Happy Birth Day

Thirty nine years ago today I entered the "Torture Chamber" as my sister and I called it years later, a hospital in Middlesex County, Massachusetts, because I was in labor.  The first nurse I encountered asked "Have you had any experience with enemas?" I explained to her I had experience giving them and not getting them.... and that was where it went down hill....My husband and I had taken the "mandatory" childbirth classes offered at this hospital so that he could stay with me and we wanted to have a natural childbirth.  So, after the also "mandatory" enema,  I was supposed to have the "mandatory" shave.   I told them no,  I was not going to have that.  Then I was placed into a labor room which by today's standards looked like an ICU room.  All glass windows, placed on a stretcher, looking out at the nurses station where they "watched" their laboring patients.  Many hours passed where they checked me, and when they  did, they kicked my husband out to the waiting room <after all, he had never seen that part of me before>.  They would then forget to tell him to come back in so I was left for long periods of time by myself laying on my back on my stretcher.  Nothing to eat or drink of course, not an ice chip, not a sip of water..... and after many hours in came one of the physician's wives.  How did I know this was a physician's wife?  She had a mink coat on. One of the hazards of delivering in the holiday times is the goodies that are brought in for the staff, especially when you have to watch through the window and do not get to eat.  This physician's wife brought them some homemade brownies..... and what I would have done for a taste of that brownie!!  Hours pass.... and it is time to push.   They take me to the Delivery Room <looks like an Operating Room> every one is gowned up and sterile with masks on including my husband.   They put a Saddle Block in Now and decide I am needing to deliver  quickly Now...so out come the forceps and a 4th degree episiotomy.... and out comes my daughter... Holly......"wait, I want to hold my baby!".... "No, she has to go over here to get cleaned up and then to the Nursery"....  "Come on Dad, you come with us....." "Is something wrong with her?"  "No she is fine,  Healthy and Fine!"   AND, I am alone again..... Wait!  What just happened???     Where is my baby?  When can I see her?  Tomorrow????  It is only 5:30 PM....   Can I walk to where she is???  NO.... Tomorrow.....  In that hospital at that time we were "allowed" to take exactly one photograph of our own baby for the entire three days we were in the hospital. Oh and I am in a semi-private room with no husband and no baby in the room either.

Some people ask why I do what I do, why do I want women to be given choices in their births.  I think it probably stems back to this experience in the Torture Chamber.....I had two more births after this and I got it right with my subsequent births.  So Happy Birthday Holly!   39 years was a long time ago and a lot of things are much improved now!   I will keep striving to make it better for all women.

It Takes a Village!

At times, running a unit like ours looks like we are on auto-pilot;  very little turnover, great customer satisfaction scores, pretty amazing breastfeeding rates, stuff just happens.  

It runs that way because we have a pretty amazing team. Around 17 years ago, I came on an interview and I knew at that time that this unit was something special and I wanted to be a part of it.  What makes it special are the people that are a part of it.  Of course we have Registered Nurses, Lactation Consultants, Surgical Technologists, Certified Nursing Assistants and Patient Care Liaisons/Birth Registrars, Obstetricians, Certified Nurse Midwives, Pediatricians, Neonatologists, we are a Birthing Suites after all! I have my secretary who does a really great job keeping me organized and making our special seasonal Wall of Babies every month!

We also have some pretty great people that back us up.  Volunteers doing what ever needs to be done to make it special, knitted hats, rice packs, Christmas stockings, blankets, quilts.   Housekeepers keep our unit looking terrific.  You can hear the housekeepers speaking to our patients on a daily basis.  Some of them help us translate for women who are arriving to the hospital for the first time and they are scared.  A smiling face that soothes them is there.   We have Respiratory Therapists who are there in a moment's notice to help us with deliveries.  We have wonderful Dietary people who are there to bring up a snack or the regular meal and are always there with coffee for us too!  Pharmacy Techs bring us medications, Pharmacists check medications for us.  Transport comes up and brings us MORE patients and takes them to places all over the hospital.  Plant Operations is there on a daily basis fixing the stuff we break, changing filters, painting a wall, you name it they do it.  Bio-Med making sure our equipment is safe.  Social Workers and Case Managers helping to solve issues.  Hearing Screeners & Healthy Start.  Laboratory to run our labs for us, Radiology to do our x-rays and ultrasounds when we need them, Cardiology to help with echo's.  Anesthesiology to come for epidurals when we need them...IV Therapy when we just can't seem to get the line in (and we are amazing at putting IVs in ourselves!).  A chaplain when we need to pray.  The Central Supply people who restock our supply room.  Sterile Processing to make sure we have the tools to do our job.  Financial Services there to make sure we pay our bills and get paid every two weeks.

Tonight it was Security who made me feel thankful.  They over heard a family who was distraught and wanted to speak to the person in charge.  So, in a flash they were there to support me and make sure I was safe.  I was, but I felt a whole lot better knowing they were there.  A little over a year ago, we started having Security on our unit to keep us safe and they have become a real important part of our day!  

So thank you.  Thank you to all of you that make our unit look like a well-oiled machine.  Thank you for our village who makes caring for women and neonates look easy.  You are all a blessing in my life.

Taking on a New Department, Taking Care of Self....

Sometimes at work, you are asked to take on new responsibilities or new duties.  This time for me it was a new department.  Well, not that new, I had this department many years ago, but new to me again.  

About six months ago, I was asked to take on this department and the start time was going to be October 1st.  I have had the pleasure over the years of starting departments/units from the ground up.  Heck, I have even had the experience of starting by finding land and building a building!    But, this time it was going to be different, it was taking over a department that was already functioning.  Over the next few months preliminary plans were developed and I was able to interview my new team and hire them/transfer them into their "new" "old" positions.

Oh, and when we started on October 1st we were over census for the amount of staff that were budgeted for the unit....so hence, we did not have enough staff to care for the patients.  There were lots of things the department had in place that were not in place in our hospital.  The team did not "know" me and I did not "know" them.  It was stressful for them and for me too.  

Stress can be good, termed eustress.   Positive stress or eustress (also called good stress) is when you perceive a stressful situation as an opportunity that will lead to a good outcome. 

Stress can also be bad called distress.  Negative stress or distress is when  you perceive a stressful situation as suffering.  The goal is to move your distress to eustress.

So, what do you do to take care of yourself while you are going through stressful situations?    What did I do?  Listened.  Tried to problem solve with the group.  Make one small positive move at a time.  One small win at a time.  Try not to do it all at one time, because guess what, you can't.  Stay positive for yourself, stay positive for your team.  Have a good friend to problem solve separate from the situation.  Learn to smile, learn to laugh at what you can.      Using humor helps!  I also find that eating good food (staying away from junk), exercising (even if it is going out for a walk around the hospital) helps!  Meditation helps me to regroup and to let go.  I do that during the day and in the evening to unwind.  I use an app called CALM to do guided meditations.

https://www.calm.com

We are now in the third month into the change and know what?  We got through a lot of challenges and things are going pretty smoothly now!  People  on the team pulled together and made it work.  We got to know each other.  We are a work in progress!  

I laugh because just as the new department is running some what smoothly,  I am getting ready to take over some job duties of a good friend at work who is retiring in January!  Here we go again!!!                                B-R-E-A-T-H-E!  JUST BREATHE!!  And don't forget to smile!

Treating Employees with Grace

A long time ago, when my oldest daughter was in kindergarten, she was in a play around Christmas time.  At that point I was working in a Newborn Nursery and I had asked my boss if it would be possible to go over to her school and watch her play and come back to work.  I was surprised with her  answer and it was NO.  I promised myself that day that if I was ever in a position to allow people to do important things with their families, I would do it.  A few years later, I was a Director myself and I have tried to stay true to this over the years.

I have been a nursing director at one facility or another for the last thirty years.  Although the locations change and faces of the employees that I have worked with change, the stories are the same.    I have found that everyone at some point in their life is going to need grace.  One thing I know is that you can think it is never going to be "your" family, it always rolls around and everyone gets a chance that they will need grace.  Stuff happens.  Your child may come home and tell you they volunteered you to make 25 cup cakes for their class and they need them in the morning, oh yeah, and you are working that evening at 7 PM.  It is never fun to get that phone call where your child who is in college in another city has been in a car accident, or your mother is very ill but life happens.  Treat your employees with grace.  Treat your co-workers with grace.   You never know when it is going to be your turn to need grace.

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