Three days at the AWHONN Conference
The Association of Women’s Healthcare Obstetric and Neonatal Nurses held its annual convention at the Gaylord Opryland Conference Center in Nashville Tennessee this week.
3000 nurses, midwives, researchers and educators swarmed a conference center so rich in Southern hospitality and decor, it reminded me of Disneyland. It even sports a riverboat cruise that winds its way through acres of hotel rooms, restaurants, shops, ballrooms and conference halls flanked by gardens, and waterfalls. An atrium and covered by a glass dome lends the impression that you’re outdoors — except you’re not. This indoor-outdoor illusion was just one of a string of elements that made the whole conference feel like a demonstration in contrasts and contradictions.
Most of the conference attendees were nurses and almost all were women. Here’s a fact: there’s no smarter, harder working, more dedicated, or compassionate group of professionals than nurses. (yes, I admit I’m a nurse, but that just means I know what I’m talking about) AWHONN nurses join the organization because they’re committed to strengthening and staying up-to-date in their practices. As much as most want to learn new information though, some are also sticklers for rules and policies and not too fond of change.
In the same halls where nurses discussed new patient care concepts and interventions, others complained about having to create new policies, “just because of some new study.” To some extent, they had a point. After decades as a labor and delivery nurse, I occasionally found myself irritated when managers returned from conferences and swiftly changed the way we did things that had been working just fine for years. Sometimes the “new plan” worked beautifully and provided better patient care, but just as often, it didn’t and we’d eventually revert to old habits. Sometimes, however managers implemented new policies that broke bad habits we’d all taken for granted.
Take for example, the long-standing practice of using Pitocin (oxytocin) liberally on normal labor patients. One session I attended entitled “The Powerful Effects Of Oxytocin: The Good, Bad and Ugly,” was moderated by Dina Viscount, MSN, CNS, RNC-OB. She discussed how uterine muscle needs three things to contract properly: oxygen, glucose and oxytocin receptors. Inappropriate use of Pitocin deprives the uterus of those key elements and leads to complications like hemorrhage and back-to-back contractions that rob babies of oxygen. While most of the time, nurses administer Pitocin responsibly, the speaker drove her point home discussing “horror story” cases where babies were permanently brain damaged and nurses’ careers were ruined. Nursing conferences are often like that — new policies intended to improve patient care are taught with lesson plans intended to scare the bejeezus out of nurses.
Another session, about the resurgence of Nitrous Oxide as a labor analgesic taught by Michelle Collins, PhD, CNM Associate Professor of Nursing and Director, Nurse-Midwifery Program at Vanderbilt University School of Nursing provided a real “Aha moment,” for many nurses and managers. Nitrous Oxide, AKA “laughing gas,” is commonly used in dental practices to ease pain and anxiety. The gas/oxygen mixture is also used for labor pain relief worldwide, including in countries with the best maternal health outcomes. It’s effective, affordable, and safe and doesn’t require an anesthesiologist’s services. Many women find they don’t need any other method of pain relief. It isn’t widely available here in the U.S. though where epidurals and anesthesiologists long ago crowded it out of American delivery rooms. But as hospitals consider options for reducing costs, improving patient satisfaction and decreasing c-section rates, they’re becoming more open to this old-fashioned, patient-administered gas that’s making an American comeback.
After several days of serious lectures covering subjects like, how to prevent the first cesarean, why birth centers matter, management of cardiac complications, warning signs of obstetric complications, teen pregnancy, leadership skills, and more, these serious minded nurses needed a break. They dressed up like cowgirls, biker chicks, glam rockers and disco divas for an after-hours party that kept them dancing for hours.
The next morning, they were back to business. Elizabeth Butrick, MSW, MPH and Program Director for the Safe Motherhood Program at the University of California, San Francisco, screened the film, “The Edge of Joy,” about conditions in Nigeria that contribute to the deaths of more than 36,000 women annually. Many attendees had seen No Woman, No Cry at an AWHONN conference several years ago and the global maternal death crisis was not new information. Others, however, had no idea this kind of disparity existed. In contrast to American delivery rooms with their surpluses of staff and supplies, Nigerian birth conditions where women die from lack of even the most basic supplies were shocking. Nurses crowded around Elizabeth and me after the screening to ask what they could do.
Perhaps the biggest contrast I saw was in the Expo hall where vendors and merchandisers displayed their wares. As lecturers talked about how excessive technology restricted laboring women’s mobility and distracted nurses from providing real care, the expo was filled with gadgets, electronics, computerized charting systems and delivery beds that do everything but have the mother’s contractions for her. In contrast to the serious shortages of basic lifesaving supplies we see in developing countries, this hall was filled with aisle after aisle of products that had little to do with normal physiologic birth.
When I turned a corner and saw a little table displaying Ergo Baby carriers (one of our partners) I felt like I’d found a touchstone for the reality of motherhood. Mothers everywhere want soft, comfortable ways to hold their babies close. If this conference also enables nurses to learn safe, compassionate ways to deliver the best patient care to mothers then all these contrasts and contradictions have served their purpose.
