Obstetrical simulator “Noelle” is administered oxygen by the anesthesia team in preparation for surgery
Overlake’s Childbirth Center had the amazing opportunity to participate in twenty-seven multidisciplinary postpartum hemorrhage (PPH) simulation training sessions during the month of March. Using a state of the art obstetric birthing simulator, approximately 300 staff participated in the simulations, recreating a “mock” PPH. PPH is an obstetrical emergency that can be sudden and unexpected and requires prompt recognition and action. The unique opportunity with the simulations was having each team member sign up to participate in their own role – to have the added value of the entire team that works together, train together – just as in everyday clinical situations. This included anesthesiologists, obstetricians, midwives, scrub techs, postpartum and labor nurses, patient care techs, health unit coordinators, blood bank and several guest observers. The opportunity to practice how to successfully manage PPH after delivery included hands-on skills, situational awareness, identification of team roles and responsibilities, and how to communicate with the patient and other team members during such a critical and stressful situation. Sessions were digitally recorded, viewed by the team, debriefed and then erased. This has provided us with an amazing opportunity to simulate PPH, a leading cause of maternal mortality and morbidity, and to collaborate with the entire team to discuss our current practice and process and opportunities for system improvement.
Obstetric hemorrhage affects 2.9% of all births in the United States and is one of the top causes of maternal death. (Callaghan et al, 2010; Berg, Callaghan, Syverson, & Henderson, 2010; Bingham & Jones, 2012)
Join us for the March for Babies on May 2, 2015! This year, it’s for Kaitlin, Makenna, Ty and Carson, this year’s Overlake’s March of Dimes Ambassadors, and all the NICU graduates.
Chilbirth Center staff, along with family and friends, will be walking. If you would like to join our team or donate, please go to www.marchforbabies/teams/overlake. It really is a lot of fun with some good exercise!
Many people don’t realize how complex infant feeding can be, as it is often so effortless for most babies. Premature infants are often asked to be able to perfectly feed by mouth before they are biologically able. This can present some extra challenges. In the old days, we used to think that preemies had “weak sucks” and that we needed to help them with special bottle nipples that provided the milk very easily. However, we now know that preemies typically have rather strong sucks, and the main difficulty that preemies face is how to coordinate breathing with swallowing. We know that by giving premature infants a slower flow rate, preemies can feed more comfortably and are better able to progress their oral feeding.
So, the main question is- how can we reduce the flow rate? First, we can use a slow flow bottle. In the NICU, we may use a disposable slow flow nipple or a Dr. Brown bottle with a Preemie nipple. The Preemie nipple is even slower than the standard newborn level 1 that comes with most bottles. In fact, for preemies that still cannot handle that flow rate, the company has recently developed the “Ultra Preemie” nipple. Another technique is to feed babies lying on their side, which reduces the impact of gravity on the flow rate of the feeding. Sidelying is also a very comfortable and stabilizing position for infants. If we can provide this support to their body, the infant can then focus on the feeding. Lastly, some infants benefit from “external pacing”, where the bottle is tipped down to stop the flow rate of milk, encouraging these important breathing breaks.
Breastfeeding can be a little more comfortable for many preemies because the flow rate can be more modulated by the infant. However, for those infants that are still overwhelmed by the flow rate at the breast, we can sometimes change the position of the mother/baby and/or bring the baby to the breast at a time that the breast is less full.
When premature infants are provided with oral feedings in a positive and supportive manner focused on quality of feedings and not quantity, we can help them develop the necessary skills to be successful oral feeders.
The demands of nurturing a newborn can be exhausting. It is important that parents find ways to feel nurtured so they will have the energy and empathy required to respond to their baby’s multiple needs. Here are a few tips to nurture the nurturer:
- Don’t’ sweat the small stuff. Good enough can actually be healthier than “perfection”. Ask is my baby safe? If the answer is yes; it is probably okay. Dirty dishes will not self-ignite and jammies can be appropriate all day long.
- Rest when baby sleeps. Put your feet up and close your eyes. Don’t stress out if you can’t fall asleep – just rest.
- Find your village. Some of the sweetest words to hear are, “that is what we are going through too”. Support groups are a great way to get out of the house, meet other new parents, and feel that you are not alone.
At Overlake we offer After Baby Comes Groups for parents with infants from 0-12 months of age. Sign up today at: http://www.overlakehospital.org/classes/.
- What do you enjoy? Do it in small bits. You may not get a huge knitting project done or a 600 page novel read but take (yes, you can be the receiver and still be a good parent – probably a better parent) the time to enjoy small portions of favorite activities.
- Go outside. A walk outside is relaxing for both you and baby no matter how exhausted you feel. A change of temperature, scenery and activity will help you from the outside in.
- Reset expectations and let go of guilt. You will not be the first perfect parent no matter how hard you try. You will fail. Forgive yourself, dust off and try again.
- Prepare snacks ahead of time. Keep healthy snacks in the diaper bag for you. Your energy levels will stay more level if you feed yourself every time you feed your baby.
Parenting isn’t for the weak of heart or body. Take care of yourself – want you and your baby to thrive.
As you can see of this recent photo of Sue Gadau, Clinical Dietitian, the donations continue to come in at Overlake’s Milk Donation Center. The donations assure that Overlake Medical Center has priority access to the milk to support fragile, premature infants in the hospital’s Neonatal Intensive Care Unit. For more information about Overlake Medical Center’s new mother’s milk depot and to learn about how to donate, call 425-635-6150.
Notes from Maternal Fetal Medicine:
A new blood test called “Non-Invasive Prenatal Testing” (NIPT) also known as cell-free fetal DNA testing is a good screening test for Trisomy 21/Down syndrome particularly in higher risk fetuses. NIPT has about the same test characteristics as the combined screen for Trisomies 18 & 13.
The false positive rate for NIPT is very high especially in the low risk population. A positive NIPT should always be confirmed by chorionic villis sampling (CVS) or amniocentesis.
Nuchal Translucency (NT), an ultrasound test, screens for much more than Down syndrome. NT allows for early diagnosis of some serious birth defects and identification of higher risk fetuses. For this reason, national guidelines are to recommend NT and early fetal anatomy examination for all patients. Examination of the heart and nasal bone are also very useful.
An abnormal NT should always be followed by the offer of further testing such as CVS or amniocentesis. NIPT is not enough.
NT and NIPT are NOT mutually exclusive: NIPT does not replace NT screening.
We are always happy to answer questions any time.
Oftentimes patients are unsure of what to expect when labor starts. They may decide to try and prepare for the unknown by touring the unit, taking a childbirth class, reading pregnancy and childbirth books, studying birthing options on the internet and writing up a birth plan – all of these are excellent ways to prepare. Some patients know nothing more than they want an epidural or they’re planning on “going natural.” Regardless of preparation, sometimes it’s still a mystery what will happen when you are actually admitted to the hospital. This is when the bedside labor nurse can be a vital resource.
In Labor & Delivery, we strive to help our patients and their families feel comfortable and stay informed throughout, but undeniably our most important goal is to provide the best possible care, utilizing best practice. We are currently working very diligently to reduce our C-section rate.
Several factors come into play when taking a look at the reason for successful vaginal delivery. Delaying admission to the hospital until labor has begun (progressively dilating cervix over 4-5cm and contractions at regular intervals) may significantly increase the laboring woman’s possibility for vaginal delivery. However, there are occasions when a patient may need to be admitted before labor starts. In this case, studies show that having bedside labor support during early labor is incredibly important. At Overlake, we are making strides in improving our bedside care and support – educating staff, seeking out pertinent research, and auditing our own patient records to see what’s working in alignment with our goals and areas for improvement.
Recently, we added a Comfort Care a la Carte menu for patients – a complimentary assortment of “tools” that can be used to get through those tough hours of labor. These tools have been found to significantly improve patient experience, especially for those planning on an epidural, but aren’t quite ready for it. We’ve found that something so small, like a headband to keep your hair back or tea light candles for an ambient setting, can make a world of difference. These items also give the patient and their birth partner a chance to connect. We’ve had excellent feedback from our patients who’ve taken advantage of our Comfort Care menu. Sometimes it’s the little things that count.
On December 13, 2014, Santa and his elf visited the Overlake Medical Center Childbirth Center. First stop was the NICU, where each infant was able to be held by Santa and a photo taken. Some of these photos we later saw as the family holiday card.
From there, Santa went to the Mother Baby Unit for more pictures with newborns. There he was able to include siblings in some of those pictures. The older brothers and sisters were thrilled by Santa’s appearance and some even gave Santa their Christmas wishes.
It is a growing trend to scrutinize the medications or vaccinations that are offered to our infants and children. As these medications and/or vaccinations become routine we no longer see the adverse effects of foregoing these medications. What is the benefit of a Vitamin K shot to the newborn after delivery? The goal of Vitamin K administration is prevention of hemorrhagic disease of the newborn, also known as vitamin K deficiency bleeding. Although rare, this disorder can result in long-term brain damage and death. Vitamin K is essential for our body to adequately clot blood and thus prevent excessive bleeding. Infants have inadequate vitamin K stores at birth and breast milk cannot adequately compensate for deficient endogenous production. Without adequate vitamin K stores the infant is at risk for excessive bleeding. This can be seen as oozing from the umbilical cord, circumcision, oral mucosal bleeding or in severe cases bleeding in the stomach or brain. At Overlake, we follow the current recommendation of the American Academy of Pediatrics that all newborns be given a single intramuscular dose of Vitamin K.
Newborn Hearing Screen is an important part of every baby’s care in the first weeks of life. Most babies can hear normally, but one to three of every 1,000 babies are born with some degree of hearing loss. This loss can be difficult to detect without infant screening. Delayed detection leads to delayed intervention and subsequent delays in speech and language development. That is why the American Academy of Pediatrics recommends that all infants are screened for hearing loss.
What makes detection difficult is that babies may respond to sound but that does not mean they have normal hearing. Most babies with hearing loss; hear some sounds but experience enough loss to impact speech and language.
At Overlake, babies are initially screened for hearing loss at the Mom & Baby Care Center. An appointment is made while families are on the Mother Baby Unit and families come back to the Mom & Baby Care Center within a few days of discharge. If passage is not attained at the initial screening, a follow up screen is performed within one to two weeks.
Overlake was recently recognized as the “Hospital of the Quarter” by the Washington State Early Hearing-loss Detection, Diagnosis and Intervention (EHDDI) program for improving hearing detection processes which promote early detection, diagnosis and intervention.
If a possible hearing loss is detected after the two screenings performed at Overlake, further testing will be done to confirm the results with an audiologist. When hearing loss is confirmed, early intervention should begin as soon as possible. Timing is important; babies have the best chance for normal language development if intervention begins before six months of age. The earlier – the better!