NANN Conference

There are a couple of things I want you to understand when reading this. This comes from a neonatal nurses conference. I am not a neonatal nurse. I am a labor and delivery nurse who on occasion plays the role of a neonatal nurse until someone who knows more about it than me, gets there to take over.

OB nurses get grouped together because so much of what we do needs to be seamlessly overlapped. I am the L&D nurse, I will take care of you when you are pregnant, and if all goes well for the next hour or two after you give birth, if there are complications I will continue to take care of you. A neonatal nurse will (hopefully) attend your delivery, and care for your baby during the time that I am still taking care of you. Post-partum or Mother/Baby nurses will take care of you when all is well with you and your child. It is our goal, at least where I work, that mom and baby are never separated. If you have a sick or premature baby that requires medical treatment for those reason the neonatal nurse becomes the most important of your nurses. As an L&D nurse, I can help you breath rhythmically I can implement your birth plan I can hold your foot/leg/hand/head while your pushing junior out. I can help you breast feed for the first time, I can also give you pain meds if you choose to go that route. These along with a whole laundry list of others are things that I can do very effectively. I have had some basic, down & dirty, training on taking care of your infant if you blow it out before anyone else gets there, and we will laugh about it some time in the future. However, in the past 18 months I have found my self in situations where I didn’t catch a “perfect” baby. I do not feel that I can effectively fulfill my obligation to mom, if I am unable to safely resuscitate her baby, should that be necessary. I don’t have exact statistics, but in my line of work 99% of the time I am in the happiest place in the hospital and the other 1% is the saddest place in the world. I want to make that 1% a much smaller number, so I have begun seeking education for myself, to assist the seamless overlapping of neonatal care. For the last 4 days I have been in Las Vegas attending the National Association of Neonatal Nurses (NANN) Educational Conference.

Terms:

Neonate – any baby less than 8 weeks old, premature babies from birth to a corrected age of 8 weeks.

Corrected age: age since birth minus number of weeks premature. So a baby that was born at 37 weeks, 6 weeks ago would have a corrected age of 3 weeks

Now to the guts of my learning adventure.

Monday:

Did you know it was important to keep a baby warm? Of coarse! Did you know that allowing a baby to get cold could cause brain damage and organ failure? Umm no. I also didn’t know that our radiant warmers were not effective sources of warming a very low birth weight baby. So if you delivery at 26 weeks or so and we saran wrap your baby, it’s because we are trying to help it maintain the heat it had inside you.

Having a baby requires an adjustment in thought process. Shocking, I know. But I sat in on a lecture by a woman who has spent the better part of her career researching ways to educate parents of sick or premature infants.  I wont go into all the technicalities but I will say that sometime what we say and what you hear are two very different things, so even if you think you understand us, repeat it back to us, so we can all be on the same page. And along those lines, if you have questions, make sure you get answers before we leave the room. We have a tendency to think if you look ok, and sound ok, that you are in-fact, ok. This is often times the case and we have no way to know unless you tell us. A birth plan helps us give you the birth you want, as far as I know there is not a “post-partum” plan, and we need to know how to give you the post-partum experience you want.

And then there were venders!

I would like to take a minute and throw in some plugs for people/companies that are doing amazing things.

Simple wishes simplewishes.com is a company founded by four sister, two of which were there. They make a hands free pumping bra, that will get you through house work, homework, pumping at the office, or for those whose baby never learned to latch, exclusive pumping is really what this was designed for

Avent couldn’t have been friendlier. They are sending me samples, and at least appeared to be interested in my suggestion for making their breast feeding products even more breast feeding friendly.  They even sent some products home with my friend who went with me to assist an exclusively pumping leaky friend of hers who was struggling. Big thumbs up guys!

Snappies snappiescontainers.com make breast milk storage containers for real people. They are not only cute and functional but they can turn into snack containers when your nursling is a little older. Or they can hold shampoo and lotions when your traveling. This is one group that is making breastfeeding easier and more mainstream! Yay Snappies!

Mighty Medela was there. They have some new products to support breastfeeding NICU babes. Not something that is available commercially but I give them 5 stars for making the lives of nurses, and moms pumping for their NICU babies easier.

A company whose demonstration made me tear up was Memories unlimited. They make memory type items for the above-mentioned 1%. I wont go into detail because I wish no one ever had to think of these things, but the next time you say a prayer, or light a candle, do one in honor of these people.

Tuesday: (ok most of this day was very nurse specific, but some things for parents to be aware of)

We learned of a great program for NICU graduates. A hospital in California has implemented a 10 week program that assist parents of neonates who were in the NICU and have special needs once they get home. The program incorporates diet and nutrition, breast feeding, postpartum depression, occupational therapy (OT) to aid development of the neonate. The OT teaches parents how to massage and stretch babies to allow for comfy tummy time, which aids in development. This is a comprehensive support program that I am in awe of. My friend and I are very excited to begin our own program like this at our hospital. 

Endocrine Disprutors effect the development of all babies. These are chemicals in products we all use every day, and NANN is working with others to get rid of these harmful chemicals. For more info go to endocrinedisruption.com and if you feel so inclined write a letter!

www.cdc.gov/getsmart information on antibiotics that YOU NEED to know!

There were not any specific education offering related to breastfeeding, however, EVERY thing we learned reinforced how important it is for babies to have their mothers milk, especially the most fragile babies.

Now its time for me to go pick up my kids off the bus, I’m glad I took the time away from them to gain more insight on such a sweet population, but for today, I’m just thrilled to spend some time with my contribution to the population!

My final thought is simply this, Parents, doctors, Nurses, and anyone involved in bringing a child into the world need to work together, and stay current on treatment options, and health risks. These little guys are our future! 

NANN Vegas here I come

I'm getting mentally prepared to leave my family for 4 days to attend the National Association of Neonatal Nurses conference in Vegas. I'm so looking forward to learning more about the most precious patients ever, and I'm stoked to find out that many pro-breastfeeding companies will be there. Its about time that someone makes money from promoting what's best for babies, especially sick ones! instead of companies promoting ole #2. I haven't received a single advertisement from any formula companies that will be there. I hope I learn some new things that I can pass on to my patients and moms with questions on forums like The Leaky B@@B! I love that site!

SANE

Saw an amazing presentation by our ER nurses about being a Sexual Assault Nurse Examiner (SANE). What a truly amazing group of ladies! I'm hard core into issues that effect women's health. This is such an overlooked and under reported issue! Current stats say that 1 in 4 college females will be sexually assaulted! Living in a college town, thats a big shocking number, its approximately 5k a year just in my back yard! And it doesn't just effect females, its also a male issue, but more prevalent in females. If that many people had cardiac problems or birth defects the medical community would be raging, and working on a cure. I hate to admit that I'm a part of that community that is painfully unaware of how this plagues our society. Lots to think about....

gender

Wondering what makes a girl "girly" or tom boy. I know it has a lot to do with society and parenting but I have 3 daughters that I think I have raised exactly the same. I have one uber girly girl, one muddy scrapped knee'd little t-ball player, and one that is some where in between. I have been told my son is "all boy" by some and that he is "so sensitive and sweet" by others. What gives? Is it DNA? Is it birth order? hmm...

dedicated little girls!

I've been talking to moms lately who toddlers refuse to wean ;) GO TODDLERS GO!!!!!

The best part of being an OB nurse and a mom is getting to come home and practice what you preach

Never underestimate the power of a woman

After 2 days of laboring, and baby not looking so great the decision was made to go to the OR and section this kid into the world. We all hoped she could delivery on her own and gave her 3 final tries, as they are rolling her into the OR, out pops baby!!! Vag delivery in the OR!!!! Good job mommy!
PS that was the most normal part of my day which included 4 deliveries, all gingers!!!

funnest thing I've seen in a long time

http://www.youtube.com/watch?v=daOHSxxb9ug

Mean Little monkey

So my 7 year old is playing with my 1 year old and kept saying she was being a monkey. The one yr old gets excited and gets tangled up in the 7yr olds hair. The 7 yr old then says "stop it, mean little monkey"

being the baby

I wonder what its like to be the youngest. I'm number 3 of 7 children so I have bigs and littles of both genders, and feel blessed. My older 3 children have seen me with their littles, diapering and breast feeding, dealing with colick and teething, and balancing 4 kids, school, work, and life in general. It makes me wonder what the youngest one will have to go by when she has children of her own. I'm convinced that my middle two children will breastfeed, and I hope that they will be laid back and not get too stressed when they have a crying baby at 2am, but what about the littlest little? my littlest little is only 12 so she has been around the rest of us when we had babies, and went to college, and learned to ride a bike and all the stuff that the bigs get to do first. Maybe its the circle and my youngest child will get to hang with her aunt in L&D and do diaper duty so she can get a nap. hmm, the future hold so much that I wonder about. Any littlest littles, or onlys, out there have any insight for me?

questions...

If you had the car seat that God designed for you baby to ride in, already strapped in your car, would you run to the store and get a different one so that someone else could strap him in?

World Breastfeeding Week Give-a-way!!!

http://www.ifbreastfeedingoffendsyou.org/2010/07/enter-to-win-free-breastfeeding-logo.html
Enter to win a FREE breastfeeding logo cloth diaper!

Statement of the day

"no one should live inside an angry cow"

foreign breastfeeders

One of my patients today was from another country, spoke english as a 2nd language, and had a really hard time breast feeding. I had a hard time explaining things to her, so I called around and there wasn't anyone who could really help me. After spending most of the day working on this, she was finally latching beautifully! Very satisfying! And the silver lining was when she asked how long she should take her prenatals, I asked how long she planned on breast feeding, she replied "at least 2 years, maybe 3, I dont usually breast feed very long"! Love it!

A nurses prospective of breast feeding promotion. Posted for world breastfeeding week carnival @The Leaky Boob. This paper was originally written for a nursing school project.

Healthy People 2010 Breastfeeding Initiative

Jackie Thurner

Indiana State University

Abstract

This paper will discuss the Healthy People 2010 goal 16-19 “Increase the proportion of mothers who breastfeed their babies” (1998). This paper does not explore alternative feeding methods and does not claim that all women should breastfeed. The Author acknowledges that certain medical conditions prevent breastfeeding. The information presented in the paper highlights some of the benefits of breastfeeding, but focuses on how health care professionals can encourage, support, and educate the public. The goal of this paper is to address practices related to the promotion of breastfeeding.

History of Healthy People 2010 Goal

As nursing is moving toward a preventative model, it has become increasingly necessary to identify behaviors that prevent illness, or lead to overall wellness. Breastfeeding is widely acknowledged by health care providers as having many benefits to both mother and infant. However, the number of women who choose to breastfeed remains relatively low.  According to the Department of Health and Human Services (DHHS) (1999) the number of infants who were breastfed in the early postpartum period was 62% in 1997, and by six months of age dropped to 26%. These numbers were improvements over the previous seven years but failed to meet Healthy People (HP) 2000’s goal of 75% and 50% respectively.

Current goals of HP 2010 for early postpartum period and at six months have not changed since HP 2000. However, goals have been added to improve breastfeeding rates through one year of age, and exclusive breastfeeding through three and six months of age (HP 2010, 1998). A progress review revealed that as of February 2010, breastfeeding rates have improved since HP 2000, but continue to fall short of desired goals (CDC, 2010). 

Reasons for Achievement or Failure

The Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) provides up to date information on the current activities related to health care topics. A 2008 MMWR reported that hospitals across the United States were participating in practices that discouraged successful breastfeeding. These practices go against what is considered evidence based (CDC, 2008). These practices are often to either curb fussiness in a newborn or to ease the new mothers fears of not providing adequate intake or nutrition for their baby (Gatti, 2008). 

While the HP 2010 goals have not been met since they were set in place nearly twenty years ago, they cannot be considered a failure. Major increases have been seen. Especially in hospitals that have or are in the process of implementing programs aimed at improving breastfeeding rates.

Review of Literature

Breastfeeding is a woman’s choice. No new mother should feel forced to nourish her child in a manner she is fundamentally uncomfortable with. Expectant parents need accurate, and current information regarding their options in order to make an informed decision on what to feed their infant (Gatti, 2008). This information should not be given in large doses to a woman who has just given birth. A perinatal education approach is best, it allows the mom to receive more information, have time to process the information, come up with questions that she will have time to get answers to, and allows her to share this information with the support people in her life (Griese, 1996). 

Infant formula is a source of nutrition, not a substitute for breast milk. When mother and child are in close contact, breast milk self adjusts to the infants needs. It not only adjust in amount, but it changes the concentration of fat, water, proteins, and antibodies, to accommodate a growing baby, exposure to viruses, and the current environment. The breastfeeding relationship is so beneficial because it is specifically designed to be perfect for that child. While some benefits are gained by using donor milk over formula, the optimal choice is milk from the infants’ actual mother. It is produced for the child, based on gestation age and length of time since delivery, making it vital for sick or premature babies. Breastfeeding is also healthy for the mother. It has been proven to reduce the risk of devastating illnesses such as breast and ovarian cancer, and type two diabetes (Godfrey and Meyers, 2009).

The United States Breastfeeding Council (USBC), boasts the many benefits of breastfeeding. Beyond the basic bonding experience and immunological benefits, the economic benefits on the entire healthcare system are impressive. According to the USBC formula fed infants cost US taxpayers billions every year. The council claims, based on its research findings, that Americans spend $2 billion annually on milk substitutes, mostly infant formula. Insurance companies and programs like Medicaid spend $1.3 billion a year more on formula fed babies for sick visits than their breastfed counterparts. The Women, Infant, and Children (WIC) program funded by the United States Department of Agriculture (USDAG) spends $578 million per year to provide infant formula to low-income families. According to the USBC for every 10% increase in breastfeeding among WIC participants the USDAG would decrease costs by $750,000 each year.

Role of Government Agencies

Breastfeeding laws are carried out primarily at the state level. Indiana law (Ind. Code 16-35-6) protects a breastfeeding mother’s ability to breastfeed in public, or express breast milk at work. Maryland makes breastfeeding supplies tax exempt, and New York has developed a breastfeeding mothers Bill of Rights. However, states like Michigan and Alabama only have laws that exclude breastfeeding from public indecency rules. Quite a few states even have laws that allow a breastfeeding mother to be excused from or permitted to postpone jury duty (DHHS, 2009).

A program designed to increase the number of mothers who breastfeed successfully is the Baby Friendly Initiative. Created by a collaboration of groups that work to decrease worldwide health disparities, including the World Health Organization (WHO) and UNICEF. This initiative gives hospitals a set of ten guidelines to promote the decision to breastfeed, and support evidence based practice to minimize breastfeeding problems (Meyers and Turner-Maffei, 2008).

Implication for Nursing

With the many benefits of breastfeeding, and those benefits increasing as they reach the sickest and most fragile neonates the role of the nurse becomes a large factor in the overall success of breastfeeding. Nurses must be patient advocates, they must support and assist the breastfeeding mother whenever possible. In light of the increasing number of mothers who breastfeed, hospital and health care system wide plans should be put in place to support a breastfeeding mother on a medical-surgical unit the same as an obstetric unit. It is important that all nurses be trained for safe medication administration to the breastfeeding mother as well as proper collection and storage of breast milk (Wenner, 2007).

Knowing the nurses role in promotion includes understanding the mothers’ perception and functional ability. Breastfeeding, having a new baby, recovering from delivery, having a sick, early, or small baby are individually exhausting events. When all of these are put together in a short period of time, the new mother needs nursing support even more. Mothers of sick or preterm infants often blame themselves and agree to breastfeed as a way to fix what they feel they have messed up. Nurses must know when to encourage mom to take a break, and need to be aware of their personal values when encouraging breastfeeding. In some cases especially with a sick baby, providing breast milk is the only connection between mom and baby. That should be utilized, not enforced. No mother should be made to feel guilty or inadequate about her decision, only educated and supported (Lee, Lee, and Kuo, 2009). 

Role of Support Groups

Support groups can be controversial in breastfeeding. Evidence shows that a support system is vital, but this typically refers to the other parent, grandparents, and others who will be caring for the infant. The perinatal period can seem like everyone in a patient’s life has an opinion on what they should do with their body and their baby. This can be stressful to the mom. One study showed that if mom wanted or sought out peer support it was beneficial to the breastfeeding experience, but was viewed negatively and as an inconvenience when presented unsolicited advice (Dennis, 2002). 

Conclusion

Because of the many benefits of breastfeeding, it should be encouraged and supported. Hospitals need to have an evidence based plan to provide education and support to expectant and new parents. Nurses, because of their unique relationship with patients, have the responsibility to assist the new mother in establishing a successful breastfeeding relationship with their child. When the entire healthcare system comes together to support this initiative, breastfeeding rates will rise to meet and likely exceed HP 2010 goals.

Reference:

Centers for Disease Control and Prevention (CDC) (2010). CDC wonder: Data 2010. Retrieved March 28, 2010 from http://wonder.cdc.gov/scripts/broker.exe

CDC (2008). Breastfeeding-Related Maternity Practices at Hospitals and Birth Centers --- United States, 2007. Retrieved February 30, 2010 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5723a1.htm

Dennis, C. (2002). Breastfeeding peer support: Maternal and volunteer perceptions from a randomized controlled trial. Birth: Issues in Perinatal Care, 29(3), 169-176. Retrieved April 8, 2010 from CINAHL database.

Department of Health and Human Services (DHHS) (2009). National Conference of State Legislatures. Retrieved February 1, 2010 from http://www.ncsl.org/issuesresearch/health/breastfeedinglaws/tabid/14389/default.aspx

DHHS (1999) Progress review: Maternal and infant health. Healthy People 2000 retrieved April 5, 2010 from http://odphp.osophs.dhhs.gov/pubs/hp2000/PROGRVW/materinfant/maternalprog.htm

Gatti, L. (2008). Maternal perceptions of insufficient milk supply in breastfeeding Journal of Nursing Scholarship 40(4) (pp 355-63) Retrieved Feb 28, 2010 from CINAHL database

Godfrey, J. (2009). Toward optimal health: maternal benefits of breastfeeding... David Meyers. Journal of Women's Health (15409996), 18(9), 1307-1310. Retrieved April 1, 2010 from CINAHL database.

Griese, M. (1996). Promoting breastfeeding success through prenatal education. International Journal of Childbirth Education, 11(4), 30-31. Retrieved April 1, 2010 from CINAHL database.

Healthy People 2010 (1998). Maternal, Infant & Child Health. Retrieved January 13, 2010 from http://www.healthypeople.gov/Document/HTML/volume2/16MICH.htm

Lee T. -Y., Lee T. -T. & Kuo S. -C. (2009) The experiences of mothers in breastfeeding

their very low birth weight infants. Journal of Advanced Nursing 65(12), 2523–2531. doi: 10.1111/j.1365-2648.2009.05116.x

Meyers, D., & Turner-Maffei, C. (2008). Improved breastfeeding success through the baby-friendly hospital initiative. American Family Physician, 78(2), 180. Retrieved April 1, 2010 from CINAHL database.

United States Breastfeeding Committee (USBC) (2002). Benefits of Breastfeeding. Retrieved March 18, 2010 from http://www.usbreastfeeding.org/LinkClick.aspx?link=Publications%2fBenefits-2002-USBC.pdf&tabid=70&mid=388

Wenner, L. (2007). Care of the breastfeeding mother in medical-surgical areas. MEDSURG Nursing, 16(2), 101-104. Retrieved April 1, 2010 from CINAHL database.

breast feeding help; is it helpful?

So I get paid well to do what I love! I am very blessed. I have always supported breast feeding, and I am very comfortable with new moms. But I often wonder if I over-help. Sure first time moms need someone to show them how to get a good latch and teach them about breast care, and diaper counts. But, is there something to be said for letting them figure it out? I had a lovely nurse with my first child who left me shocked but properly latched when she grabbed my breast and popped it in my sons mouth. It was wonderful that he was nursing but the next time he was hungry I still didn't know what I was doing. It goes against my nature to sit back and watch a new mom struggle, so I try to balance instruction and stepping back for a few moments. What are your experiences? did you have a helpful nurse? did you know what to do when you got home? Did your nurse ask for your permission before grabbing your boob?!?!?! (I always do, and have never been told no) Would you feel comfortable telling your nurse you didn't want to be touched?

Nurse V. Patient

A great friend and mentor of mine is currently facing surgery to rule out ovarian cancer. This wonderful lady was my preceptor when I was a student, a info resource, sounding board, and a shoulder to cry on when I was a new nurse. I will be there for her, and make sure she is well taken care of. But that poses the question, how do you go from nurse to patient? Every health care provider does things just a little different, so how do you step back and let some one care for you, "their way"?

soon to be and new "Dad" Comments

so how long will it take? 

I want to help her, but she hates me!

why buy the cow when you can get the milk for free (exhausted new dad, encouraging his wife to breast feed)

He looks just like me....and Yoda

Dad: how do I get her to stop crying? Nurse: is she hungry? Dad: She ate right after the baby was born

I have the privilege  of assisting women through the labor/birth/early postpartum period. This is something I am passionate about, and I love my patients. While I dont take care of males as patients, unless they are newborns, there is nothing I enjoy more than an excited new dad. Watching a grown man cry like a baby when seeing his child for the first time, is definitely the icing on the cake. 

what a week

So this was my second week at my new hospital. I LOVE this place. They totally support breast feeding, and actually have enough staff to take care of patients. Its nice to only have to drive 20 minutes as well. I feel very blessed to be a part of such a great organization. There is even a "breast feeding welcome" sign in the cafeteria. The food is even good :)