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Posts tagged ‘delivery’

JUST. SAY. NO. –> You can’t take my baby……

JUST. SAY. NO.

You CAN’T Take MY Baby to the Newborn Nursery!

All too often, we~ as hospital staff in Labor and Delivery- Mother Baby units or the Newborn Nursery, want to take YOUR baby away for this test or that exam saying we’ll be right back.  Well it isn’t always that quick- in fact it is RARELY that quick. One thing leads to another and before you know it, it is 1 to 2 hours before you have your baby back.

This is beyond wrong.

We are horrible for doing this.

We need to be a better support system for you.

I am working on getting all staff involved in increasing our exclusive breastfeeding rates. This begins with the first feeding. (well- it really begins with birth interventions but of course that is a totally different post)…….

Your baby should stay with you until he latches and feeds.

Stay.

Skin to Skin is the best way for him to get accustomed to his new habitat and learn where he will be feeding.

STAY WITH YOU

We can do virtually everything~ all routine newborn exams, procedures and tests at the bedside, with you right there.

Speak up and tell us NO

Thank You

Amazing Woman has an Amazing Home Water Birth

Go GINA GO!

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.

Photo of the TFB Blessingway Group

Here’s one of the beads I gave her for her necklace.

ICAN Cesarean Awareness Bead

Congratulations Gina and John!

Welcome Jolene!

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!

CIMS urges ACOG –> Remove Barriers to VBAC

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.

Additional Information:

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!

NIH Conference on VBAC’S ~ Continuing to Spread the Word

Spreading the word from the NIH VBAC conference….It’s now coming thru via AWHONN Vitals!!!

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!!!!!

From the recent AWHONN newsletter~

“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

America Scores a “D” on the Premature Birth Report Card

_

Hello Everyone

I haven’t disappeared… I’ve just been too busy outside for computer time!

This is a copy of a letter I received today trying to

spread the word

about Prematurity in this country……

Today is the release of the second annual Premature Birth Report Card, and I wanted you to hear the news from me: America receives a “D.” As a country, we are failing to give our babies the healthy start they deserve.

Your state has received its own report card. I’m afraid you’ll agree we have a long way to go. In fact, before the end of this year, more than half a million babies will be born too soon, some very sick.

It’s Prematurity Awareness Day® — the day when we’re all focused on the terrible toll of premature birth on babies and families. The report card reminds us how urgent the problem is. But with the support of people like you, we can continue to fund lifesaving research and programs.

If you haven’t already, I hope you’ll visit our Web site and join the fight for preemies.

Warmly,

Dr. Jennifer L. Howse

President

We Deliver? How about we make it a better delivery?

permission from CartoonStock

permission from CartoonStock

Our Maternity Services

Need Help!

The Maternal Child care delivery system in this country as a whole needs vast improvement. All of these 10 steps as well as the 10 steps to ensure optimal successful  breastfeeding are very important.

These items are sadly grossly misconstrued or ignored by many facilities offering maternity services in this country. I have been having the same discussions and occasional arguments with co-workers  lately on this battle of the newborn baby staying in the moms room overnight!!! I know~ it is a no brainer to those of you who read, research and understand. Many of my co-workers still defend their philosophy that the baby needs to come into the nursery at night so the mom can sleep!!  Many argue with me about labor positions and inductions!! AARRGGHH! I won’t get into our details right now…….

What I have here for you today is NOT new info but I recently reviewed it again as I was searching for evidence to back my discussions with staff. If you haven’t placed this information in your workplace to nudge some resistant peers, I urge you to do so!

This document : THE COALITION FOR IMPROVING MATERNITY SERVICES:
EVIDENCE BASIS FOR THE TEN STEPS OF MOTHER-FRIENDLY CARE
can show you research studies or data which support the ten steps below.

The 10 steps for Mother-Friendly Care from CIMS {Coalition for Improving Maternity Services} taken from their website…..are:

Ten Steps of the Mother-Friendly Childbirth Initiative
For Mother-Friendly Hospitals, Birth Centers,* and Home Birth Services

To receive CIMS designation as “mother-friendly,” a hospital, birth center, or home birth service must carry out the above philosophical principles by fulfilling the Ten Steps of Mother-Friendly Care.

A mother-friendly hospital, birth center, or home birth service:

  1. Offers all birthing mothers:
    • Unrestricted access to the birth companions of her choice, including fathers, partners, children, family members, and friends;
    • Unrestricted access to continuous emotional and physical support from a skilled woman—for example, a doula,* or labor-support professional;
    • Access to professional midwifery care.
  2. Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.
  3. Provides culturally competent care—that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother’s ethnicity and religion.
  4. Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.
  5. Has clearly defined policies and procedures for:
    • collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary;
    • linking the mother and baby to appropriate community resources, including prenatal and post-discharge follow-up and breastfeeding support.
  6. Does not routinely employ practices and procedures that are unsupported by scientific evidence, including but not limited to the following:
    • shaving;
    • enemas;
    • IVs (intravenous drip);
    • withholding nourishment or water;
    • early rupture of membranes*;
    • electronic fetal monitoring;
    • Has an induction* rate of 10% or less;†
    • Has an episiotomy* rate of 20% or less, with a goal of 5% or less;
    • Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals;
    • Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.
  7. other interventions are limited as follows:

  8. Educates staff in non-drug methods of pain relief, and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.
  9. Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.
  10. Discourages non-religious circumcision of the newborn.
  11. Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding:
    1. Have a written breastfeeding policy that is routinely communicated to all health care staff;
    2. Train all health care staff in skills necessary to implement this policy;
    3. Inform all pregnant women about the benefits and management of breastfeeding;
    4. Help mothers initiate breastfeeding within a half-hour of birth;
    5. Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants;
    6. Give newborn infants no food or drink other than breast milk unless medically indicated;
    7. Practice rooming in: allow mothers and infants to remain together 24 hours a day;
    8. Encourage breastfeeding on demand;
    9. Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants;
    10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics

† This criterion is presently under review.

I endorse these steps. You can visit their website to also endorse.

Kathy from Woman to Woman Childbirth Education wrote about the CIMS press release on the Need for Transparency regarding the rising C/S rates. Excellent information is discussed here by the CIMS and I enjoyed the discussion between Kathy and RealityRounds.

I also would urge you all to visit and give information to The Birth Survey.

How is your birth place measuring up to these initiatives?

Let’s all continue to make this a better world

in which to give birth!!

A Full Moon doesn’t always bring lots of babies

Full Moon Flight

A Full Moon Flight?

We had a Full Moon this past weekend. October 4th– according to my calender.  Over the past 35+ years in this business, it has been my experience that the full moon does NOT bring all the babies! We had just one baby born this whole weekend….  and hardly any labor checks. It was eery Quiet. (The “Q” word. Something we only say after our shift!)85902615

The weekend before, however, is another story! We had 13 deliveries during the 2 day wkend and L&D was packed most days during the whole week leading up to this full moon! We had to use a lot of overflow rooms for evals and non-stress tests. Everywhere I turned, it was crazy busy.. and not just in L&D. It seems we get more babies with high bilirubins, more early babies with transitional breathing problems and other little issues whenever we have high census!

In my experience, I have seen the most babies born either on a new moon or the week of waxing or waning of the full moon and not on the actual full moon.  Is it like that where you work?? I would really like to know the experiences of other L&D nurses.

So tell me—  what happens in your world?

No VBAC’s Banned: So Far so Good

iStock_000004564778Small My little hospital is not one of those hospitals which has banned VBAC’s.

We’ve been doing VBAC’s since 1984. Here is our first VBAC story. You may have read and heard that some places had specific policies against a mother attempting a VBAC.  There is really only a small percentage of women who truly are not a good candidate for a vaginal delivery after a cesarean. (Having a previous vertical incision in the uterus for example). There are several places a mother can go to for facts, scientific research, honest information and support if her provider or hospital has denied her an opportunity to VBAC. If this has happened to you, it will be important to do your homework, get the facts and have a really good conversation with your provider. It is important to make an informed choice weighing your benefits and any potential risks.

We do just under a thousand deliveries a year.

From January through July 2009~

We had a 100% successful VBAC rate!!!!

We had 2 mom’s last month that ended up having to go for a cesarean after labor began. I don’t know all the numbers but I had looked over the perinatal data sheets yesterday and I was so very happy to see how we were doing.

Let’s hope we keep it up!

😉

Frustrations in Obstetrical Care …Culturally Sensitive? Oppressive Male Partners?

027 The drama  that went on here this weekend would be fodder for 10 or more Jerry Springer shows!

~Unreal~

I kept thinking…

“Please help me”

I am not and never have been prejudiced or bigoted in thought process, personality or behavior towards others. I am actually on a campaign to help educate our staff on being culturally sensitive and delivering culturally competent care in relation to obstetrical, breastfeeding and newborn care…. I’m currently organizing a quick reference handbook so certain beliefs & cultural values are better understood by our staff.

This type of sensitivity is very important to me.

It may not matter how I say this. Despite me trying to convince you that I am not intending to offend any type of people…..someone will most likely get annoyed or upset. I don’t usually enter into this type of discussion. I am quite adept at diffusing anger. I am not singling out a problem with any specific culture, ethnicity, or country of origin. I am not attributing any certain behavior to any certain culture.

 

This weekend, we had mother’s giving birth who have recently arrived in the United States from the following  areas: Argentina, Poland, Liberia, Egypt, Iraq, India, Dominican Republic and Nigeria. Sometimes their husband,  boyfriend or significant other was from yet another different country.  These are not unusual immigrants for our patient population. It is however,  unusual to have such diversity in a single 2-3 day period!

My concern is this— As a health care provider– how do you even begin to try to understand another’s strong belief’s or values when you are treated with tremendous disrespect and confronted with attitudes which are unusually demanding of the caregivers to “provide” for any and all needs. Now this is of course what we do…. provide for the needs of those in our care. That includes our responsibility for understanding different certain religious beliefs, cultures and their various norms and values. But this should be done within an environment or culture of MUTUAL RESPECT.

As  much as it is our responsibility to provide for those individuals in our care….. to be culturally sensitive. I feel there should at least be some responsibility on the part of the patient — and or their family- to learn what may be expected of them …. to communicate their history, needs and or wishes to the doctors and nurses~~ or at least to try to understand when it is explained to them at the time of birth and not lash out with anger or disrespect to their caregivers.  Is it too much to ask for a little bit of responsibility to understand at least a little something about what is involved in childbirth, postpartum, newborn care and the legal recording of birth in the facility, state and country in which they have come to and chosen to give birth!  {Many times I have been told they came here so their baby would be an American citizen.} Am I allowed to ask that those from other countries try to be somewhat sensitive to and try to understand our culture? I am not trying to victim blame here.  Really. Many of the patients exhibited rude entitled behaviors and were very disrespectful to staff.  We are all “others” to each other –> but one big blending of society. Lets ALL understand and respect each other.

Some of the behaviors we dealt with include:

  • A mother is married, the father of her baby is NOT her husband. The FOB becomes physically violent that his name can not be on the birth certificate–yet– until there is an affidavit submitted that the husband is not the father…. This turned into an all out fist fight between the the 2 men. “SECURITY!!”
  • A husband refused to allow his wife to be examined in labor during his absence, yet left for hours at a time demanding the hospital provide for his transportation to and from his business 15 – 20 miles away.
  • This same father would not allow his wife to speak for herself…. then called our unit many times after the birth when he was not there to say he was sure his wife was suffering from post-partum depression and we needed to treat her!
  • An unmarried young girl had a PFO against the father of her baby — She did NOT want to see his family yet that FOB’s family demanded to be allowed to visit, displaying hostility, speaking loudly and threatening staff  in a non-English language outside the entrance to our unit!
  • Another mother delivered and the father of her baby was currently in jail on drug charges. She met the criteria (for other reasons) where she and her baby were screened for drugs…. Both were positive for cocaine and heroin… sadly.. 😦  This infant needed to be placed in protective custody of Children’s Services and treated for withdrawal. This is always difficult and heart wrenching. This mother spoke very little english, was ANGRY the tests were done and we were not able to help her understand a situation of this magnitude easily with the language line….
  • Frenzied inpatient banging on the window and yelling for the only nurses’s attention to simply ask a question or get more supplies for their infant even though she was involved in an exam with a doctor on a new very sick infant and had signaled she’d be there “in a moment’…
  • The family and multiple extended family members demanding minute by minute updates on a sick newborn, interrupting our care by knocking on the doors and windows to the nursery… after we have explained all  minute by minute updates to the parents of that baby who were at the bedside.  I have a feeling that culture may have placed a value on the elders decisions over the actual parents, but this mother did not want the father’s family to be in the nursery with her. They don’t understand HIPAA or even know what it is! My job is to support the mother and keep her informed and with her baby.
  • A family not wanting to answer most of the questions for the birth certificate because… it was simply an invasion of their privacy. Alright then.. it will remain blank and the Bureau of Vital Statistics can deal with it, right?
  • A father of a baby requesting then ultimately demanding to speak to the doctor ONLY for each and every one of his questions.. (I am just a nurse).. did I mention it was the weekend?? We don’t have doctors present 24/7 !

 

 

There are times when these situations unfortunately occur. Many times the individuals involved are Americans who are 2nd or 3rd generation of mixed ethnic background or are of no discernable ethnic or cultural background, have lived in this country all of their lives and still exhibit the same type difficult personality traits.  Since they are more “Americanized” shall I say-or however is politically correct to discuss it— it isn’t so difficult to diffuse hostility’s, discuss options, assist with birth, newborn care, breastfeeding, do birth certificates…etc. It is my opinion that sometimes they understand things better simply from living here. We will ALWAYS encounter individuals with difficult personalities regardless of background who may be demanding in nature. They may not initially understand what’s happening but usually respond well to a gentle receptive approach.

That was NOT the case this weekend!

I only wish for strength and future guidance to help and support those who don’t quite understand.

Don’t yell at me or treat me with disrespect.

I ask those individuals new to our country to help themselves a little and learn some of our language and the framework for which we deliver our obstetrical care.

Please.

Not your Usual Birth Plan

002

 

A birth plan is usually a written plan from the mother to her caregivers describing her wishes, what type of options she’d like to take advantage of, things she would like to happen thru out her labor and birth, what things are important to her as she experiences birth.  There are various resources out there to help a new mom explore options and formulate a plan.. especially for a hospital birth.  It is important that the mom review this with ALL her care providers AND especially the L&D nurses…. the advocates who help you actually realize the goals with in your plan. I have a fellow L&D nurse blogger who has done extensive research on the topic and wrote a 2 part series on Writing Your Birth Plan- Tips from an L&D Nurse over at nursingbirth. I would highly recommend you check it out especially if you plan on a hospital birth.

Many times these birth plans accompany a mom’s prenatal chart weeks in advance of her birth. Over the years there has been a gradual acceptance of the plans in my facility where historically, there had been much resistance for the mother’s input what so ever.  Much like the attitudes towards homebirth…. The doctors or nurses would casually peruse the plan then toss it aside and have a good laugh…. saying…. ” oh- she’ll end up a section for sure!”  Unfortunately, they were often right about that– many of those early birthplans never seemed to go as mom wanted, giving the staff fodder for snide comments and remarks. Sad but true. 😦

Recently, we recieved a birth plan that was not at all like any other.  Maybe some of you have seen plans like this… maybe some of you actually wished for births like this…. Hey~ who am I to judge? …. I am only here to help,  it isn’t my birth.

Her Birth Plan requested:

  • Pain medication as soon as possible….. I prefer to have an epidural as soon as possible
  • Please do not try to make me have breathing patterns through contractions… I’m afraid I’ll be too nervous
  • If a Cesearean is needed, please put me to sleep
  • I want only my mother with me in the labor and delivery of my baby
  • When the baby is born, I do NOT want to touch him until you clean him off
  • You can do his eye ointment and Vitamin shot, bath and all procedures before I hold him
  • I want to hold him wrapped in a blanket, not skin to skin
  • I want the baby to be in the nursery as much as possible at night so I can rest
  • I want to feed my baby formula from a bottle. I don’t want to breast-feed
  • I want to stay in the hospital for the whole allotted time so I can rest

My first thoughts were… Sweetheart, you could have ALL THIS without even asking!” ……..

Sadly, despite all efforts to improve,  …  things still happen exactly like this for many births.  We just don’t usually see it written out as a formal request or plan!  At least this is how this mother wanted things to happen.

This little mommy came in and delivered vaginally. Her plan was very easily carried out. 😉  I am very happy to report that she and her son were healthy and she displayed very postive interaction with him. Very loving and caring. She was very very happy with her birth and with being a mother!

That is all that really matters in the end.  Options– and what you as an individual would like to have for your birth. How much education she had before chosing these options… I’ll never know.

 Now I am asking the rest of cyberspace world.. have you ever seen birth plans like this???