tsclark

Hi, I spent 50 days as an antepartum inpatient. The art therapy is a nice thought, but um, I am here to tell you that its a waste. Any crafty thing I was forced to make (I was NOT into that at all and I knit, crochet & sew and was a music major -- it wasn't the time for that sort of thing... I could not read or do anything except pray and learn what to expect) I threw away. I do not want to be reminded of that hell. I went home for bedrest for another 33 days, but 6 months later, I still have some issues that began when I got hospitalized. If it were my husband who had to do nothing and be waited on hand and foot, he would have LOVED it. Me, I went insane -- my blood pressure is still high! If you don't have egotistical MFM peeps, incorporate them! So, I did write the following to the hospital, hope it helps: June 24, 2014 Chief Executive Officer Adventist Hinsdale Hospital 120 North Oak Street Hinsdale, Illinois 60521 Dear Mr. CEO: On November 7, 2013, my doc admitted me to Adventist Hinsdale Hospital (hereinafter “AHH”) due to pre-term labor (my cervix was dilated to 4 cm when my pregnancy was 26 weeks and 6 days gestational age with a bulging sac of membranes). I spent 50 days on antepartum bedrest. Thankfully, I was discharged December 27th and am happy to report that my baby was born full term in January at AHH via VBAC at 38 weeks and 6 days gestational age. While I am in the process of recovering from this disorienting event, I have become aware of perinatal support programs that other area hospitals already have in place to support the family unit in times of perinatal crisis. The Perinatal Family Support program at NorthShore’s Evanston and Highland Park Hospitals and Northwestern’s Prentice Women’s Hospital are two local programs that stand out. My goal in writing you is that perinatal family support, or comprehensive, ongoing, coordinated, culturally appropriate emotional support provided by professionals and/or non-professionals to families during pregnancy and up to one year after, be provided to your future perinatal (including antepartum) patients. Regardless of the outcome of pregnancy, all families anticipating a birth need the support of their families and communities during and after a pregnancy (Indiana Perinatal Network, 2007). I am an extremely independent person and when I lost all independence by being hospitalized November 7th, it transformed me. While there is no way for me to change what happened, I feel very strongly that AHH and future perinatal patients can benefit from programs that can be inexpensive to incorporate; easy to maintain; and beneficial both monetarily and from a social standpoint to patients and healthcare providers. These programs may also make AHH more competitive. In conversation, my doc mentioned that one thing he will never understand is why some women in Hinsdale and neighboring communities prefer to deliver their babies at Northwestern. I can only surmise these women choose Northwestern over AHH due to its reputation. Three programs that should be relatively easy to establish within the antepartum unit of labor and delivery are inpatient physical therapy; social support; and inpatient peer support groups. Physical Therapy While I was a patient, I asked my doc if it would be okay to exercise in bed. He brought me some weights to use. While I am grateful, I have also endured three different physical therapy courses for a different issue in my past and am aware of how much harm can come to a person who is not instructed or performing physical therapy the correct way. As I was on hospital bedrest for cervical dilation, I was very wary of performing any exercises that may strain my abdominal muscles or affect my condition negatively. It says on your website that you have inpatient physical therapy services, and it would have benefitted me to have (even one) physical therapist visit just to show me what I could and could not do. I have insurance which would have covered the expense. Once I left your establishment, I had a very difficult time with the simplest of physical activities. Other hospitals incorporate physical therapy into the care of patients like me. Northwestern’s Prentice Women’s Hospital has a program and Edward Hospital, in Naperville, has an online video of exercises that may be appropriate for patients at the following link: Antepartum Unit Naperville, Illinois (IL) - Edward Hospital and Health Services. Social Support As stated in Perinatal Family Support Consensus Statement published by Indiana Perinatal Network in April 2007: “The process of maternal role attainment during pregnancy (maternal identity) was fairly well researched over the past several decades, in particular by Reva Rubin, RN, PhD and Ramona T. Mercer, RN, PhD. Rubin outlines four tasks of a mother during pregnancy: 'Seeking safe passage, ensuring acceptance of her child, binding-in to her unborn child and learning to give of herself' (Rubin, 1967, 1977; Mercer 1981). This developmental and interactional process occurs over time as the mother becomes attached to her unborn child. The ability of the woman to move through these stages depends on factors such as personality, self esteem, cultural beliefs, support systems, health, anxiety, etc. Several factors can enhance maternal-fetal attachment including fetal movement, hearing the fetal heartbeat and viewing the fetus via ultrasound. A review of the literal reveals that women may not easily or successfully move through these tasks for a variety of reasons. The 'normal' process of maternal role attainment may be disrupted if a woman experiences: An unintended or unwanted pregnancy Complications during pregnancy, e.g. bleeding, preterm labor, diagnosis of a congenital anomaly, depression, substance abuse, domestic violence, etc. Pregnancy after a previous high-risk pregnancy or perinatal loss, e.g. miscarriage, termination, still birth or infant death (Armstrong, 2004). Subsequent to any of these experiences, women and their partners may experience anxiety, guilt, fear or denial. They might avoid investing in the fetus and developing an attachment for fear of a poor pregnancy outcome or infant loss (Cote-orificenault, 2001; Reid, 2000). Women may be less motivated to comply with medical care until the baby reaches the age of viability. In addition, the treatment plan for many high risk conditions can challenge women and their families. For example, treatment for preterm labor (and several high risk conditions) is often extended bed rest for weeks or even months. Findings support the need for health care providers to assess these women for specific concerns throughout the pregnancy and provide ongoing education, support and resources (Kemp & Hatmaker, 1993). Women may also be nervous or anxious about becoming pregnant following a perinatal crisis. Contemplating pregnancy following an infant loss or the birth of a child with a chronic illness or disability can be extremely stressful for families. Preconception counseling and partner support prior to a subsequent pregnancy may be recommended. Anecdotal information from families indicates they find such parent-to-parent support reassuring and helpful.” Labor and Delivery Support during labor and delivery empowers families and benefits health care systems. When they find themselves in a hospital setting, parents often feel powerless and 'out of control' – particularly during a crisis. The cost benefits are clear when healthy outcomes are increased by decreasing maternal stress. Families supported by other parents experience less postpartum depression, fewer repeat visits to the doctor and report an increase in their ability to cope. Given the research, it is reasonable to assume that family support not only fulfills the mission of health care systems, it also decreases the cost of patient care as evidenced by a decrease in repeat admissions to the hospital, fewer repeat visits to the doctor and decreased lengths of stay. Strober (2005) evaluated a program designed by 'veteran' parents to help acclimate newer parents the workings of a hospital (hierarchies, how information is communicated, etc.) and what to expect. Although families who experience a perinatal crisis may receive some support from family, friends and healthcare providers, studies” show that parents report they are not getting enough support from these resources (Kerr & McIntosh, 2000; Blackburn & Lowe, 1986; Ritchie, et al., 1994; Kant, 1994; Kazak, 1989). . . . “Parents state that they want more support, in particular from other parents with similar experiences” (Quittner, et al., 1990; Gibson, 1986; Havermans & Eiser, 1991; Ritchie, et al., 1994; Singer, et al., 1999). AHH could begin providing similar family perinatal support. It would require some resources, but the reputation of AHH may be positively affected. Another hospital, Stanford Children’s Health, in Palo Alto, California, has “parent mentors” who they say . . . “[a]re available to visit expectant mothers at the bedside to provide support, validation and information about the antepartum experience. Mentoring sessions vary in length and can be one-time visits or regular meetings during your hospital stay. Our Antepartum Unit parent mentors spent time as patients in the unit during their own pregnancies, and are a great resource for expectant mothers and new parents” (Antepartum Care - Stanford Children's Health). (If you incorporate something akin to the parent mentor program, please know I would be pleased to be a volunteer.) And, The Women’s Hospital of Texas, in Houston, Texas, has a social support group they call “tea timers.” They say “The Tea Timers provides a wonderful reprieve from the stress of high-risk pregnancy and meets once a week for mother-infant education classes on breastfeeding, infant CPR, scrapbooking sessions and special holiday-related festivities” (http://womanshospital.com/our-services/antepartum.dot). I had the pleasure of being cared for by some outstanding labor and delivery nurses. During my stay, a nurse in the labor and delivery unit, who was hired sometime in December 2013, informed me she quit her position with Northwestern Memorial Hospital’s Prentice Women’s Hospital and began working at AHH to be closer to home and spend more time with her young child. She spoke of how she worked with a great deal of antepartum women and how Prentice has physical therapy; group meetings for patients with wheelchair privileges (with doctor approval); and other amenities that impact perinatal patients positively. As you already employ her, it may behoove your organization to utilize her experience and expertise while setting up perinatal programs. I came back to AHH to give birth in January 2014. While there, I met with a social worker. This indicates to me that social workers are already on the scene at AHH. While it may cost AHH to include social workers as counselors to perinatal patients, it also may lower costs. Going through this transformative ordeal has impacted me and my family in ways I would never have imagined. Almost six months after my ordeal, I deal with days where I feel as though the only thing I think or talk about is “the hospital” or “the doctor.” I still have dreams about 900 gram babies. And I am dealing with physical issues as well (for instance, an odd, chronic migraine that was just diagnosed yesterday (because it stumped many doctors), which started back when I was first hospitalized). For me, talking with other women who have experienced a perinatal crisis is very beneficial to my overall health. With that in mind, I am sure you will not be surprised to find that you probably have a large number of volunteers at your service – that is, former patients who were hospitalized at AHH for a perinatal crisis. After experiencing this life-changing event, many former patients may be inclined to support others. I would love to make a difference in the life of a woman who is experiencing a perinatal crisis. It would make me feel better to know that I can make a difference for someone else. If you establish any of these or other programs, and need volunteers, please do not hesitate to contact me via e-mail at [email protected]. I would be honored to volunteer. It was not easy for me to be on bedrest. Having great support from AHH and my doc helped me survive it and I hope that future perinatal patients will be able to experience the above-mentioned recommendations to enhance their quality of care. Sincerely, Tara REFERENCES Armstrong D and M. Hutti. 1998. “Pregnancy After Perinatal Loss: The Relationship Between Anxiety and Prenatal Attachment.” Journal of Obstetric, Gynecologic, and Neonatal Nursing 27: 183-198. Blackburn S. and L. Lowe, “Impact of an Infant’s Premature Birth on the Grandparents and Parents,”Journal of Obstetric,Gynecologic, and Neonatal Nursing(Vol.15 no.2, 1986), 173-178. Cote-orificenault, D., D. Bidlack, and A. Humm, “Women’s Emotions and Concerns During Pregnancy Following Perinatal Loss,” American Journal of Maternal and Child Nursing (2001), Vol. 26 no. 3, 128-134. Dunst,, C.J., C. M. Trivette and A. G. Deal, Enabling and Empowering Families (Cambridge: Brookline Books 1999). Gibson, C.H. “How Parents Cope with a Child with Cystic Fibrosis,” Nursing Papers (Vol. 18, 1986), 31-45. Havermans, T. and C. Eiser, “Mother’s Perceptions of Parenting a Child with Spina Bifida,” Child: Care, Health and Development (Vol. 17 no. 4, 1991), 259-273. Indiana Perinatal Network, “Perinatal Family Support Consensus,” April 2007. http://c.ymcdn.com/sites/www.indianaperinatal.org/resource/resmgr/policy_makers/family_support_042007.pdf Kant, R.V. “An Analysis of Caregiving Work,”Australian Journal of Marriage and Family(No. 15, 1994) 66-75. Kazak, A.E.“Families of Chronically Ill Children: A Systems and Social-Ecological Model of Adaptation and Challenge,”Journal ofConsulting and Clinical Psychology(1989) Vol.57 no.1, 25-30. Kemp, V.H. and D. D. Hatmaker, “Health Practices and Anxiety in Low-Income, High and Low-Risk Pregnant Women,” Journal of Obstetric Gynecologic and Neonatal Nursing (1993) Vol.22 no.3, 266-272. Kerr, S.M. and J. B. McIntosh, J. B. “Coping when a Child has a Disability: Exploring the Impact of Parent-to-Parent Support,”Child: Care, Health, and Development(Vol. 26, No. 4, 2000), 309-322. Quittner, A.L., R. L. Glueckauf and D. N. Jackson, “Chronic Parenting Stress: Moderating and Mediating Effects of Social Support,” Journal of Personality and Social Psychology (1990) Vol.59 no.6, 1266-1278. Reid, T., “Maternal Identity in Preterm Birth,” Journal of Child Health Care (2000), Spring Vol. 4 no.1, 23-29. Ritchie, J.A., M. J. Stewart, P. McGrath, D. Thompson and B. Bruce, “Support and Burden Experienced by Mothers of Chronically IllChildren,” final report submitted to the Hospital for Sick Children Foundation, Grant No. XG 92-024 (1994, Winnipeg, Manitoba:The Spina Bifida Association of Canada). Singer, H.S., J. Marquis, L. Powers, L. Blanchard, N. Divenere, B. G. Ainbinder and M. Sharp. 1999. “A Multi-Site Evaluation of Parent-to-Parent Programs for Parents of Children with Disabilities.” Journal of Early Intervention 22(3): 217-229. Strober, E., “Is Power-Sharing Possible? Using empowerment Evaluaton with Parents and Nurses in a Pediatric Hospital,” Human Organization (Summer 2005)

Hi Elvish, Thank you for your post! I am a mother of two, and the final baby was coming early (or so we thought). I ended up in the hospital's L&D unit for 50 days! Then I went home for 33 days and gave birth to my baby girl when she was 36 weeks, 6 days. It was rough. I have a healthy baby and I feel fortunate for that. However, I also have residual stress, what to me feels like a post traumatic stress disorder from feeling like I was hanging over a cliff for 50 days (and then another 33 days at home, which was a little easier than being in the hospital). Now that it is all said and done, when I tell professionals who are involved with women like me about what I went through, they are somewhat shocked. They ask if I ever saw a social worker (answer: nope). Did I get physical therapy (answer: nope). So I now feel compelled to contact that hospital and try to affect some change in their antepartum unit. I know they have nurses there who previously worked for other hospitals that have lots of activities and things like physical therapy and counseling available to women on bedrest. Do you have any tips for me before I submit a letter to the manager of the L&D unit? I really want them to take me seriously and not just toss out my letter thinking they have another irritated new mother on their hands. Thank you so very much! Tara