Women’s Health and Neonatal Care – Page 4

September 09 2018

Case Study on Continuous Support During Birth

Most recently I was contacted by a mother to be who was interested in having a doula at her birth. She was very excited to have a natural childbirth because she had heard about horror stories when women went into labor and their doctor rushed them through the delivery. Much to her disatisfaction, she was told that she could not have a doula and her family in the room at the time of delivery, she had to make a choice because the doctor did not want that many people watching. I let her know that the choice was ultimately hers as we are not friends or family but we are part of the medical team helping the moms to be through labor and delivery. She decided that she would go with her family in the room and hope for the best.

Delivery day came and she was very excited to give birth, what she did not anticipate was being in labor for almost 2 days with a failure to progress. She received her epidural the minute that she arrived there and she thought surely she would deliver within a few short hours. Well, she notes that was not the case after she failed to progress. The Epidural slowed the labor down and because she was bed bound, she was not able to put all the labor tips into action to help herself along. She ended up with a C-section for failure to progress. The good part is that both mom and baby are doing great, the sad part as she put it was that she was never given an opportunity to try to birth her baby naturally before she was offered an epidural the minute she walked in the door.

The benefits of having a doula documented by the 2017 Cochrane Review indicated that having continuous support for women during childbirth, showed positive outcomes when a doula was part of the birth team. When a doula is present, it decreases the chances of having pain medications, c sections, and it helps the mother have a positive birth experience that she will remember for life.

Here is the study that was done by the Cochrane Review https://www.cochrane.org/CD003766/PREG_continuous-support-women-during-childbirth

Review: 26 studies on the effectiveness of continuous support during labor, which can include doula assistance. The studies included more than 15,000 women from a variety of backgrounds and circumstances.
Results: “Continuous support during labor may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter duration of labor, and decreased cesarean birth, instrumental vaginal birth, use of any analgesia, use of regional analgesia, low five-minute Apgar score, and negative feelings about childbirth experiences. We found no evidence of harms of continuous labor support.”
Quick birth terminology lesson: “Analgesia” refers to pain medication and “Apgar score” is how babies’ health is assessed at birth and shortly afterward — the higher the score, the better.The researchers also looked to see if the type of support made a difference. They wanted to know—does it matter who birthing persons choose for continuous support? Does it matter if they choose a midwife, doula, or partner for continuous support? The researchers were able to look at this question for six outcomes: use of any pain medication, use of Pitocin during labor, spontaneous vaginal birth, Cesarean, admission to special care nursery after birth, and negative birth experiences.For two of these outcomes (designated with asterisks*), the best results occurred when a birthing person had continuous labor support from a doula– someone who was NOT a staff member at the hospital and who was NOT part of their social network. The researchers found that overall, people who have continuous support during childbirth experience a:
- 25% decrease in the risk of Cesarean; the largest effect was seen with a doula (39% decrease)*
- 8% increase in the likelihood of a spontaneous vaginal birth; the largest effect was seen with a doula (15% increase)*
- 10% decrease in the use of any medications for pain relief; the type of person providing continuous support did not make a difference
- Shorter labors by 41 minutes on average; there is no data on if the type of person providing continuous support makes a difference
- 38% decrease in the baby’s risk of a low five minute Apgar score; there is no data on if the type of person providing continuous support makes a difference
- 31% decrease in the risk of being dissatisfied with the birth experience; mothers’ risk of being dissatisfied with the birth experience was reduced with continuous support provided by a doula or someone in their social network (family or friend), but not hospital staff
The rate of special care nursery admissions was no different between people who received continuous support and those who received usual care. The rate of Pitocin was also no different but there was a trend towards more Pitocin with continuous support from hospital staff and less Pitocin with continuous support from a doula.

If you have questions about your birthing plan, contact us for a complimentary 20 minute call to discuss your concerns 407-760-1662 or email us at info@windermerebabyandfamily.com

www.windermerebabyandfamily.com

September 09 2018

The Benefits of Hiring A Doula

Doulas provide emotional, physical, and educational support to expectant mothers during the labor process and postpartum. The doula is professionally trained in childbirth with the purpose of helping women have safe, memorable experiences and empowering a birth the way the mother desires.

The doula services begin typically a few months before the birth in order to establish a relationship with the expectant mother. Having the relationship early allows the doula to answer any questions that the mother and father have prior to delivery, ease any anxiety, and assist in developing a birth plan.

During labor, the doula will provide the mother with comfort measures, position changes, breathing techniques, and partner involvement in the birthing process. A doula leads to a better birth outcome and helps to reduce complications for both mother and baby. Doulas use touch and massage as a means to decrease stress and anxiety during labor. They use the sound of their voice to have the mother focus during the difficult stages of labor allowing this moment to engage the birth partner on the focal point.

February 02 2017

Cultural Sensitivity and In-vitro Fertilization

A nurse once shared a situation from her workplace involving in-vitro fertilization (IVF). In this case, a treating physician did not want to be involved in the patient’s delivery because five embryos had been terminated and three remained. This raised important questions: Could all eight embryos have survived? Could some have been frozen for future use? Beyond the medical decisions, this opened a deeper discussion about cultural sensitivity and religious beliefs in healthcare.

For some, an embryo may not be considered “alive” or “a baby” yet, while for others it represents life from the very beginning. These different perspectives make patient care more complex, particularly when personal and professional values conflict.

Consider another scenario: a nurse working on a GYN floor encounters a woman experiencing complications after an abortion. The nurse is a Christian who does not believe in abortion. The patient is not there for the procedure itself but for treatment of her complications. Should the nurse refuse care based on personal beliefs, or provide care because the patient is in need?

These are difficult but necessary questions. As managers, we also face the challenge of balancing employee requests for religious accommodations with the responsibility to ensure safe, compassionate care for every patient. Partnering with human resources and taking a holistic approach helps to respect both the nurse’s values and the patient’s needs.

Cultural sensitivity is not about everyone holding the same beliefs—it is about acknowledging differences and working through them with respect. When we do this, we strengthen trust, improve collaboration, and move closer to providing excellent care for all.

Reference
DeNisco, S. M., & Barker, A. M. (Eds.). (2013). The slow march to professional practice. Advanced Practice Nursing (2nd ed., pp. 6-17). [Vital Source Bookshelf].

February 02 2017

Quality and Safety at Well Baby Clinics

Recently, I was speaking with a health nurse at a clinic about the increase in babies being sick due to a lack of well baby check ups and vaccinations. In speaking with the health nurse and in review of her concerns about her well-baby clinic, one of the critical dimensions that came to mind was inquisitiveness to determine whether offering immunizations at her clinic was working or not working to get the parents to come to the clinic. If it is a well baby care clinic, are the parents bringing in the babies for any other check ups? For instance are they coming in when a shot is not needed?

After our conversation, the health nurse decided to seek information about the mothers that were not coming and noticed that there was a drop in the amount of people who came because they did not have public transportation available for them, due to the distance that they lived from the clinic (she is in a rural area). I suggested that there should be some creativity on the clinic’s part to establish a new way for the immunizations to get to the parents.

Creativity and inquisitiveness were two critical thinking dimensions that I identified in this well baby clinic scenario as I was speaking to the health nurse. The structure is the routine immunizations that they provide to the parents at the clinic. The process is based on the age of the infant and that will determine when they come in for their routine immunizations. The outcomes are the hopes of reducing childhood illness, for instance measles (Rubenfeld & Scheffer, 2005).

In thinking, there are a few alternative ways that I think would help the well baby clinic and also help these families. First of all, finding out where the majority of the families that were affected by the lack of transportation live. Once that is determined, locate a school, church or shopping center that will allow once per week or once per month depending on the amount of babies that need immunization, to set up an immunization clinic for those families affected by the bus system. The schools, church and shopping centers are places that parents will need to go to if they have school age children or if they have to buy groceries or attend a church. Even if they don’t attend the church, if it is in the community they have easy access to bring the baby for the immunizations.

Another alternative, is working with the resources available in the community. Perhaps the clinic can find out if the transportation available to take people to doctor’s appointments would be available to bring the parents on a specified appointment day. If the bus can pick up the parents where they used to take the city bus and bring them in to the clinic to get the shots, then go back to the bus stop once the group was done.

When the clinic presents these alternatives to the stakeholders making the decisions on what they will pay to make the clinic a success, it is important to share the benefits for doing the immunizations. If presented in a narrative format, explaining first, the subpopulation that uses the clinic, then the treatment and frequency that they come as well as the consequences of the parents not coming. Presenting the stakeholders with realistic facts if the babies are not immunized and that they can get a childhood illness like the measles, and how an epidemic can spread in the community, is an eye opener. If there are complications from the illness without having proper care to the child or even an adult who was never immunized as a child, there can be an inpatient hospital stay. The inpatient hospital stay would cost the tax payers and stake holders more money when simpler solutions could have been implemented.

In conclusion, education and preventative care is the basis of the well-baby clinic, but when the parent does not have the means to get to the one and only clinic, then an alternative to provide the same service has to be sought to keep the community healthy and avoid unnecessary inpatient hospital stays.

References

Rubenfeld, M. G., & Scheffer, B. K. (2015). Critical Thinking TACTICS for Nurses:Achieving the IOM Competencies (3rd ed.). [Vital Source BookShelf]. Retrieved from http://online.vitalsource.com/books/9781284059571

January 01 2017

Critical Consciousness

My awareness of critical perspective has expanded beyond the arena of where I work, it has involved my charity The Gift of Life and my wedding business 27 Miracles. I started out my nursing career working in a high risk labor and delivery unit. In labor and delivery you meet all kinds of people from different walks of life, different religions, different ethnicities and socioeconomic status. During a critical time such as labor when there is pain, this is when you learn about other people’s cultures and how pain is perceived by them. As a nurse we learn about those different cultures through experience so that when we do encounter them, we can understand what level of privacy and respect they need.

My husband and I own a wedding and event planning business called 27 Miracles. Through the years we have become well known in our town for working with ethnic weddings from different countries as well as interracial. It has allowed me as an individual to learn many cultures and be able to show respect for other cultures and their ways of communicating. It is a beautiful thing to see love spoken and expressed in so many different languages and cultures through music, food and traditions.

I have learned through my nursing experiences and my wedding experiences how to appreciate people more and take interest in who they are as a person. As nurses we get busy when we work on the floor or in an office and talk about our patients as just another number because we are in a hurry. Even on our busy days, we need to stop along the road and take a moment to say hello to our patients, provide a gentle touch to their hand or shoulder, and a listening ear. These are all part of critical perspectives or as I like to call it cultural awareness.

Many say that the parents of premature babies experience preterm birth because the parent did something wrong, they smoked, drank, did drugs or a teen age pregnancy caused the premature birth. Although some of those reasons may be true, there is another side to prematurity that people do not think about. The mother that develops maternal illnesses like Diabetes and Hypertension, or the baby that for some reason starts developing intrauterine growth retardation and it is unsafe for him or her to be inside the womb. It is very easy to judge when you don’t know the situation or have never experienced it, but as nurses we need to develop ways of thinking that allows us to be aware about ourselves and those around us (Gotzlaf & Osborne, 2010).

Working with a population of parents that have premature babies, has shown me that premature birth happens all over the world. Premature birth limits no race, religion or economical status. Our job as a nurse is to be aware of the different cultures and take the time to learn about their culture and how you can work with that person.

References

Gotzlaf, B. A., & Osborne, M. (2010). A Journey of Critical Consciousness: An Educational Strategy for Health Care. International Journal of NursingEducation Scholarship, 7(1), 1-15. http://dx.doi.org/ 10.2202/1548-923X.2094

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Years of experience in Work Comp, Case Management, Disease Management, Utilization Review and Prior Authorization.

Category Archives: Women’s Health and Neonatal Care

Case Study on Continuous Support During Birth

The Benefits of Hiring A Doula

Cultural Sensitivity and In-vitro Fertilization

Quality and Safety at Well Baby Clinics

Critical Consciousness