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Barefoot and NOT Pregnant

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THE BUS!!!  I jumped up and ran outside to the bus stop when I realized I was late to pick up my boys. It was a nice day and I was picturing them alone waiting for me. In my rush I didn’t slip on my shoes. I slowed down when I saw that the bus hadn’t arrived. Then something unexpected happened.  I became aware how wonderful my bare feet felt treading along the side-walk. I could feel ever pit mark and seam in the concrete. I felt the difference in temperature when I crossed from sun to shade. I arrived at the corner and let my toes wander into the grass. What ecstasy! I walked around relishing every texture. I couldn’t remember the last time I had been outside barefoot.  I felt like I had as a child.

Being a birth nerd, I quickly realized my barefoot walk was similar to my unmedicated birth experience. My journey was comfortable and enjoyable. I felt the roughness of the cement, but it added to my experience. I noticed more about that walk  than any previous ones.  If I had worn shoes, I would have missed out on connecting with my environment.  Wearing shoes simply does not feel the same as being barefoot.  I feel the same about natural childbirth. Bringing a baby into this world is a miracle under any circumstances.  Natural childbirth is the barefoot version of birthing.  There is an added dimension that going natural brings to the experience.  The difference between my medicated and natural births were marked and undeniable.  I was more in tune with my body. I was at peace during the storm of contractions.  I felt euphoric and energized after my 3 natural deliveries, which was a surprise after my first two medicated births.

The conditions were perfect for my barefoot adventure. If the temperature had been different, or if there had been broken class on the sidewalk, shoes would have been necessary.  Similarly, it is not safe or prudent for every labor to be unmedicated.  When the conditions are right we have a choice.  Our society has become accustomed to a medicalized model of birth, just as we have become accustomed to wearing shoes.  We forget that there are other choices.  We absentmindedly slip on heels or tie on a pair of sneakers.  In the majority of our healthcare experiences we trust in the safety and necessity of our medical ‘shoes’.  Birth is not inherently medical in nature.  We have been conditioned to believe that the monitors, drugs and interventions are just part of giving birth.  Medical intervention is a luxury and a safety net for a natural process.  If a mother chooses to have an epidural for comfort, great!  If a mother needs to be induced due to a medical issue, we are grateful for the medical technology.  Just as I chose to walk barefoot, natural birth is a choice.  It doesn’t mean I think my birth is better than yours.  It especially does not say anything about any one else’s choices.  It doesn’t mean that I would want to have a surgery without medication, or try to heal my hypothyroid with herbs.  Sometimes its just nice to experience life in a basic way.  I experienced birth with all my senses and I loved it.

 

 

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If Hogwarts was Nursing School

Nursing school is hard! 

It would be nice to magically memorize anatomy or conjure perfect care plans.

What if Hogwarts was your Nursing School?

sorting hat
The sorting hat would assign you into clinical groups.

Professor Snape
Snape would be your pharmacology professor.

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Care Plans would be VERY individualized. 

robes
Wizard robes would come in pediatric cartoon styles.

McGonagall
McGonagall would be the teacher you asked to pin you in the pinning ceremony.

timeturner
Time-turners would be required for every student.

psych
Trelawney would be your Psych clinical instructor.

Hermoine
 Hermione would be the student that kept the class in lecture the day the teacher said it would be a short class.

ron
Ron would ask to study off your indexed and cross referenced notes and then lose them.

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OWLS would be the HESI exam, but everyone knows only the Newt exams get you your license.

voldemort
You would miss out on the whole Dark Lord has returned thing, because you are always in the library’s  restricted section studying acid base balance and Kreb cycle.

graduation
Graduation would be in the Great Hall.

friends
Your nursing school friends are there with you through it all!

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The 5 Worst Nursing Errors I’ve Made

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I, like many of my fellow RNs, have been appalled at the treatment the nurses with Ebola have been getting online and in the press.  Nursing is hard.  Nursing is scary.  Nursing is sad.  Nursing is stressful.  Nursing can kill you and not just from Ebola.  There are lots of dangers to nurses from the smallest bacteria up to corrupt corporations or governments.  Even the patients that we are caring for sometimes kill us.  These nurses have had their reputations trashed and blamed for contracting this terrifying disease.  In support and solidarity with my fellow RNs I am sharing my top 5 nursing errors.

1. The first year I was a nurse there was a huge outbreak of Rotavirus in my community.  Nursing homes were shutting down in quarantines and the med/surg floor was overflowing with vomit and diarrhea.  Everyone was on contact precautions so I should have been safe, right?  NOPE.  I got rotavirus two times that winter.  All the nurses were taking turns being sick at home and sick at work.  As careful as I was I couldn’t help catching the nasty bug.

IV2.  I was inducing a woman’s labor and I had started her oxytocin at 0800.  Two hours later she wasn’t having any contractions.  I had increased the drip every 20 minutes.  When I got her up to use the restroom I saw the problem.  The IV tube had never been connected to the patient and there was a puddle of oxytocin on the side of the bed.  I was so embarrassed to tell the patient and the doctor I had wasted two hours and we were just now starting.

3. I was askmed2ed to be the labor nurse by a patient that I knew.  Her delivery was   beautiful and I was honored that she had asked me to be her nurse.  I was watching her husband cut the cord and smiling like a goober.  Cord blood squirted right into my eye.  I had to leave the delivery and wash out my eye.  We both had to be tested for bloodborne pathogens and thankfully were negative.  I felt terrible and wished that I had just held the blanket up higher or looked away or wore my stupid glasses.

4.   One time I was trying to start an IV on a patient that was admitted for preterm labor.  I didn’t hit the vein on the first stick which is bad enough.  I forgot to hit the retractor button on the needle and poked the woman in the abdomen with it when I reached across her for a bandage.  It barely scratched her belly, but I was devastated that I had hurt that poor mama.

5.  If there is one smell nurses loathe it is the odor of a GI bleed.  I was taking care of a patient with this condition and became overwhelmed by the aroma.  I stepped into his bathroom and puked into the trash can.  I returned to his bedside, after cleaning up the mess in the bathroom, looking pale and remorseful.  That man broke my heart when he asked if I had been sick and then apologized for his smell.

We all make mistakes.  No one regrets those mistakes  more that the nurse whom made them.  I don’t know if these ladies made mistakes that allowed them to get Ebola.  I can’t imagine that they would take the situation lightly.  I assume that they would take every precaution that was afforded them, just as I would have.  Sometimes no matter how careful you are, it is not enough.  While so many people are criticizing these ladies, I will be joining those that are praying for their full recovery.  I also pray that I don’t ever have to live a day in their scrubs.

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Birth Plan Basics: Using BRAIN

image“Well, you are the expert; we will just do what you tell us.” Admittedly it is nice to be regarded as an expert, but these are dangerous words. There is something about wearing a white coat and a stethoscope that grants healthcare professionals great power over their patients. Intelligent women and men come to the hospital and abdicate their decision making power at the door.

Your perinatal team has varied knowledge, training, experience, bias, fear, and motivation. They are experts, but they are not perfect! They have seen a lot, but they haven’t seen everything. Some have not read a new research article in years, some haven’t slept in 2 days, and some had a maternal death patient with similar risk factors as yours. Sometimes they just want to go home on time and your labor is taking too long. Some of them are biased towards low intervention, others have never met a patient they didn’t want to take to the operating room.

When you are admitted to the hospital you will not know what is behind the smiling faces and monitoring machines. In most cases what you see is what you get. Doctors and nurses that are working hard to make ensure you and your baby make it safely through labor and delivery. There are many paths to that outcome. You need to be a part of the decision making.

The first step is to get educated prior to the delivery. Taking a prenatal class is an excellent way to prepare for childbirth. I personally recommend the Hypnobabies course, but there are many other programs available. Check with your local hospitals. They often offer low/no cost courses and you will be able to learn more about how labor is approached where you will be delivering. If you do not have time to attend a traditional class, there are self study options or online courses available. AWHONN, INJOY, and Evidence Based Birth are websites that have great information.

The second step is to make a birth plan. If a written birth plan is not appealing, you can still take time to discuss with your support person and your doctor/midwife your thoughts, goals and wishes for your labor and delivery. Having a mutual understanding can help make decisions during labor easier.

Third: Use your BRAIN! Every decision you make should be collaborative between you and your healthcare team. The most important person in the equation is you. Each time a decision is required, use the simple decision making tool BRAIN.

Benefits: What are the benefits of the intervention?brain

Risks: What are the risks involved? It is important to explore this and get the full list of risks. Many times healthcare providers will mention the most common or the most devastating risks. You need to be told all the risks to be able to make an informed decision.

Alternatives: Are there alternatives? Sometimes there are no alternatives, but in many situations there are alternative interventions that can be attempted. Find out your options and if you have an alternative in mind, suggest it.

Intuition: Take a minute to think and discuss with your support person. What is your gut telling you? Doctors and nurses use intuition to care for their patients too.

Nothing/not now: What if you did nothing? What if you waited an hour or three? Time can clarify most situations. In other situations doing nothing may cause a bad outcome for you or baby. How does doing nothing affect this particular situation?

Being empowered and educated will help you have the birth experience that is best for you and your baby.

Remember to use your BRAIN!

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Why October Sucks

A year ago today I was happily pregnant with my 6th baby and easing into my second trimester. Within 24 hours I knew that my baby was dead. I became pregnant again after 6 months of sorrow and grief. I was over the moon happy and put aside my fears of losing the new life growing within me. I lost my seventh baby by 8 weeks of pregnancy.

Since I work in labor and delivery, each day is a constant reminder of the two little holes in my heart. I’m beginning to see women come in with the due date I should still have. I literally bite my tongue to not cry sometimes when I place the fetal monitors on their growing bellies. When I teach childbirth class for new parents, I can’t watch the birth videos. I thought about leaving this area of nursing, but I couldn’t do it. It’s my life work and I’d be even more empty if I left it behind.

I just discovered that October is Pregnancy and Infant Loss month. I had no idea. My first reaction was a little incredulous. Parents don’t need a special month to remember their loss. All they need is for it to be any day of the week or to get a well wish from someone who still thinks you are pregnant or seeing a TimeHop from about your happy “I’m pregnant” Facebook announcement you couldn’t bring yourself to delete. I have been thinking about it over the last few days, as the one year anniversary of my first miscarriage is closing in on me. Maybe it’s a good idea to have an awareness month for perinatal and infant loss. Maybe it’s a blessing to have an excuse to talk about our wee ones that aren’t with us. Most people don’t want to be “that person” whom is constantly talking about their dead baby. It’s too depressing although incredibly common.

Part of coping is moving on with life and a lot of people are trying to do this every day. But this month is set aside for awareness and it’s not taboo to talk about perinatal loss apparently. So today I will cry while I’m blogging and share my feelings and remember my two little babies I won’t see grow up. Tomorrow I’ll paste on a smile and try not to relive all the horror from a year or six moths ago. Next month will be Thanksgiving and then Christmas and I’ll pretend that my heart isn’t broken, because there isn’t another stocking to be hung up for Santa. Eventually I won’t think about it every day or even every week. It will get easier, but it never goes away.

 

My Facebook pregnancy announcement 1 week before my miscarriage.
My Facebook pregnancy announcement 1 week before my miscarriage.

 

 

To remember and honor the little ones who left us too early, reach out to a parent this month and let them know you remember their baby and are thinking of them. Having someone acknowledge my baby’s existence, near my due date or the anniversary of the miscarriage, has been the most helpful thing anyone has done for me.

 

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Sharing Breastmilk: Outdated or New Solution?

 

Wet nursing, or a woman nursingSkin to Skin another woman’s baby, has always been a part of the human experience. Although this practice has fallen out of fashion for most of the world, it still occurs. In the United States, mothers who feed other women’s babies are most likely doing it through breastmilk donation. There are several milk donation organizations that coordinate the screening, collections, treatment, and distribution of the breastmilk to NICUs (neonatal intensive care units) and newborns throughout the country.

I have heard situations where a neighbor will donate breastmilk to a mother who is struggling or unable to breastfeed. I have seen a community rally around a grieving father and donate breastmilk to a motherless newborn. I thought these situations were rare. I did not understand the vast resources that exist today for breastmilk donation outside of the hospital.

I met Kathleen Little at a breastfeeding support group. She had done everything that a breastfeeding mom is counseled to do to stimulate and establish a good milk supply. Despite her efforts her milk never progressed past the colostrum phase or Lactogenesis I. Kathleen learned through consulting an IBCLC (a board certified lactation consultant) and her physician that she has tubular breasts. Women with this condition have varied success breastfeeding due to having less glandular tissue in their breasts than is normally needed to exclusively breastfeed. Disheartened and spiraling into postpartum depression Kathleen reached out to other breastfeeding mothers for help. Her son was eight days old and wasn’t getting enough to eat. This mom wanted desperately for her baby to have the benefits of breastmilk even if it wasn’t from her breast. One mother put her in contact with a birth center that had a history of giving moms donor milk. Her baby started on donated breastmilk right away and continues to be healthy and thrive. Kathleen knew the donated breastmilk wouldn’t last long so she began searching for alternatives. She discovered organizations that guided her screening of donor mothers and helped her feel comfortable choosing this feeding method for the long term.

She states that one of the biggest obstacles was accepting the fact that she was unable to feed her baby exclusively from her own breast. An ongoing barrier is finding enough donors to supply her son. She supplements with formula when necessary. Kathleen shares, “…formula…isn’t evil, but it’s not what we prefer to have him eating yet.”

Her story amazed and touched me how important it was to her to feed her baby breastmilk. As a nurse red flags go up in my mind when someone tells me they got breastmilk off the internet. The possibility of infection, disease and improper handling overtook my medical brain. My first instinct was to reject her choice as an unnecessary danger to her baby. Kathleen was patient with my questions. She has done her research and referred me to websites that addressed all my concerns and some that I hadn’t thought about.

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Kathleen’s advice to mothers in a similar situation.

1. Don’t beat yourself up if you have low milk production. It’s not your fault. It will drive you crazy if you let it.

2. A baby needs a healthy happy mommy more than he/she needs to attach to a breast to eat.

3. If you reach out for donor milk, do not be afraid to ask the donor any and every question about health and diet or to ask for disease screenings (be willing to pay for this lab work). Full disclosure is the key.

4. You should never have to buy breastmilk from an individual. If you go through a milk bank that may be different. Do replace your donor’s bags!!!

4. Trust your mommy instincts. Only you know what will work best for you and your family.

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Read more about Kathleen’s journey in her own words.

katyohann-2

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Why I love Hypnobabies

During my fifth pregnancy I used the Hypnobabies self study course. I had two deliveries with epidurals and two unmedicated births  I knew I could deliver without pain medication again.  I also knew that birth hurts! I was a skeptic, but after seeing several comfortable births due to the Hypnobabies program I decided to give it a try.  It became a common occurrence for a fist time mother to show up in labor and delivery to check to see if she was in labor, and be dilated to 7 or 8 centimeters.  That really sealed the deal for me!  If a first time mom could be so comfortable I knew it could work for me.  My birth was beautiful and comfortable. I had to be induced and was worried the selfhypnosis would be more difficult to attain, but I was comfortable, laughing and happy throughout the labor process.  I recommend the program to my sisters and friends and they loved it too.  I will use it again if baby number six comes along.

My Beautiful  Hypnobaby click pic for more info
My Beautiful Hypnobaby
click pic for more info
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The Art of Nursing

red mom

Nursing is described as an art and a science.  I learned the science component with hundreds of hours of clinical, classes and study.  I read research articles for enjoyment.  I have used vacation time to attend nursing conferences to sit in hours of lectures to learn the latest techniques and evidence that guides my nursing practice.  Learning the art of nursing has been a more subtle occurrence.

Artists are naturally gifted, but they rely on instruction from the masters of their craft and practice to hone their skill.   I learned the art of nursing at the bedside of my patients.  My patients helped me to develop my compassion, empathy, and patience.  I learned what a person needs to feel comfortable while leaving this world.  Children have taught me how to soothe, smile and distract to ease painful experiences.   Young men addicted to drugs and alcohol have taught me tolerance of choices I do not understand.  Grieving families have helped me to find the best words to comfort.  I have learned that, “I’m so sorry,” is the only thing you can say; and that every silence does not need to be filled with words.

My personal space bubble has evaporated over the years.  Patients and families need a hand to hold or a hug to feel safe and human.  I have learned the art of humor.  Laughter is a welcome treatment in nearly all situations.  I have learned to listen in a way that a person feels heard.  I have learned what people need to hear in order to leave this life or cling to it.  I can motivate an exhausted mother to find her strength and push one more time.  I am grateful to all the patients that have helped me to learn the art of nursing.

I am not an artistic person in a traditional sense.  I can’t sing, paint or dance.

I have sat at the feet of countless people who have taught me the art of being human.  My patients and their families have been both muse and master instructors.

Nurses sometimes forget about the art, and become lost in checklists, charting and extra shifts.  It is easy to view patients as room numbers, ailments or obstacles to having lunch or taking a potty break.  Remember to practice your art.

Patients are human.  Humans need beauty in their lives.

Nurses create beauty at the bedside.

-Carrie Halsey MSN, ACNS-BC, RNC-OB