Prenatal Mindfulness Seminar Aug 1, 2015

YOU'RE INVITED

WHAT:  St. Luke’s Meridian Nurse-Midwife Clinic Presents: Prenatal Mindfulness Seminar

WHEN:   Saturday August 1          10:00-11:30am 

WHERE:  St. Luke's Meridian Medical Center 520 South Eagle Road 

(I84 and Eagle Road, Meridian) 

WHY:  Stress and anxiety during the prenatal period can make pregnancy more uncomfortable, lead to a more difficult birth and increase chance of postpartum depression 

Mindfulness practices such as meditation and yoga are proven to reduce stress and anxiety, help prepare you for childbirth and parenting, and help optimize your baby’s development through the release of beneficial hormones. 

In this seminar you will learn about the benefits of mindfulness and have the opportunity to practice some simple techniques that you can use anywhere to help you cope with stress and to connect more deeply to your growing baby. 

Please dress in comfortable clothes suitable for practicing relaxation techniques 

$5 donation is suggested 

Integrative Health: Acupuncture & Guided Meditation

Holly Lammer has accepted the Integrative Health Coordinator position for St Luke's Women's Services in Boise.  She is excited to assist in coordinating and offering complementary therapies to our patients!  In addition to the services of massage therapy and craft projects, Holly is piloting a project to add a team of Guided Meditation Facilitators and Acupuncture Therapists to the menu of options.

This is exciting as we are one of the first and only hospitals in the entire nation to offer inpatient acupuncture at no cost for our Antepartum and Post-Surgical patients.  St Luke's Women's Services is dedicated to making your hospital stay as comfortable as possible, and we are working hard to integrate state of the art therapies to assist in your holistic health care needs.

Complimentary therapies are proven to be effective in reducing stress and anxiety, increasing the body’s natural ability to heal, and improving overall well-being.

Guided meditation and relaxation is offered weekly to our Antepartum and Women's Surgical patients.  Experienced facilitators will be available for 20-40 minute sessions.  Research shows that meditation can increase the body's natural ability to heal by promoting rest, decreasing stress, and enhancing immune response.

Acupuncture is a form of treatment from traditional Asian medicine which involves the stimulation of one or more specific points on the body with sterile needles for therapeutic effect.

Acupuncture for Antepartum and post-surgical patients at St. Luke’s is provided by licensed and nationally certified acupuncturists.  Your treatment can help manage side effects and symptoms as well as improve your sense of well-being.  Participation in this service is voluntary and you can stop treatment at any time.  This service is free of charge.

Your acupuncturist does not diagnose illness or disease.  They will not prescribe medical treatment, medications or herbal supplements.  Acupuncture is not a substitute for any treatment your provider has recommended.

If you have any questions about these services, please request additional information from your healthcare provider or from our staff who are caring for you during your stay.

Adoption and Surrogacy

There are times when our family plans do not go according to plan.  Disappointment, frustration, and anxiety can all be related to this.  However, reproductive medicine has experienced incredible advances in medical knowledge, options, and success.  And we are excited to be part of the team leading the way here in Idaho.  The information shared here is only a brief overview of how the team providing care at St. Luke's have also advanced to enhance the experience and serve those who experience family growth in unique and various ways.

In October 2014 all of our staff at St Luke's attended an educational seminar entitled "Serving the Unique Family".  Dixie Weber, our administrator, arranged for Rebecca Vahle, from Parker Adventist's Family to Family Adoption Support Network, to come and speak with us about her own experience and feelings surrounding infertility.  Her story, enthusiasm, and passion inspired each of us to reflect on the way we view the families we serve.  We are excited to focus on family centered care, with a renewed perspective of the families we serve.

 

Since this time, a group has been formed and the process has been evaluated.  From reproductive assistance through prenatal care & delivery, and beyond to family education and billing practices, a team of our staff have become experts to assist families in this process.

St. Luke’s is proud to announce that our hospital is now an adoption and surrogacy sensitive health system.  Melissa Ward, has accepted the position of Program Manager for Unique Families at St Luke's.  She has worked tirelessly to help streamline the processes we have in place to support our patients who deliver babies as well as the families anxiously awaiting their arrival.

At St. Luke’s all families participating in an adoption or surrogacy arrangement can expect:

• ·         Adoption and Surrogacy trained staff and physicians that embrace the uniqueness of adoption and surrogacy. 
• ·         Respectful, supportive care recognizing that this looks differently for everyone. 
• ·         Specific Birthing Plans for birth mother and the prospective parents
• ·         Specific Birthing plans for surrogates and intended parents
• ·         Rooming in rooms for prospective and intended parents whenever possible
• ·         Individualized hospital tours

St. Luke’s is dedicated to providing a positive birth experience for all families.  We look forward to meeting you!

For more information on the Family to Family Adoption and Surrogacy Support Program at St. Luke’s contact Melissa (208)381-2431, Elaine (208) 381-2662 or email familytofamily@slhs.org

Induction of Labor - Make an Informed Decision

The Association of Women's Health, Obstetric and Neonatal Nurses, (AWHONN) is currently running a campaign to educate and promote a full 40 weeks of pregnancy to allow all babies to grow and develop completely before delivery.

If induction is chosen or necessary here are a few things you should know.

MEDICAL INDUCTION OF LABOR:  A medical induction is one that is determined by your provider.  If they believe that delivery provides more health benefits for mom, baby or both than remaining pregnant would, a medical induction is scheduled.  Medical indications to induce before 39 weeks are determined by ACOG (American Congress of Obstetricians and Gynecologists). 

ELECTIVE INDUCTION OF LABOR:  There are times when induction is scheduled for life circumstances or convenience not dictated by medical necessity.  These are personal preferences and are a commonly accepted practice in the United States.  There are times when a planned delivery is much less stressful to patients, their families, as well as their providers.  These are elective procedures.  Elective inductions can only be scheduled after 39 weeks of pregnancy (within 1 week of the due date).  They are most effective when the cervix is ready and has already started to thin and dilate on its own.

• Elective inductions are scheduled on a first come first serve basis by providers.  

• We recognize the anxiety and excitement of each delivery, and the importance to some that a specific date or schedule be honored.  Please be aware that if an unexpected number of patients come in laboring on their own, or need medical attention, elective inductions can be delayed or even re-scheduled to keep all of our patients safe as they labor and deliver in our care.

Induction of labor does come with risks.  Among those are increased risk of cesarean section, increased risk of an NICU stay if the lungs are not quite mature at delivery.  Over stimulating the uterus with medication to induce labor can lead to major complications for both mom and baby, and must be carefully managed by trained professionals.

For this reason we caution you against home remedies to induce labor.  Careful management of how baby tolerates contractions is critical for both mother and baby's well-being.

Labor may be induced utilizing a variety of methods.  You may wish to discuss the best option for your situation with your provider.

Catheter Induction:  A catheter, or tube, may be inserted into the uterus through the cervix and a balloon inflated.  Some providers choose to inflate an internal uterine balloon while some choose to also inflate a 2nd balloon on the outside of the cervix.  Either procedure increases pressure on the cervix and thins and dilates the cervix slowly without the use of medication.

Cervical Ripening Medication:  Multiple options are available to soften or ripen the cervix.  They may come in gel or pill form.  Cervical ripening medication can be a slow process but it also can cause full labor to kick in so attentive monitoring and assessment are needed during the initial phase after medication is given.

AROM:  Artificial Rupture of Membranes is a procedure in which your provider breaks the bag of water around your baby during a routine cervical exam.  This may be done by use of an Amnihook,

or an Amnicot.

The choice is usually based on physician preference and patient dilation.  Occasionally this may be all it takes to induce labor, but often is in addition to another type of labor induction method, typically Pitocin.

Pitocin Induction is the most common medication used to induce labor.  Pitocin is a uterine stimulant which mimics the natural occurring hormone Oxytocin.  There are risks, benefits and side effects to any medication given.  

• Risks:  Pitocin causes uterine contractions and if not managed effectively can over stimulate the uterus affecting blood flow to the placenta and causing harm to the baby.  For this reason continuous monitoring must be used while using Pitocin to induce or augment labor.
• Benefits:  Pitocin causes uterine contractions.  Therefore it will eventually bring about delivery.
• Side Effects:  Pitocin causes uterine contractions which are painful.  Other side effects are extremely rare but can include shortness of breath, dizziness, headache, increased heart rate, and others.

In the end, it does not seem to matter to most women how labor started or progressed. Once that baby is in their arms, at that moment, all is right in the world.

Who says labor is painful? What is your PLAN?

There is no way to predict the level of pain each woman will experience during labor.  Some women need little or no pain relief while others may find that pain management using medication assists with relaxation and provides a more enjoyable experience. 

Your nurse will be there every step of the way to help guide you through this process.  There is no right or wrong answer to this decision, but preparation and knowledge is key to feeling like your pain was managed they way you would choose, and well controlled during your stay with us.

St. Luke's offers a variety of classes to provide education as you make decisions regarding your care during your labor experience.  

http://www.stlukesonline.org/classes_and_events/boise_and_meridian/pregnancy/index.php

Here are some things to think about when considering the pain management plan you will choose while in labor:

Natural Childbirth: refers to labor in which no medication is used to manage pain.  Patient's who choose Natural Childbirth are most successful when they have prepared and practiced their plan to work through contractions with their support person/team.  This can include relaxation techniques such as massage, Jacuzzi tub, or more formal methods such as Hypno-birthing, Bradley Method, rhythmic breathing or Lamaze.  Frequent position change and active support person involvement is key to being successful in this labor decision.  

Nitrous Oxide: is inhaled through a tube or mask which makes this a great way to take the edge off while avoiding some of the "loopy" feelings that other medication may cause, or limits on movement with an epidural.  Nitrous Oxide takes about 30 seconds to be effective and lasts for 1-3 minutes.  Timing on the breathing of Nitrous Oxide is key for it to be most effective at the peak of each contraction.

A "Nitrous Oxide for Labor" teaching sheet is available on our Labor and Delivery Unit if you would like additional information about this practice before you arrive in labor.

IV Pain Medication:  Various options of pain medication can be given through IV access.  This will depend on your provider's preference and your stage of labor.  IV pain medication typically takes effect within just a few minutes of delivery and effects last for approximately 1 hour.   Small amounts of IV pain medication can cross the placenta and both mom and baby may be sleepy.  For this reason we try to avoid IV medication within the last hour of labor.

Anesthesia:  We have anesthesia providers available 24 hours every day on our unit.  Certified Registered Nurse Anesthetists (CRNA) place hundreds of epidurals and spinals for us, and are the experts in their field.  They have the back up on the strongest Anesthesiologist team in the valley.  We feel very lucky to work so closely with Anesthesia Associates of Boise!

Epidural:  An epidural is the placement of a tiny tube which delivers pain medication directly into the epidural space around the spinal cord.  This tube remains in place for the duration of your labor.  It typically takes 5-10 minutes for the CRNA to arrive once the epidural has been ordered by your physician and requested by your nurse.  You will sit on the edge of the bed supported by your support person or nurse.  

Your position does make a huge difference in how easy or difficult placement of the epidural may be.

Placement typically takes 5-15 minutes and then a bolus, or larger dose, of medication is given to initiate pain relief.  The epidural tube is then hooked up to medication and programmed into a pump to manage medication delivery throughout the remainder of the labor process.

A patient controlled button is provided for some control over the amount of medication you receive and how numb you choose to be for your desired experience.  

After placement, epidurals take about 20 minutes to completely set up.  During this time contractions start to feel shorter, as the beginning and end of the contraction becomes numb. Most people with an epidural will still have control of movement, but will no longer have the strength or sensation to be able to get up and walk without falling so we insist that you remain in bed.

Because of this, a catheter will be placed to help keep your bladder empty.  This helps to keep the pelvis unobstructed and reduce the risk of damage to your bladder as the baby descends.  The catheter will be removed when it is time to start pushing.

Epidurals work by gravity.  The medication delivered through the tube will cover the nerves and settle onto the side you are laying on.  For this reason, frequent position changes are necessary for the epidural to be effective.

Most women still feel pressure and an urge to push which is very helpful during the 2nd stage of labor.

After delivery the epidural pump will be turned off and within 1 - 1.5 hours you will have the strength to stand and walk to the bathroom with assistance from your nurse.

Epidural catheters can be used to deliver stronger medication if the need for a cesarean section were to arise.

Spinal:  Patients who plan to deliver surgically by cesarean section are given a spinal.  This is a one-time dose of medication which is strong enough to block pain in the lower half of your body.  By providing pain management through a spinal block or epidural, our patients are able to remain awake during the surgical delivery.  An anesthesia provider remains at the head of the surgical bed throughout the procedure.

Anesthesia Associates of Boise have a great website where you can see each of the providers and read the answers to Frequently Asked Questions. 

http://anesthesiaboise.com/

 If you have additional questions you can call them directly at  (208) 489-6789

Position is Key

Using movement and frequent position changes can assist as the baby descends and aligns in the pelvis for a shorter, less painful labor experience.  Endorphins and hormones are released with movement which can decrease the perception of pain and can even assist with increasing the diameter of the pelvic outlet.

As contraction intensity increases it is sometimes hard to find the motivation to move.  Plan ahead.  Pick the positions that feel the best when you are not contracting and practice them before labor. Also remember that stages of labor change, and positions that were once uncomfortable may be more comfortable later on, so keep an open mind.

We are here to help you with whatever position feels the most comfortable as you labor.  Here are some ideas for you to consider:

SQUAT BAR

The squat bar can be used for multiple positions during labor and pushing.

HANDS AND KNEES

 This position can be beneficial for many reasons.  It can help to rotate a baby out of a position which may be causing decelorations in the fetal heart rate, or may help to turn the baby into a better position for descent.

 It can take the pressure off of the back reducing painful back labor.

BIRTHBALLS

Can be used in a variety of positions

Using a birthball can assist with opening the pelvis and repetitive rocking movement may be comforting.

STANDING or WALKING

 These positions use gravity to help with descent.  

 Lunges may also be helpful to open the pelvis during labor.

 Rhythmic rocking, or dancing, can be comforting with the assistance of someone to support you.

BIRTH STOOL

 The use of a birth stool can help open the pelvis just like the birthball, but also allows access for delivery in this position. 

SIDE LYING

Assists with oxygenation for baby and can be relaxing.

 EPIDURAL POSITION

 Occasionally sitting in this type of position does just the trick, with or without epidural placement.

Be creative - use the tub.  Many of these positions work even better in the jacuzzi tub!

Authorized Surgical Staff Only

There are a number of reasons that surgical delivery may be the safest route for mom and baby.  Most moms do not get to plan their first C-section, but find that conditions that are out of her control make it necessary.  Cesarean Section delivery is offered to patients for various reasons.  Whether it is a scheduled repeat Cesarean Section or recommended for mom's and baby's well-being we are here to help!

All of our nurses are specially trained through the Association of Peri-Operative Registered Nurses (AORN) to provide the safest operating room care available.  This allows your labor nurse to follow you through the delivery process regardless of  the delivery route.  It is comforting to know and trust your chosen provider, as well as, the nurse primarily responsible for your care.

If an emergency were to arise we have OB-certified Laborists who are in the hospital 24 hours every day.  They are skilled and available to begin surgery until your chosen provider arrives and can assume care.  Our anesthesia department also provides 24 hour immediate coverage. 

As part of our Labor & Delivery team, we have a Certified Surgical Technician who works specifically on our unit, ready and available if needed, all the time.

Operating rooms are closed to the public to keep the environment as sterile as possible for the safety of our patients.

Because of the unique situation of the delivery of a baby occurring in our operating rooms, we allow one guest to join us in the O.R.  The only time this would not occur is if there was a need for general anesthesia.  If our patient needs to go to sleep for any reason, our undivided attention must be on the situation and outside guests are asked to wait just outside the O.R.

Guests who do join us must change out of their own clothing and into hospital scrubs.  In addition, they are required to wear the protective hats, masks and shoe covers, just as the medical team, to keep a sterile environment and patient safety our top priority.

Our guest waits just outside the O.R suites while we get ready for surgery.   We will come and get you just before surgery begins.  This can seem like a long wait, but we are working as quickly as possible to ensure everyone and everything are exactly as they need to be!

We have 3 operating rooms located on our Labor and Delivery unit.  They are always ready for any urgent need.  

Still photographs are welcome and encouraged in our operating rooms to capture those irreplaceable delivery photos.  Video in the O.R. is against hospital policy and therefore not allowed.

We do have CD players in our operating rooms.  As in any delivery on our unit, the patient can request or provide music to be played during delivery.

A member of our anesthesia team will be supporting you the entire surgery.  They will stay with you and your support person at the head of the bed to assist with any needs, questions, or concerns while in the operating room.

Once the baby is delivered, the NICU team waits at the warmer, just to the patient's left, to assess the baby.  If mom and baby are both stable, we encourage skin to skin bonding while in the operating room.  The NICU nurse coordinates with anesthesia to make this happen.  We like to keep our moms and babies together as much as possible.

 Once surgery is complete, our patients are moved to one of our Post-Operative recovery rooms.  We have 2 located on our Labor and Delivery unit.  These rooms are equipped specifically for patients who are recovering from surgical anesthesia.  We anticipate that this recovery will last for the next 2 hours.  During this time, one of our Newborn Nursery nurse experts will visit to provide education, breastfeeding support and follow up assessments as needed.

Because the level of assessment care is higher during this initial recovery period, we allow additional visitors to come and meet the new arrival at this time.  However, we ask that visitors be limited to 2 at a time in order for our staff to provide the exceptional care expected while at St. Luke's.

After this recovery period, patients are transferred to our Mother Baby Unit.  Continued level of higher nursing assessment is maintained post surgery, and although length of stay is anticipated to be a little longer than a vaginal delivery (typically 72 hours), the learning and bonding with this new baby is not different.  

Finally 10 helpful insights about Cesarean Sections that might be helpful to know:

#1  This is YOUR birth story.  You just had a baby.  If you have a C-section don't allow anyone else influence your experience by convincing you that a surgical delivery is any less of a birth experience.  That is not true.  What is true is that C-sections are major abdominal surgery and that the recovery takes a little longer. There are more risks associated with surgical deliveries which is why we prefer to attempt vaginal delivery whenever possible.  However, the outcome is the same - a new baby has been delivered and the joys and pains of parenthood do not diminish based on route of delivery.

#2  Take Advantage of the TIME - the first day will be spent mostly in bed.  After anesthesia you will not have the strength or control to stand or walk for the first few hours.  Because of this you will have a Foley catheter placed to help drain your bladder.  You will have compression devices on your legs to assist with circulation which will help prevent blood clots.  IV access will be maintained until you are able to get up and care for yourself.  The first few times you are out of bed we want to be there to assist you and make sure that you do not fall.

Do not think of this as being "stuck" but enjoy this time to catch up on the sleep you have missed (and will miss in the future) and to bond with your baby.  Take time to practice and receive expert help with breastfeeding.  Enjoy the leg massage from the compression devices and the fact that you no longer have to get up every couple of hours to empty your bladder.  Sometimes we forget to look at the positive aspects of this TIME!

#3.  Right after delivery you may feel itchy or uncontrollably shake.  This can be very normal.  One possible side effect of anesthesia is itching.  If the itching is more than you can tolerate, or lasts longer than a few hours tell your nurse - there are things that we can do, or medication we can give for this.  Try not to scratch.  When you are numb you don't always realize how hard you are scratching and this can be very painful as anesthesia wears off.  Another thing you may notice is shaking.  This can also be a normal side effect of your body's hormone shift as well as anesthesia.  The more you try to stop shaking the harder you will seem to shake.  RELAX.  Warm blankets may be comforting.

#4  Speaking of warm blankets - BE COMFORTABLE - most patients after any delivery feel cold.  Warm blankets and ice chips seem to be everyone's favorite things!  If your blankets are not warm - ask - we have plenty!

#5  SHOULDER PAIN.  Referred nerve pain from the abdominal muscles may present as shoulder pain (your shoulder is not numb but your abdominal nerves still are) or it may be caused by air trapped after the incision was closed.  Either way, shoulder pain can be uncomfortable.  Initially we will treat this with heat or ice packs.  If it continues, we can give medication to help with the nerve and/or gas pain until it subsides.  Please let us know!!

#6  Breastfeeding.  Regardless of method of delivery we encourage all moms to initiate breastfeeding within the first hour after delivery whenever possible.  Positioning to breastfeed initially after a C-section takes a little more patience.  Things to consider are that it will be more difficult to sit all the way up, and as anesthesia begins to decrease, sensation in the incision area increases.  Our nurses will assist you with position options, and help to figure out what positions work best for your situation.

#7  EATING.  Go SLOW - before surgery it is most likely that you will not have eaten anything solid for quite a few hours.  You will be hungry.  Your stomach is still waking up so start with ice chips.  If you are able to eat them without feeling nauseated then move to sips of water.  Many patients advance their diet too quickly and end up vomiting.  This can be extremely uncomfortable after abdominal surgery.  I promise you will eat again, but be patient and take it slowly!

#8  Pain Medication.  Stay on top of the pain.  Although we do not encourage you to take more medication than necessary, we do suggest that you take your medication as prescribed.  Cesarean Section surgery is not pain free.  If you manage your pain appropriately, you will still experience some discomfort, but you will heal faster and be able to provide care for yourself and your baby.  Take pain medication when you need it and document the time so that you remember how often you have taken it and how much you needed.  This will help your provider to manage your pain levels and assist you as you are preparing to discharge home.

#9.  Once a C-section NOT always a C-section.  There was a time when having a Cesarean delivery for any reason meant that you would be counselled that Cesarean Delivery would be the safest method of delivery for every pregnancy going forward.  This is not the case any longer.  Vaginal Birth After Cesarean (VBAC) definitely comes with risks but is more commonly practiced and accepted.  Discuss the reasons for the previous Cesarean section with your provider and understand the risks and benefits associated with attempting a VBAC.  Facilities that have 24 hour immediate O.R. access typically offer this as an option.

#10.  ACCEPT HELP!  When you are discharged home accept help from family and friends.  If no help is offered, ASK.  During your recovery you will be advised not to lift anything heavy, take the stairs, or even vacuum.  Simple things like coughing or turning can cause discomfort.  Over doing it during recovery can prolong your recovery and possibly cause avoidable complications.  While you are hospitalized take advantage of room service dining and the staff who are there to assist you.  When you are home, think ahead and have someone help you to position pillows, prepare meals, organize diapers, bottles, etc so that you have easy access to whatever you may need if you are alone.