Oregon AWHONN

Promoting the Health of Women and Newborns

November 2014 Vol. 1 No. 3

In This Issue

Oregon AWHONN Goes National

by Deb Castile, MN, RNC, CNS, NE


Fall is here. Winter's cold weather is soon upon us, and before we can blink, 2014 will come to a close. But before 2014 comes to an end, let me tell you what your Oregon AHWONN Leadership team was up to this year and how we are helping support AWHONN's goal of promoting the health of women and newborns.


This year, we focused on increasing the visibility of AWHONN. To fulfill this goal locally, Oregon AWHONN partnered with Professional Education Center (PEC) during their Portland Advanced Fetal Monitoring course in March, with the Swanman Perinatal Conference in May and with Northwest Perinatal Resource Network (NWPRN) during their summer courses. During each of these partnership events, one to two lucky attendees won an annual AWHONN membership. The memberships were offered either through Oregon AWHONN or by a generous donor.


Oregon AWHONN had the opportunity to shine several times nationally. First, early in the year, Oregon AWHONN learned that it was one of the Every Woman, Every Baby donation campaign winners. As a result, Oregon AWHONN awarded Diana Richardson a registration to the National Convention in Orlando. Second, Oregon had a solid representation at the National Convention; our own Dr. Linda Veltri presented findings from her research on the use of simulation nursing education and the experiences of Obstetrical nurses who work with undergraduate nurse students in the clinical setting. Third, four Oregon AWHONN Leadership members attended the AWHONN Leadership Conference in early November. Again, Dr. Linda Veltri had the opportunity to present abut Oregon's strategic succession planning, specifically the purposeful engagement of nursing students within the Oregon AWHONN Conference Committee. Additionally, Becky Moore and Deb Castile represented Oregon AWHONN and received a beautiful certificate for being the 2013 Every Woman, Every Baby (EWEB) Participation winner. Lastly, I have been invited to represent AWHONN members on two different AWHONN National Committees -- Development Committee and Advisory Panel. Through each committee, we are looking at ways to grow and develop AWHONN.


I can't wait to see what 2015 has in store for us. I know that we will increase awareness of AWHONN within the state of Oregon. We will do this by partnering with more local and national organizations, holding more Chapter meetings throughout the state and increasing visibility within hospitals and at local Women's or Children's events. With all the activities and goals your Oregon Leadership team has, we can sure use a few more people on our team. If you desire to get more involved with your local AWHONN Chapter or Section, please reach out to me at [email protected] and let me know how you would like to get involved.

Oregon AWHONN Membership Update

by Kendra Coleman MS, BSN, RN, NE-BC


The Oregon AWHONN section has had an incredible year with membership recruitment. So far this calendar year, we have gained more than 89 new members with 12 of them at Oregon Fall Conference alone in September. To put this into perspective, in 2013 we had 32 total new members! Our increase in membership can be attributed to our focus as a Leadership team on member recruitment. Not only have we made a tremendous effort to increase membership, we have strongly encouraged members to recruit as well. As a member of AWHONN we encourage you to recruit a colleague to our fantastic professional organization. If you recruit 3 new members in a calendar year, you receive a free one-year membership. If you recruit more, see what rewards you can earn!


If Eleven more members join AWHONN before December 31, 2014 the Oregon Section will have 100 new members for the year. I encourage each of you to recruit a friend or colleague. If they ask why they should join, I hope you can share some wonderful personal experiences of the benefits of membership. You can also share the following benefits:


  • free access to nurse-reviewed evidence-based articles
  • discounted materials and conference fees
  • free AWHONN publications
  • incredible networking opportunities
  • tax-deductible dues


Many other benefits can be found on the AWHONN website! Don't forget the special Oregon AWHONN membership benefit of access to all of AWHONN's current recorded webinars. Help us reach 100 by the end of 2014!

From the Editor's Desk

With the holidays upon us and the year coming to an end, I find myself reflecting on the year gone by. It's common practice this time of year. What did I accomplish? Who did I influence? What difference did I make?


Being a part of Oregon AWHONN, I've had many opportunities to make quite a difference this year. Not only have I helped many women bring new babies into this world, I've helped other nurses keep their knowledge of women's health, obstetrics, and neonatal care current. Volunteering with Oregon AWHONN has been a rewarding experience -- one I highly recommend to everyone. Here's to another great year!


Donna Talain

AWHONN Leadership Conference Report

Four Oregon AWHONN Leaders went to Washington D.C. to attend the AWHONN Leadership Conference. Linda Veltri, Donna Talain, Becky Moore and Deb Castile learned about the projects National AWHONN has been working on including, but not limited to, creating a Late Preterm Toolkit, a Postpartum Hemorrhage Project, creating and revising position statements like Non-Medically Indicated Inductions and Augmentations of Labor, revising the Fetal Monitoring Principles and Practices 5th Edition Book and many other great projects. In addition to hearing about what National AWHONN is doing, we learned about some great activities and projects other Sections are doing, including sharing some excellent Chapter meeting ideas.


Your Oregon team came back energized from the Leadership Conference. The entire Oregon AWHONN leadership team will be getting together in early 2015 to create some solid 2015 short term goals and to create some long term goals for three to five years into the future. One of the focal areas for 2015 will be on reenergizing and resuming Chapter meetings. So stay tuned for upcoming fun Chapter meetings.

Herpes Simplex Virus and the Neonate

by Pat Scheans, DNP, NNP-BC


In the United States, 20-25% of adults have genital herpes caused by herpes simplex virus (HSV) type 2, and HSV type 1 may account for 20-50% of cases of genital herpes. First, the good news: HSV infection of the neonate is an uncommon occurrence with 1,500 cases per year in the U.S. Now the bad news: 60- 80% of women with an HSV-infected infant have no clinical genital HSV infection at the time of delivery, nor a history of genital herpes or a sexual partner who reports having HSV. To make matters worse, 20-30% of women of childbearing age are seronegative for both HSV-1 and HSV-2, and if her partner is HSV-1 or -2 positive, the chance that she will acquire either virus during pregnancy is estimated to be 3.7%. More than 60% of women who acquire genital herpes during pregnancy remain asymptomatic. More bad news: mothers who have a first episode of genital HSV infection during pregnancy and are shedding virus at delivery are 10-30 times more likely to transmit the virus to their newborns than mothers who have recurrent genital herpes.


Fortunately, the American Academy of Pediatrics (AAP) has guidelines (including algorithms) for the assessment and management of asymptomatic neonates born to women with active genital herpes lesions. Here is a synopsis of those guidelines, which can be found at http://pediatrics.aappublications.org/content/131/2/e635.full.


Neonatal HSV infection (viral replication without illness) and neonatal HSV disease (having symptoms like skin lesions, encephalitis, hepatitis) are separate entities, but once an infant is infected with HSV, it rapidly progresses to neonatal HSV disease. Our goal is to prevent this by administering parenteral acyclovir preemptively to HSV-infected neonates. Correlation of lesion viral type with serological status allows for determination of maternal infection classification and neonatal transmission risk, which determines length of treatment for the newborn. In the case of neonatal symptomatology such as skin lesions or mouth ulcers, consult your friendly, neighborhood pediatric infectious disease doctor.


The rates of transmission of HSV infection to the newborn:


  • Intrauterine - 5%
  • Intrapartum - 85%
  • Postpartum - 10%


Factors known to influence transmission of HSV from mother to neonate:


  • Type of maternal infection (primary versus recurrent)
  • Maternal HSV antibody status
  • Duration of rupture of membranes
  • Integrity of mucocutaneous barriers (e.g. use of fetal scalp electrodes)
  • Mode of delivery (cesarean versus vaginal delivery)


What can you do?

Women in labor with visible genital lesions that are characteristic of HSV should have the lesions swabbed for HSV PCR and HSV culture. Any positive test result then requires further analysis to determine if the virus is HSV-1 or HSV-2. If mother does not have a history of genital herpes preceding pregnancy, send maternal serum for HSV-1 and HSV-2 IgG and IgM in order to determine maternal antibody status. Use scalp electrodes with caution. In women with no history of genital herpes preceding pregnancy, refer to the table in the article once lesion PCR/culture and maternal antibody status return, to classify the maternal infection as first-episode (primary or nonprimary) or recurrent. If a genital lesion is strongly suspicious for HSV, clinical judgment should supersede a negative virological test of the lesion for purposes of conservative management of the neonate.

References


Kimberlin, D., & Baley, J. (2013). Guidance on management of asymptomatic neonates born to women with active genital herpes lesions. Pediatrics, 131(2), e635-e646. doi: 10.1542/peds.2012-3216

Discordant Priorities in Contraceptive Decision-Making

by Nancy Irland, DNP, RN, CNM


Are you using the contraceptive your provider likes, or the one you wanted? Odds are you're using your provider's choice, rather than your own. It's been estimated that of the 4 million births in the United States a year, a little more than half of these are unintended (Finer & Zolna, 2014 as cited in Donnelly, Foster, & Thompson, 2014). Of those, 43% are unintended because of inconsistent or incorrect contraceptive use. The reason for that? Providers and patients have discordant priorities, and contraceptive methods are more often based on the provider's preferences instead of the patient's. If you're in the market for a contraceptive, knowing your provider's priorities might help you advocate for yourself better.


What's most important?

A 2014 study of 417 mostly white women with bachelor's degrees and 188 mostly white, female providers (27% nurse practitioners, 20% physicians) showed an interesting discordance between what providers and patients considered to be most important in choosing a contraceptive. They were given a list of 34 questions and asked to prioritize them in order of importance. Most important to the patients was the question, "How does this contraceptive work to prevent pregnancy?" For the providers, the most important questions were religious acceptability for the patient, convenience, and the partner's perception of use (concealability).


So, while the providers were teaching about what they assumed was most important to their patients--religious acceptability and concealability of the method -- they were missing the things of importance to their patients.


Do providers care about safety?

Twice as many patients as providers ranked safety in their top three questions, yet providers ranked safety as low on their priority list. Researchers suggested that perhaps providers automatically assumed all methods relatively safe, so safety was not of concern.


What about side effects?

Although side effects are a major cause of method discontinuation, it was surprising that fewer providers than patients prioritized side effects as something to discuss. Instead, questions about mode of use, frequency of administration, and when it begins to prevent pregnancy, were prioritized more frequently by providers than patients.


Where should the conversation start?

Recognizing that providers are making incorrect assumptions about what women want to know about a contraceptive and what they find most important is crucial for women as both patients and for us as medical professionals. In order to avoid the potential of ineffectively answering women's possibly unspoken questions when making choices in contraceptive methods, it might be helpful to begin the conversation by asking the question, "What's most important to you?"

References


Donnelly, K. Z., Foster, T. C., & Thompson, R. (2014). What matters most? The content and concordance of patients' and providers' information priorities for contraceptive decision making. Contraception, 90, 280-287.

Member Spotlight: Sierra Anderson, Kaitlin Moore, and Branddy Walter

Oregon AWHONN Fall Conference: Nursing Students' Lived Experience

Students highlighted from L to R: Sierra Anderson, Branddy Walter and Kaitlin Moore

Being a part of the Oregon AWHONN Conference Committee as students easily goes down as one of our most memorable and invaluable experiences in nursing school thus far. As students about to enter our senior year, we were fortunate enough to see the inner workings of a professional committee from a nursing organization. All the members of the committee were open and friendly, while being more than happy to offer their advice and insights of an experienced nurse. We discovered the benefits of joining a nursing organization and getting involved with a state chapter. Besides the experience of working on the committee, the conference was absolutely incredible. We heard some lectures from amazing nurses who have made a difference in the world of nursing. Furthermore, we were moved more than ever to pursue an advanced nursing degree in the future. If we only had one word to sum up this experience, it would be inspirational. We would encourage any and every nursing student to jump at chances like these. We hope one day that we can be a part of a group of nurses such as these and, in turn, inspire future nurses.


Our main contribution to the Oregon AWHONN 2014 Fall Conference was the requesting, gathering, organizing, and distribution of raffle prizes. This was an awesome and inspiring experience as so many individuals and companies gave so freely knowing that it would show their appreciation of nurses. The handcrafted quilts in particular were amazing works of art donated to raise money for the charity "My Sister's Place", a charity that helps women dealing with domestic violence. By the time the conference began we had an overwhelming number of gifts for our hard-working nurses to enjoy. Each night we would have fun arranging baskets that we would present as prizes the next day. Our job was more fun than chore and it felt nice to help contribute to the event.


All the nurses that attended and organized this conference were outstanding and extremely grateful that we were there to help. As students, we were awestruck by the kindness and generosity that the Oregon section leaders showed to us. These women gave us nothing but warm, friendly greetings and made it their mission to make us feel welcomed. They constantly checked in on us to ensure that we were having a good time, and went out of their way to ensure that we were comfortable. We were there to sell raffle tickets, but these women made sure we were learning and benefiting from the conference as well. We would also like to acknowledge our instructor, Dr. Linda Veltri, who advocated for us students to have such an influential role in this conference. Without her guidance before the conference, we would not have been able to gather as many raffle prizes as we did. We would like to thank Deb Castile, Oregon AWHONN's Chair, and Becky Moore, the Secretary/Treasurer for being so warm and welcoming. We were also able to interact and pick the brains of conference co-chairs Nancy Alt and Robin Cothrell-Tubbs. Cathy Ivory, AWHONN's national president personally greeted us by name and thanked us for our help, which as student nurses was a very exciting moment. All of these women made a lasting impact on us as students, and we will forever be grateful for the experience we had because of their friendliness.

Oregon AWHONN Fall Conference Report

The 2014 Oregon AWHONN Fall conference at the Oregon Coast was another huge success. Sunday to Tuesday was packed with education related to obstetrics, newborns and professional issues. Participants had multiple opportunities for networking with their peers while enjoying wonderful food and atmosphere. Our participants had the opportunity to discuss issues with our speakers, both local and national! In addition, participants were active and eager in donating to this year's quilt raffle which raised over a thousand dollars for a local women's shelter. The committee sincerely thanks those individuals who donated quilts for our raffle.


We would also like to acknowledge the hard work of the student volunteers who helped during the conference. Their work behind the scenes helps the conference flow in a much more seamless fashion.


The committee is busy planning next year's conference! We will have exciting news about location soon... but do mark your calendars for mid-September. The conference will provide sessions for obstetric, neonate and professional topics AND our keynote speaker will be Lisa Miller! You won't want to miss this one! September 2015 Oregon Fall Conference... Be there!!!

Healthier women, safer pregnancies, stronger babies and the best prepared nurses - you make this possible! Gifts to Every Woman, Every Baby help achieve important outcomes for our most precious resources, our patients.


Announcing the Every Woman, Every Baby Award for AWHONN Sections


Two Sections will be awarded complimentary registration to the 2015 AWHONN Annual Convention in Long Beach, CA for supporting and promoting the Every Woman, Every Baby campaign.


Award: Section with the greatest participation rate based on a percentage of their total Section membership.


Award: Section that raises the most for the Every Woman, Every Baby campaign.


Prize: AWHONN Convention Registration


Award Year: January 1 to December 31, 2014


So far, Oregon AWHONN is in the top five for both award categories! Help us win them both by making a donation today.


www.awhonn.org/donate