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It's the Little Things
Reflections on Women’s Health
It’s the Little Things LORI WENNER
H Illustration © iStock Collection / thinkstockphotos.com
Her birth was unremarkable, medically at least. A spontaneous vaginal birth, healthy, fullterm, 6 lbs, 5 oz, a profusion of hair as black as night—a product of her French heritage. She was our first child and my parents’ first grandchild, and her arrival was highly anticipated with the requisite baby showers filling her closet to bursting with frilly dresses. Her room in our home was a nursery decorated with much thought and planning, in the colors of mint green and peach and the theme of the lion and the lamb from the Bible verse in Isaiah. Although I’d been a NICU nurse for 6 years, I devoured the second edition of What to Expect When You’re Expecting as we faithfully attended childbirth classes. I watched my diet and napped regularly, as only a pregnant woman without other children can. After a 16-hour labor, Daddy, an enthusiastic coach, lay snoring on the tiny pullout couch, his long body
extending over every edge. With a low temperature after her initial bath, Alexa was placed on a radiant warmer located across my room by Roz, my labor and delivery nurse who assisted with my birth and then cared for Alexa during transition. Roz then pushed the warmer to the head of my bed and raised my bed so that Alexa and I were eye level with each other. The darkness enfolded us like a blanket, the lone illumination the tiny, soft overhead light of the radiant warmer. It was after midnight and our excited but weary visitors had gone home. We were alone together for the first time, my daughter and I, and as we gazed at each other, time became irrelevant; all around me disappeared as I fell deep into the color of her eyes and even deeper in love with her. We became one, mother and daughter, my first daughter of four. This was 20 years ago, in a hospital that had only recently converted to labor/delivery/ recovery/postpartum (LDRP) care. Epidurals, induction of labor and cesarean surgical birth
continued on p. 203
204
© 2015, AWHONN
http://nwh.awhonn.org
continued from p. 204 were the standard, while skin-to-skin care was seemingly unheard of, and any other infant with a low temperature would have found herself taken from her mother’s room to be monitored in the newborn nursery, possibly with a septic workup. But Roz went out of her way; she did something special, took a chance and did something out of the norm. Perhaps, because of my NICU experience, she trusted me more than the average mother with a low-temperature newborn. Whatever her reasons, I was thrilled beyond belief not to be separated from my baby, my new love, the child who had been my dream since I was a little girl. Extra temperature checks and the placement of my baby next to me took only a few extra minutes out of Roz’s work night, but their impact was monumental—at least to me, and I believe, to my baby. The practice in our facility at the time was to send infants with vital signs outside of the normal range to the newborn nursery for closer monitoring. This practice falls under the category, “it’s the way we’ve always done it.” My daughter was in no danger, with an unremarkable pregnancy history and no indication that she had the dreaded group B strep infection. Roz monitored Alexa’s temperature frequently and it soon returned to normal. She didn’t have to do this. She could have just as easily turned Alexa’s care over to the newborn nursery, resulting in our separation. Most nurses will tell you they went into nursing to make a difference in people’s lives, to help others. Our daily activities often include some mundane activities—charting, making phone calls and obtaining supplies. At the end of the shift, when you think about your day, I would dare say that you think of the stimulating, endorphininducing accomplishments—you know, the ones depicted in the latest top-rated medical dramas on TV. There’s the resuscitation of the 25-week infant with Apgar scores of 3 and 5, the prolapsed cord that had you on a stretcher with
April | May 2015
your hand up a woman’s birth canal, on your hands and knees, butt in the air, traveling down the hall at breakneck speed racing to a stat cesarean surgery. You remember the pulmonary embolism that you caught during the routine shift assessment of a postpartum woman. You detected the newborn’s heart murmur, barely audible at 6 hours of age, resulting in early intervention and a better outcome. And who could forget the pneumothorax you detected
her hand as your tears merge. With calm patience, you walk anxious parents through their first bath of their preemie even though it would have been less time consuming to bathe the baby yourself as they watched. Understanding a postpartum mother’s anxiety and exhaustion, you review her home care instructions for a third time. You do all these things even though your children are waiting in carpool, you haven’t charted a thing the entire
I propose that nurses make an equal or even greater difference in lives every day with small things
early with your excellent auscultation skills and your indefinable, but oh so important, clinical judgment? These scenarios, exciting and memorable and with good outcomes, are the product of excellent nursing skills, experience and judgment. There’s an immediate, or at least fairly quick, sense of gratification, a feeling of accomplishment. I propose that nurses make an equal or even greater difference in lives every day with small things they do that are usually unnoticed by their colleagues and often by the women and families they serve. I would also propose that nurses underestimate their ability to make a long-term difference in people’s lives through these little things. Unfortunately, with inadequate staffing and high census and acuity, even the small things take time a nurse doesn’t have. But you do it anyway. You stay after your shift to see a birth to completion so that the mother will not have a new, unknown person inserted into her birth experience. You spend extra time reassuring a breastfeeding family that, yes, the baby is getting enough at the breast, and then you stay even longer teaching them how to assess the adequacy of the baby’s intake at home after discharge. You sit at the bedside of the heartbroken, shocked mother of a stillborn infant, holding
shift, you haven’t gone to the bathroom for 6 hours, you haven’t had lunch, you should get home and cook supper, help with homework, wash clothes and finish the latest online education that was due last week. You do this because you care, because it’s just what we, as nurses, do. After 21 years, five pregnancies, four births and bearing witness to hundreds of births professionally, it’s with good reason I remember Roz’s kindness. Roz probably didn’t think twice about what she did that night. She had no way of knowing how precious that moment in time would be, that we would have relatively few such moments with our baby who would succumb to sudden infant death syndrome (SIDS) on her 77th day of life. Roz may have had to stay late that morning to chart or she may have skipped her lunch break, I don’t know. What I do know is that with her kindness she gave a precious memory, an irreplaceable gift of sweetness and comfort. NWH
Lori Wenner, RNC, MSN, IBCLC, is the owner/ lactation consultant at Mother’s Milk Lactation Consulting, LLC, in Beaumont, TX. The author reports no conflicts of interest or relevant financial relationships. Address correspondence to: info@ mothersmilkibclc.com. DOI: 10.1111/1751-486X.12194
Nursing for Women’s Health
203
It’s the Little Things LORI WENNER
H Illustration © iStock Collection / thinkstockphotos.com
Her birth was unremarkable, medically at least. A spontaneous vaginal birth, healthy, fullterm, 6 lbs, 5 oz, a profusion of hair as black as night—a product of her French heritage. She was our first child and my parents’ first grandchild, and her arrival was highly anticipated with the requisite baby showers filling her closet to bursting with frilly dresses. Her room in our home was a nursery decorated with much thought and planning, in the colors of mint green and peach and the theme of the lion and the lamb from the Bible verse in Isaiah. Although I’d been a NICU nurse for 6 years, I devoured the second edition of What to Expect When You’re Expecting as we faithfully attended childbirth classes. I watched my diet and napped regularly, as only a pregnant woman without other children can. After a 16-hour labor, Daddy, an enthusiastic coach, lay snoring on the tiny pullout couch, his long body
extending over every edge. With a low temperature after her initial bath, Alexa was placed on a radiant warmer located across my room by Roz, my labor and delivery nurse who assisted with my birth and then cared for Alexa during transition. Roz then pushed the warmer to the head of my bed and raised my bed so that Alexa and I were eye level with each other. The darkness enfolded us like a blanket, the lone illumination the tiny, soft overhead light of the radiant warmer. It was after midnight and our excited but weary visitors had gone home. We were alone together for the first time, my daughter and I, and as we gazed at each other, time became irrelevant; all around me disappeared as I fell deep into the color of her eyes and even deeper in love with her. We became one, mother and daughter, my first daughter of four. This was 20 years ago, in a hospital that had only recently converted to labor/delivery/ recovery/postpartum (LDRP) care. Epidurals, induction of labor and cesarean surgical birth
continued on p. 203
204
© 2015, AWHONN
http://nwh.awhonn.org
continued from p. 204 were the standard, while skin-to-skin care was seemingly unheard of, and any other infant with a low temperature would have found herself taken from her mother’s room to be monitored in the newborn nursery, possibly with a septic workup. But Roz went out of her way; she did something special, took a chance and did something out of the norm. Perhaps, because of my NICU experience, she trusted me more than the average mother with a low-temperature newborn. Whatever her reasons, I was thrilled beyond belief not to be separated from my baby, my new love, the child who had been my dream since I was a little girl. Extra temperature checks and the placement of my baby next to me took only a few extra minutes out of Roz’s work night, but their impact was monumental—at least to me, and I believe, to my baby. The practice in our facility at the time was to send infants with vital signs outside of the normal range to the newborn nursery for closer monitoring. This practice falls under the category, “it’s the way we’ve always done it.” My daughter was in no danger, with an unremarkable pregnancy history and no indication that she had the dreaded group B strep infection. Roz monitored Alexa’s temperature frequently and it soon returned to normal. She didn’t have to do this. She could have just as easily turned Alexa’s care over to the newborn nursery, resulting in our separation. Most nurses will tell you they went into nursing to make a difference in people’s lives, to help others. Our daily activities often include some mundane activities—charting, making phone calls and obtaining supplies. At the end of the shift, when you think about your day, I would dare say that you think of the stimulating, endorphininducing accomplishments—you know, the ones depicted in the latest top-rated medical dramas on TV. There’s the resuscitation of the 25-week infant with Apgar scores of 3 and 5, the prolapsed cord that had you on a stretcher with
April | May 2015
your hand up a woman’s birth canal, on your hands and knees, butt in the air, traveling down the hall at breakneck speed racing to a stat cesarean surgery. You remember the pulmonary embolism that you caught during the routine shift assessment of a postpartum woman. You detected the newborn’s heart murmur, barely audible at 6 hours of age, resulting in early intervention and a better outcome. And who could forget the pneumothorax you detected
her hand as your tears merge. With calm patience, you walk anxious parents through their first bath of their preemie even though it would have been less time consuming to bathe the baby yourself as they watched. Understanding a postpartum mother’s anxiety and exhaustion, you review her home care instructions for a third time. You do all these things even though your children are waiting in carpool, you haven’t charted a thing the entire
I propose that nurses make an equal or even greater difference in lives every day with small things
early with your excellent auscultation skills and your indefinable, but oh so important, clinical judgment? These scenarios, exciting and memorable and with good outcomes, are the product of excellent nursing skills, experience and judgment. There’s an immediate, or at least fairly quick, sense of gratification, a feeling of accomplishment. I propose that nurses make an equal or even greater difference in lives every day with small things they do that are usually unnoticed by their colleagues and often by the women and families they serve. I would also propose that nurses underestimate their ability to make a long-term difference in people’s lives through these little things. Unfortunately, with inadequate staffing and high census and acuity, even the small things take time a nurse doesn’t have. But you do it anyway. You stay after your shift to see a birth to completion so that the mother will not have a new, unknown person inserted into her birth experience. You spend extra time reassuring a breastfeeding family that, yes, the baby is getting enough at the breast, and then you stay even longer teaching them how to assess the adequacy of the baby’s intake at home after discharge. You sit at the bedside of the heartbroken, shocked mother of a stillborn infant, holding
shift, you haven’t gone to the bathroom for 6 hours, you haven’t had lunch, you should get home and cook supper, help with homework, wash clothes and finish the latest online education that was due last week. You do this because you care, because it’s just what we, as nurses, do. After 21 years, five pregnancies, four births and bearing witness to hundreds of births professionally, it’s with good reason I remember Roz’s kindness. Roz probably didn’t think twice about what she did that night. She had no way of knowing how precious that moment in time would be, that we would have relatively few such moments with our baby who would succumb to sudden infant death syndrome (SIDS) on her 77th day of life. Roz may have had to stay late that morning to chart or she may have skipped her lunch break, I don’t know. What I do know is that with her kindness she gave a precious memory, an irreplaceable gift of sweetness and comfort. NWH
Lori Wenner, RNC, MSN, IBCLC, is the owner/ lactation consultant at Mother’s Milk Lactation Consulting, LLC, in Beaumont, TX. The author reports no conflicts of interest or relevant financial relationships. Address correspondence to: info@ mothersmilkibclc.com. DOI: 10.1111/1751-486X.12194
Nursing for Women’s Health
203