year hosting.  We always have had the most mothers at our location out of all the locations in SW Florida.  This event is fun because we get to see the women and the babies that have been delivered at our hospital.  (and some of them are getting big!)  Looking at all those healthy babies and mothers makes me proud of getting mothers and babies off to the best possible start by all the hard work our team does to make breastfeeding successful for these families.  Food is medicine and this begins right from the start with our newborns receiving breast milk from their mothers.

But, seeing these women who have also formed bonds through our weekly breastfeeding support group was exciting too.  They have found each other and are now supporting each other through this parenting journey.  Breastfeeding is not always easy.  But it becomes easier with a community of support.  I am proud of Cape Coral for providing this support!  Normalize breastfeeding.  Give a mom a high five if you see her nursing in public!

Here is a link to a video taken from yesterday by the News Press.  It shows some of our wonderful participants!   

http://www.news-press.com/videos/news/2016/08/05/88303080/

Breastfeed with Pride Moms!

You are simply AMAZING!

Florida AWHONN Section Conference

The last few days I have spent with my Florida AWHONN Section family.  I have been a part of the conference committee for the last few years.  It is a terrific group of women who work hard to put this show on every year.  It may look seamless to the attendees, but we have been working via conference calls over the last year since we left Sanibel last year to put this year's conference together.  The committee does everything from finding a venue to have the conference to finding topics and speakers to speak to arranging every little thing that happens during the four days of the conference.  I can tell you my friends did a fabulous job with this conference!  So much fun!  So much energy!   I am also happy that some of the great people I get to work with every day also made their way here to the conference!

AWHONN Lee Collier County Chapter Members

If you ever want to help with any AWHONN Florida committee, just ask!  We are all volunteers.  Volunteers with a passion for what we do and we would be glad to have you! Oh and conference committee..... nice job!   It has been a fantastic conference!

Creating a Sacred Space for Birth in the Hospital

It is important for the birthing space for women to be a safe and private place, as some will call it, a sacred space.  When the woman comes into the birthing place, she should be encouraged to make the birthing space her own.  That is why I encourage women to come on hospital tours during pregnancy and look at the spaces available for birthing.  In this space, she will be doing incredible work, that of bringing her baby into the world.

Here are some things to think about:

• What is in the room?  Is there the ability to have music? Nature sounds? Sounds of ocean waves? TV? DVD?
• Can the room be full of light? or dark as night, even in the day?  
• Are there signs that can be put on the door to keep the room private?  Can you bring your own signs?
• Is there room to walk around in the room?
• Is there room in the bathroom for you and your partner to be in there comfortably?
• What kind of seating is available in the room?
• Any availability to have aromatherapy?   Diffusers?
• Are birth balls available?
• Make notes of the things not there.  If you are going to birth there, you will need to put them on your list.

After the tour, make your list!  What will you bring with you in your birth bag?  Here are some things that women find helpful:

• CD Player or your phone with your favorite play list
• Flameless candles, battery operated tea-lights are great around the tub and around the room  (remember, candles with lighted flame are not allowed)

  

  Flameless candles

• Make your own door sign!  Have fun with this! 

Door Signs for Your Labor Room

• Affirmations for birth.  Signs in the room to look at and give you strength
• Aromatherapy diffuser OR cotton balls with some pure essential oils.  Some favorites peppermint (for nausea), lavender or your favorite (for relaxation), a citrus flavor (to perk you up for the pushing stage)
• Snacks available for you and your partner
• Your own pillows and perhaps a favorite blanket

When you get there:

• Keep the door to your room closed.  Put your door sign up!
• Everyone who comes into your birthing space should knock on the door prior to coming in.
• If there is also a curtain in the room by the door, pull it.  This will set up a double barrier so that others will not walk right in on you while you are laboring.
• Do you have something special you want to wear during labor?  Most of the time, this is ok too!
• Turn on your music.
• Set the lights to how you like them.  Ask if the lights can be turned down.
• Remember, if everything is going great, you do not have to stay in the bed!  Get up, walk around, be comfortable

This is your space while you are birthing.  Make it your own!  Feel comfortable!  
This is your own sacred birthing space!

A Nurse-Doula's Bag of Tricks

My first exposure to doulas came when I was working in Atlanta almost 20 years ago.  My office was in the middle of a long hallway that led to the Labor and Delivery unit.  Everyone going to Labor and Delivery had to walk by my office.  I am not one who keeps the door of my office shut (except when it needs to be of course) on this day, I saw a lady walking by my office with a large ball and a big bag heading to Labor and Delivery.  I was curious so I followed her there.  We introduced ourselves and I found out her name was Teresa Howard and she was a doula coming to be with one of the women in labor.  Teresa is the founder of Labor of Love Doula Services in Atlanta.  This is her logo for her doula business and I still LOVE it! 

I was curious so I went in to watch her do her magic with this mother.  The ball she had was a birth ball.  It was magic.  The mother was able to be upright on the ball and it promoted movement of her hips.  I was so impressed that I asked Theresa to come back and talk to my staff at a staff meeting after this birth.  (I think it may have been Theresa's first speaking experience with a nursing staff, but it was certainly not her last!)  I watched as she was able to work her magic and help the mother through her labor.  Massage and oils were involved.  One to help the mother relax (lavender) and when it was time to push, one to help her wake up (citrus) and get in the groove with pushing!  

I moved to Florida in 2000, but Theresa and I stayed in touch.  I also kept a thought in the back of my mind that some day, I wanted to take doula training and learn all the skills to help mothers in labor.  Labor Support Skills.   I had moved to SW Florida and found myself at a hospital where Birth Balls were the norm.  They are used every day.  This hospital also had nice tubs that mothers labored in and they work like a charm.   I met Polly Perez who was writing a book on Birth Balls and she asked if I would write a quote for her book.  

By 2004, I was ready.  I attended a doula training course and I became a labor doula.  Kind of strange I know:  A nursing director who is also a doula, definitely not the norm.   I  learned all I could on labor support and began collecting things for my own labor bag of tricks.  My bag of tricks includes massagers, stress balls, birth balls including the peanut balls, rice socks, essential oils, and the rebozo.  Over the next few weeks, I will be posting about the use of these tools for labor support. 

It has been great incorporating all these tools into the care of women in labor.  The best part is that I work in a hospital that encourages this for all women.  It is part of our Optimal Healing Environment.  Nurses need to have their own tool kit to use for providing Labor Support for all women and know when to use each tool.  This is a gift we give to laboring mothers.