Continuous Labor Support for Every Woman

Last year at the AWHONN (Association Women's Health Obstetric and Neonatal Nurses) national convention I spoke with two other colleagues, Catherine Ruhl and Paris Maloof-Bury on Labor Support for Every Woman:  Changing Unit Culture.  This is a topic that the three of us are very passionate about.   We are also huge AWHONN supporters and volunteer for AWHONN in many different ways.

In late summer we were contacted by AWHONN because they were interested in revision of the Position Statement that was originally approved in April of 2000 and revised and retitled "Nursing Support of Laboring Women" and re-approved in June 2011.   We were very excited about working together again this 'new' project and met with AWHONN in August and then by synchronizing our calendars and our time zones (Cathy lives and works in New Mexico, Paris lives and works in California and I live and work in Florida) set up some meetings where we could hash out the position statement.  We used Google docs and went back and forth with ideas and sharing to get the best possible document to send back to AWHONN in October.  

During this time I was also working with the Florida Perinatal Quality Collaborative on the development of the PROVIDE Initiative that would be rolled out to hospitals across Florida to work together to decrease the primary cesarean rate for Nulliparous, Term, Singleton, Vertex deliveries.  This Labor Support for Every Woman AWHONN Position Statement will be very helpful for hospitals working to decrease their cesarean rates.

I am pleased to report that the newly revised Position Statement, Continuous Labor Support for Every Woman was just published in JOGNN this month!   Here is a link to the article:  http://www.jognn.org/article/S0884-2175(17)30482-3/pdf

Nurses often ask me how do I get involved with AWHONN?   I give this advice, first, join.   Go to the chapter meetings in your area, go to the section meetings in your state and then try to go to the national convention every year.   Reach out, ask if you can help and you will be surprised who will take you up on your offer!   Follow your passion.  Meet with other colleagues and don't be afraid to make new friends outside of your organization!   

p.s.  Let me know what you think of the position statement!

Connecting NICU Mothers to their Babies

A little over a year ago, one of my staff nurses found a system called the NICView that allows mothers to see their babies 24/7 using a webcam technology.   This seemed like it was going to be an easy thing to implement for our unit, except for the money it was going to cost to implement, I thought it would be an easy sell to get it put into place.   Who doesn't want a mother who has a baby in the  Neonatal Intensive Care Unit to have access to see her baby all the time?

Here is a link that explains what the NICView System is: http://www.natus.com/index.cfm?page=products_1&crid=1027

What I found out was it was not as easy as I had thought.   I had to use a lot of my negotiation skills to get this approved and then the staff nurse who had the idea took this to our hospital volunteers and they decided they would fund this remarkable system for our unit.   
A policy had to be written, a consent had to be written and we had to work through all the implementation pieces with our Information Systems department.  

In November, we implemented the NICView and it has been a great success story.  It is so wonderful to hear the stories of the mothers with babies in our NICU saying how it brings them peace when they are not with their babies.  They can turn on their phone and see their baby and it allows them to fall asleep easier knowing their baby is ok.   

To Amy, RN who brought the idea to our unit, thank you!  To our Volunteers who helped us purchase the system, thank you!  To our Information Systems team who helped with the implementation, thank you!   To our Risk Managers and Legal Services, thank you!  To my Security Department, thank you!   WE love this system!  Optimal Healing Environment, that is what it is all about!

The Florida Highway Patrol and Me

So today, I had a great experience!   I had an early morning appointment with my ophthalmologist (Point A) to check on my cornea transplants followed by a meeting at the Children's Hospital (Point B) with the Vice President and NICU Director.   I was driving from Point A to Point B and stopped at a stop light to turn left.  A Florida State Trooper car pulls up on the right side of me and motions for me to roll down my window...

Thoughts go through my head.... What is wrong with my car?   Did I turn my directionals on?  Was I speeding?  Is it because I have this hot red Kia Sportage with a UGA Bulldogs tag holder? Oh no!

I roll down my window.... He says to me...."What's the deal with 40 Weeks?"

I laughed. "40 Weeks is the number of weeks for a full term pregnancy!!  Takes 40 Weeks to grow a baby!!  I deliver babies!" 

He responded with a smile, "Oh Ok Ma'am!  That is cool!  Makes Sense!  I just had to ask!!"

I start laughing and say, "Have a great day!"   

You made my day Officer!    Go the Full 40!

Surviving Hurricane Irma in SW Florida

What I am thankful for...

<in no particular order>

The leadership team at the hospital where I work. Long stressful hours, keeping their cool and keeping everyone safe in our care. Praying when things got hairy as a group.  

My team. Long stressful hours, smiling, good snacks, their professionalism and expertise in taking care of patients and families, including some very complex cases during the hurricane. Right down to seeing people who do not usually do housekeeping services routinely, doing them and whatever else needed to be done.  

The physicians and midwives who stayed with us in the storm. Thank you. Not one complaint.

The support staff... Security, Plant Ops/Construction, Food Services, Housekeeping, Information Systems, Pharmacy, Lab, X-Ray, Care Management, Social Work...Some of these people took the brunt of the abuse from people who should have been thankful that they were there during the storm. I thank you. You were amazing.

The people who worked in both the Pet Shelter and the Child Care Center. Thank you Thank you. It made such a difference to our team to have you there and care for their littles and fur babies. 

Hugs. No matter who you are, if you gave me a hug, I thank you. Hugs are good.

Families of my team who were there sheltered on my unit. Thank you. Thank you for being great during the storm. Helping and volunteering to do what ever needed to be done. The kids were amazing! And who can't smile with cute little kids around? I also learned the second verse of the Star Spangled Banner from a 95 year old dad! We had two elders who were with us too and so special to us.

The pregnant ladies and their support people in the Stork's Nest. They were wonderful and appreciative. Even though several of them went into labor and we had to deliver them! 

The patients and their support people on our unit. Why? because they were amazing too. Even when we had to move them into the hallways to be safe, not one complaint.

The people in the Command Center. They were great at coordinating the show and getting us information when we needed it.

Us, Monday Morning After the Storm

Tonight I can rest because I know my Team B will be there picking up after the storm and continuing to keep people and families safe under their loving care.

Looking out the window on the 5th Floor at our Cape Coral
Hospital, We are the Heart of the Community!

I thank you!

Sign, Sign, Every Where a Sign!

I work on a LDRP obstetrical unit.  This means, in one room, we may have a woman in labor, the next room a mother/baby couplet, the next room an antepartum patient, the next room a cesarean birth mother baby couplet, the next room a gynecological surgical patient.  It is important to know who is in what room and to maintain the privacy of each patient.  We have a lot of signs on our unit to help us do this.

One of my favorite signs is one we have on every laboring mother's room.   It looks like this:

Labor Room Sign Lee Health

I like this one because it makes everyone who is entering the room take a deep breath and enter the room with intention.   It brings the family voices down and helps with providing the woman respect for doing the hard work of labor.  

We encourage women to be up and about when they are in labor. Walking and movement is great for supporting the natural birthing process.  We have noticed that women read the things on the unit walls when they are up doing their labor walks!  A few months ago, we started posting some positive affirmations for women around our unit.  <as well as some cute baby sayings>  What do you think of our affirmations so far?

 Be Awesome Today

Do Something Amazing

Enjoy the Little Things

Be the Reason Someone Smiles Today

She Believed She Could so She Did

Sometimes the Smallest Things Take up the Most Room in Your Heart

A Person's A Person No Matter How Small

Believe In Yourself

Nothing is Impossible the Word itself Says I'm Possible

Enjoy!  Don't forget to enjoy the little things and be the reason someone smiles today!

My Little Bag of Sunshine

I just returned from the Florida AWHONN Section conference that was held in Jacksonville, Florida.  As part of the leadership team for Florida AWHONN I was a part of a   leadership meeting prior to the conference starting and we were each given a beautiful bag with our name on it and some very colorful pieces of blank paper!

Our Florida Section leader, Dr. Shannon Morse, asked us each to write something about each of the other leaders around the table.  It could be anything, something you liked about them, some thing they do that has inspired you, something that they did!  We had a few hours to write our thoughts and then deposit them in each other's bags.   It sort of reminded me of valentines day a long time ago when I was in school and we did this with our valentines day cards!   

When you are surrounded with so many amazing women that you do not get to see every day, but know they are all making a difference in their communities promoting the health and well being of women and newborns, you have a lot to say about them.  These are some pretty special women to me.   

Tonight, I made it home from the conference and sat in my bed, opened my beautiful bag and read my colored pieces of paper from my friends and it really touched my heart and made me smile.   It also made me think.  We all need to reach out and touch the people who make a difference in the lives of others.  Tell them that they make a difference. I will strive to do this more often.  

A lovely experience that you had us do, Shannon! I am very inspired once again at AWHONN!

Our Journey to Become a Baby Friendly Hospital

The Baby Friendly Hospital Initiative is a program that was launched by the World Health Organization and the United Nations Children’s Fund in 1991 to encourage and recognize hospitals that offer an optimal level of care for infant feeding and mother infant bonding.  The program recognizes and awards facilities that successfully implement the Ten Steps to Successful Breastfeeding and the International Code of Marketing Breast Milk Substitutes.  This program assists the hospital to provide mothers with the information, confidence and skills needed to successfully initiate and continue breastfeeding their babies or feeding their babies formula safely.   The journey is exciting, challenging and worth it!  Our journey has created opportunities for development of a high performance team and has built leadership skills among our staff.  The team is very proud of our work on the Baby Friendly project.  It has definitely enhanced our patient satisfaction and has improved health outcomes for our mothers and babies.

Becoming a Baby Friendly designated hospital is a comprehensive, detailed and thorough journey toward excellence in providing evidence based maternity care with the goal of achieving optimal infant feeding outcomes and mother infant bonding.  During the process, the facility has to examine, challenge and modify policies and procedures.  It requires training and skill building of all levels of the team.  As part of this program we decided to certify all of our Women’s Services Registered Nurses as Certified Breastfeeding Counselors.  We currently have 100% of our nursing staff certified.

In support of Baby Friendly USA 10 Steps to Successful Breastfeeding, the Florida Breastfeeding Coalition designed the Quest for Quality Maternity Care Award program in 2012 to reward birthing facilities in the state of Florida for improving hospital maternity care and infant feeding practices based on the Ten Steps to Successful Breastfeeding.  The program awards a series of 5 stars for each level of the program ending with Baby Friendly Hospital designation when the fifth star is awarded.  The Women’s Services team at Cape Coral Hospital embraced the program and applied for the first star in July of 2012.  In October 2012, Cape Coral Hospital became the first hospital in the state of Florida to receive the one star award.  As the team continued to implement more of the 10 Steps to Successful breastfeeding they have had the honor of being the first hospital in the state of Florida to receive the second, third and fourth stars.

One of the important steps of the Baby Friendly Hospital Initiative is providing skin-to-skin care for healthy mothers and infants immediately after birth and for the first hour after birth.  In 2011, Cape Coral’s rate of skin-to-skin care was 48%.  Currently, the rate skin-to-skin care is 90%.  In 2012 Cape Coral Hospital implemented the Gentle Cesarean program where babies born by cesarean birth were able to go skin-to-skin in the Operating Room.  This program was well received by the birthing community in Lee County.  In May 2013, Cape Coral Hospital became the first hospital in the United States to place triplets skin-to-skin with their mother in the Operating Room during a cesarean birth!

In 2015 Cape Coral Hospital joined the EMPower Breastfeeding program (Breastfeeding Enhancing Maternity Practices, a hospital based quality improvement initiative focusing on maternity practices leading to Baby Friendly designation).  This initiative was funded by the Centers for Disease Control and Prevention’s Division of Nutrition, Physical Activity, and Obesity and is implemented in partnership with the Carolina Global Breastfeeding Institute and Population Health Improvement Partners.  This program gave the hospital the funding needed to enter the Baby Friendly USA 4D Pathway to designation.  Currently Cape Coral Hospital is in the 4^th and final phase, the designation phase.  We expect to have a site visit from the Baby Friendly USA team in the fall of 2017.  

This project has had many other benefits to our community in the formation of Breastfeeding Clubs for women in our community, the formation of the Lee County Breastfeeding Coalition, and a closer working relationship with the Lee County Health Department and the hospital.

I can not wait to write the blog post that says we ARE a Baby Friendly Designated Hospital, but until that time, if you are trying to decide if you should go on this journey, do it!  It is important for the health of women and for the health of our babies.  Food is Medicine, right from the start!