Cholestasis and Listening to Your Intuition with Jenn Johnson of RX For Growth.

Jenn Johnson shares her personal pregnancy stories and discusses how even as a nurse she had to advocate for herself during pregnancy. Jenn also shared info on her book, A Nurse’s Happy Place.      

Subscribe to our newsletter, check out Kristin’s birth and baby book, and see more about our Doula services & online courses below:

https://linktr.ee/goldcoastdoulas

Transcript

Jenn Johnson shares her personal pregnancy stories and discusses how even as a nurse she had to advocate for herself during pregnancy.  Jenn also shared info on her book, A Nurse’s Happy Place.

Hello, hello!  This is Kristin with Ask the Doulas, and I am thrilled to chat with Jenn Johnson today.  Jenn is the owner of Rx for Growth, and our topic today is all about trusting your intuition with your pregnancy and your health, not only in pregnancy, but also in the postnatal phase. 

Jenn Johnson is a wife, mother of two, and a registered nurse in Ontario, Canada.  She’s spent the last 14 years of her career in the emergency room of big and small hospitals all over northern and southern Ontario.  She’s personally been a part of all the heartbreak, drama, life and death moments, and also trying to cope in the ER journey and ongoing pandemic. 

Her books are her battle cry to all other nurses struggling through this pandemic who are losing their love of nursing.  They are burned out, depressed, and feeling hopeless.  The love, caring, and camaraderie of nursing has changed for all of us, and the expectation that nurses continue to show up to a job that puts their lives on the line is new to them.  And obviously, coping has been hard, not only in the pandemic, but just for health care workers in general. 

So now more than ever, Jenn is focused on supporting nurses and helping raise each. 

Welcome, Jenn! 

Thank you!  

I have such a respect for nurses, working with labor and delivery nurses closely as a birth doula, and also in my experience in the postpartum units and the antepartum units with the nursing staff there. 

That’s a job where – it’s one of the floors where it’s like, I’ve got some education and background in labor and delivery.  I’ve never actually physically been hired on labor and delivery and worked it, so much kudos to those nurses, because am I ever triggered by loud noises?  And that whole department is nonstop screaming and yelling.  Kudos to those people who can sit there and take moms through it because having had two kids, you know, your body takes over, and you are absolutely out of control.  Your body is doing it for you, and the nurse – I thought I could rely on the nurse background, but man, she flew away real quick.  And you’re at square one with everybody else.  You’re just another scared mom trying to get through it, and the pain is new.  The fear is new.  Everything is new, and you’re not sure what to expect and how things go and how the day goes, so it’s – yeah, kudos to those guys, because every specialty is their own special people, but I’ve got a lot of labor and delivery friends, and man, they are the most special people. 

Well, I feel that way about the ER department.  You never know what you’re going to get. 

That’s the fun part! 

You like adventure; okay! 

There’s an ongoing meme that circulates the ER and labor and delivery.  Somebody comes in, and the ER nurse – she’s pregnant.  Oh, I hope it’s not a baby.  I hope it’s a snake.  And here’s labor and delivery – oh, my God, I hope it’s a baby, not a snake!  We’re very comfortable with chaos and weird, but for some reason, the responsibility of helping bring in another life, and all the legalities and risks associated with birth and pregnancy scares the living daylights out of us.  So we’re very happy when you're over 20 weeks and we get to say, you know what, you’re get to go right up to L&D.  Have a great day! 

Right!  I know when I had my daughter, there wasn’t yet a separate entrance for our women’s center, and so I went through the emergency room and triaged there.  People had head injuries and so many different things going on, and I was just in labor having a baby, so…

Right.  This is the normal thing.  The rest of these are accidents.  

People were coughing and sick.  It was interesting.  But now we have a whole separate entrance and triage, which is very nice. 

That’s so epic! 

Yes!  Well, I would love to hear about your personal journey and how that really led you to want to not only advocate for nurses but also speak for mothers. 

So I started out with a biology degree, just kind of barely getting through.  I failed organic chemistry and was just like, okay, this is clearly – I’ve never failed anything.  What is happening?  And thankfully, I had a girlfriend in residence who was already in nursing, so we’d pour over her textbooks and kind of go like, okay, this is cool.  This is what I want to learn.  So I swapped into nursing and graduated in three years out of four because we had a fast track program and I already had some university credits.  I ended up meeting my husband and starting my first job.  My first job was in a very, very small hospital where there was only one nurse for emergency, one nurse for the floor – one RN for the floor with two RPNs, and maybe 14 beds, but the town size was maybe 5000 people.  So we were doing it all.  We were doing, theoretically, labor and delivery and med surge and emergency and all this, and you’d just kind of rotate back and forth based on the day. 

Fortunately or unfortunately, they did end up closing the L&D portion down fairly soon after I started, which kind of sucked, because I was like, oh, I’m doing my perinatal certificate.  I could help.  I’ve got my fetal monitoring certificate and I’m all ready.  But here we are; on to the next thing.  I ended up moving down south to southern Ontario, getting married, and having my babies.  It wasn’t until getting pregnant and having trouble getting pregnant that it was like, oh, man, there is so much more to this other world that I had no idea about.  Thankfully, after about a year or so, we ended up getting pregnant with my first.  Pregnancy was going like, okay, puking my brains out.  I’m thinking, okay, this is all normal and this is what’s happening.  And it's like, okay, well, it’s kind of continuing, but I’m not hungry; I’m nauseous; I’m losing weight.  Something wasn’t quite right, but I wasn’t clueing into it.  Thankfully, we had midwives, and the midwife appointments up in Ontario – you’ve got 30 minutes to 45 minutes with your midwife, so you chit chat and you hit all the marks, versus kind of the OB route where a lot of people I knew were kind of in and out very quickly, and it was like, okay, let’s check your weight, let’s check your pee, and out the door you go.  So I was so thankful that we were able to get in with a midwife and a phenomenal team in the area. 

It wasn’t until I was 38 weeks and literally walking out of one of these appointments going like – and one of my midwives and I were just chatting, and I was like, hey, my feet are so itchy.  Like, I’m over it.  Every night, itching my feet.  Is there any kind of salve or a medication I can take or something?  It’s just driving me nuts.  And she looks at me, and she goes, oh, crap, you were so textbook.  I’m like, what do you mean, was? 

So she kind of explains to me, okay, it could be cholestasis in pregnancy, and we’re just going to send you from the office down to our sister hospital and we’re going to just get you checked out.  I was like, all right, not a big deal.  I was not thinking in the moment that it was anything too much to worry about.  But genius me, I started googling, like a moron, like any good scared mother.  And of course, all that keeps coming up is cholestasis in pregnancy – the risk is late term stillbirth.  So at 38 weeks, I am losing my marbles, going like, it’s a 25, 30 minute drive down the highway, and I’m going, what is happening?  Oh, my God, everything has changed. 

So we go up to OB.  We get checked out.  They draw bile salts, which is a very specific test that is used to diagnose cholestasis.  So I’m sitting there; I’m being triaged up in OB.  They’ve got me all hooked up; they’ve got Wyatt all hooked up while he’s still in me.  And the OB comes back and goes, okay, so your bile salts are really elevated.  You’re not getting up off the stretcher.  We’re going to induce you right away. 

I’m like, look, we left our car in one place; our house is in another; I don’t have anything with me.  We’re just going to go.  We’ll get all the stuff.  We’ll come back.  And the OB was like, absolutely not.  You’re not getting up off this stretcher.  We’re inducing you this instant.  I’m like, holy crap.  Okay. 

So everything changed very, very quickly.  It was already probably 5:00 or 6:00 at night.  And again, the Googling, and you’re just going like, well, what is this?  I’ve never heard of this.  I’ve even got a perinatal certificate, and I’ve never heard of this.  And they’re like, oh, it’s so rare and it’s very nonspecific.  

And so you go through the beginning induction process with the one they stick up there. 

Cervidil? 

Cervidil, thank you.  Started with that and then they moved me to a room and they put in the IV and we got Pitocin started.  I had some experience with Pitocin, being the one to adjust it.  To all my previous labor and delivery moms, I am so sorry! 

It can be intense!  I’ve not personally experienced it, but my clients certainly have. 

I am so sorry to my moms who I kept increasing the Pitocin!  And I’m like, I had no idea that the pit pains were so bad.  A nice, regular, average birth, you’re just very slowly working up to the pain, whereas the pit pains, you go from zero to 60 in an instant without having time to kind of cope or adjust or anything.  And you’re just going.  And so tried to get an epidural.  The epidural failed three different times.  And by the third time – I think they’d actually gotten it in the third time, but as they were taping it up my back, I was like, oh, my God, I’ve got to push.  My girlfriend, who actually was my OB nurse, thank God – she was there.  She goes, okay, well, we’re just going to check you, but you were only 3 or 4 centimeters an hour ago.  And I was like, no I’ve got to push. 

And so she checks me.  She’s like, well, so you’re 10 centimeters and he’s right there.  I’m like, no, bolus me the epidural.  I want the pain meds.  She’s like, no, we’re way past that.  I’m very sorry.  I’m like, no, don’t tell me!  Please give me the meds! 

So Wyatt was out.  He was deemed a precipitous delivery because he was out in an hour 45 from time of water break, and it was just this whirlwind of everything happened so very fast.  So then you’re in new mom mode, and when everything starts to kind of settle – the dust starts to settle just a little bit.  You’re finally feeling like yourself again.  I get my liver enzymes checked again.  They have come back down to normal.  We’re all good that way.  

Doing my research – because now I’m super curious about cholestasis, now that I know about it.  Like, let’s see what’s going on.  So the time that I read things, they didn't know whether it was the physical weight of the pregnancy, the chemical weight of the pregnancy, the hormonal weight of the pregnancy – what caused, for some reason, your body not to process your bile salt anymore.  So what they would do is they would actually kind of accumulate in your body but settle to your feet as little crystals within your system.  That was what was causing the itchiness.  So I’m like, okay, let’s do all this research and let’s get going.  I’m so curious about this now.  So, reading, if you’ve got the same baby daddy, you’ve got a 70 to 90% chance of getting cholestasis again.  Oh, great.  So the miracle is not getting cholestasis again.  

So yes, I was worried and whatever else, but because everything happened so fast with Wyatt, not super concerned.  Normally, I think they find it roughly 34 to 36 weeks.  Something happens where you’re having symptoms and they detect an elevation in your blood.  At 28 weeks, I sat there and I’m going, okay, I’m not sick.  I don’t feel unwell.  But something is telling me that there’s something wrong.  So at 28 weeks – I had OB coverage but was still with my midwives.  With the cholestasis, I did go back to my midwives and say, hey, I’m just feeling off.  Is there any way we can do to the bile salts just to see if they’re elevated?  And sure enough, at 28 weeks, they were already starting to climb.  

So I’m like, oh, here we go.  So I actually ended up with the same OB who delivered Wyatt.  It’s like, okay, so you’re getting weekly blood work that was not covered by OHIP, which is the Canadian healthcare system, so I had to pay out of pocket – fun.  That was $70 a week for bloodwork that I had to fast for.  Then it was biweekly ultrasounds.  So all of a sudden, this pregnancy turned into a full time job.  And I kind of found that the bile salts were just slightly elevated at 28 weeks.  I found that for me personally, I couldn't eat anything that was super refined sugar or anything deep fried.  So for those of us who were of age, the Simpsons, where Homer robs the burger because he’s trying to gain 150 pounds – he robs the burger on the wall, and if it’s clear, that’s your window to gaining all this weight.  So I was like, okay, anything beige and anything deep fried, I’m going to have to see.  For some reason, I just got super nauseous with it and it didn't sit well with me. 

So cutting those out without realizing it, my bile salts ended up coming down and coming back down into normal range.  So I was like, oh, so this is just diet.  My OB was like, oh, we want you to take these pills.  They’re usually used for gallstones.  You need to take these, blah, blah, blah.  So me being the great nurse that I am, I went through all of the research and trying to find a lot of really good evidence-based studies and trials to back this up.  I’m worried about my kid, so what are the long term effects?  And trying to do what I could to find any information.  Well, because it was not necessarily an off-label use for this medication to use it in pregnancy but it was kind of not advised.  And when I went to go fill it, the pharmacist called me three different times.  Do you know what this medication is for?  You’re pregnant?  Does your doctor know you’re pregnant?  What’s your weight?  Are you sure?  He really kind of freaked me out.  The pharmacist never calls anybody at home.  Why is the pharmacist calling me three different times, no less, about this medication?  So I was super hesitant to take the medication.  I ended up not taking it because by the time I got that prescription and everything was filled and we’d been doing the weekly bloodwork, my bile salts were already coming down. 

So I said, you know what, my bile salts are already coming down without the medication.  I can’t find a lot of evidence on this and long term use and XYZ.  Trying to explain to my OB that I wasn’t comfortable with this, and that was the first time I really got a lot of pushback from the OB to be like, oh, my God, we use this in England all the time.  I don’t understand why you’re not just taking the medication, and kind of gave me a what-for.  And I’m like, wow.  I’ve never been on this end before. 

Right, as the nurse. 

I’ve never been the patient getting the what-for, and do I kind of – the number of times myself I’ve kind of gone like, oh, why is this patient not taking their medication?  It’s the best thing for you.  The doctor’s prescribed it.  We wouldn't be just throwing it at you.  So to be on the other end and be kind of refusing and having to advocate for myself and say, look, I don’t understand why the pharmacist was so upset, why there’s not a lot of evidence and data to back up the use of this medication in cholestasis in pregnancy.  I’m just a little leery.  And even just saying I was a little leery, that really aggravated the docs.  I was like, oh, I’ve never been here.  I can’t remember if he knew I was a nurse or not, but I was just like, man, this is weird.  Okay, note to self.  I’m going to have to really keep this in mind for when I come up on the other side of this later in life and so when people are telling me that they’re not taking their medications, maybe to dig a little bit deeper as to why they’re not taking their medications.  So that was just a little takeaway. 

And so I went through the pregnancy.  Bile salts were fine.  Everything was great.  Halloween rolled around, and Elise was due, actually, at Christmas.  Halloween rolls around.  This is my favorite holiday.  We’ve got Wyatt out and trick-or-treating.  We’ve got all the candy lying around the house because we’re in a busy area.  And I kind of binge hard on all the candy, and suddenly my bile salts shot up.  So by November, the middle of November, my bile salts were all of a sudden elevating, and the OB is looking at me: I’m not going to sleep until I induce you.  What are you doing Thursday – and this is Tuesday?  I’m like, absolutely nothing!  And he goes, okay, we’re going to induce you.  And I’m like, okay, that would make Elise 36+6, which is technically preemie, so I’m like, okay, we’re just kind of walking that line.  

I got induced, and this one at least was a scheduled induction, so I kind of knew what I was walking into.  He was like, call the floor; make sure they’ve got a bed for you.  Make sure they’ve got a nurse for you.  I said, I’ve got midwives, and he was like, I understand, but we still also pair you with an OB nurse.  I was like, great, I know most of the girls on the floor.  So at 6:30 or 7:00 in the morning, I call.  Yeah, we’ve got a bed.  Fantastic. 

I am raring to go.  I’m like, let’s get this kid out of me.  I’m done stressing about what’s going to happen.  I just want my body back, the whole bit.  So we go.  We get induced.  And thankfully, Elise comes out just fine.  And going back and looking at test results, with Wyatt, by the time we found the cholestasis with him, my bile salts were in the 200s, when the range is 0 to 10.  With Elise, by the time we induced with Elise, I think we were only at 15 or 20.  So I was really glad that I didn't know this when we were having Wyatt.  I’m really glad, because I think I just would have hit the roof.  But it was one of those things where you can trace it back to that feeling of, I’m not sick.  Like, I don’t feel unwell, but just something in my being is telling me that something is off. 

With Elise, we made it to the hospital about noon and had the repeat of the pit pains.  I definitely wanted the epidural, and it was successful, thank God, so a little bit of a different experience than my son where there was no time for the epidural.  The midwives had been telling me the whole pregnancy that when I do start having contractions, please make it to the hospital ASAP.  Your son was precipitous; we expect you to go within 45 minutes once your water breaks.  So I was on high alert.  

When I got to the hospital, we started the Pitocin and nothing really happened.  It took what felt like forever and a day for the doc to come in and break my water.  I was like, okay, 45 minutes; let’s go!  And nothing happens.  I was like, what’s going on?  So we waited enough time, and clearly, this isn’t moving fast enough.  I think it was that time that I decided to get the epidural.  It was 45 minutes after the epidural was given that Elise decided to show her adorable little face.

She was technically preemie, so we had decided to stay a couple of days.  Her sugars were a little on the rough side, so the nurses and the midwives were like, well, we can either admit her to NICU, put in an IV, and get some dextrose and we can be exclusively breastfed, or we can supplement with formula and kind of keep you in the OB side and Elise can stay with you and we’ll just check her sugars really, really regularly just to make sure that she’s going.  I said, look.  I’ve already played the blame and the grief game with breastfeeding with Wyatt.  That did not go nearly as planned.  And to the point of crying in Walmart, looking at the formula.  It says on the box that breastfed is best.  I’m like, I know breastfed is best, but it’s just not working! 

It doesn’t for everyone; right. 

It’s so hard.  And again, thinking I was a nurse and I had a little bit of experience with OB; oh, I can just wing it.  No, stupid.  Don’t do that.  I should have gone to a breastfeeding class.  I should have really given it some effort and some planning ahead because you hear about all these wonderful breastfeeding stories and you're like, oh, it’s going to work perfectly and everything is going to be fine and it definitely did not.  So when it came to Elise and they’re like, oh, are you going to exclusively breastfeed?  I was like, forget that.  I’ve already played that game.  I’ve already cried those tears.  Give me the formula.  There’s no point in an invasive procedure if we can just get away with formula for a little while.  Not a big deal. 

We stayed in the hospital for a few days because not only were her sugars a little irregular, my husband, my son, and my mother-in-law who was visiting all got gastro at the same time in the house.  I was like, okay, I’m clearly not taking a brand new, fresh, preemie baby to a gastro household.  This is not happening.  I ended up going to my parents and spending a week there.  It actually was lovely to have that experience with my mom and my dad and Elise and just kind of relax that way.  But the whole process is just so crazy, and then to have somebody say, oh, cholestasis is so rare, and you’re like, what do you want to bet it’s not actually so rare, it’s just that the symptoms are just so ridiculous.  It’s itchy feet!  You would chalk it up to another weird pregnancy symptom, blah, blah, blah. 

Right, like the itchy, dry belly. 

Yeah.  It’s nothing.  It’s itchiness.  It’s not a big deal, except when you're up itching for an hour and you just can’t satisfy the itch.  It’s rough.  Your feet start bleeding and they’re sore and you don’t want to get up and it’s a whole thing.  But I’m like, okay, if more people knew about this very real complication with very serious results or potential outcomes – we need to start educating, especially when people come into the ER.  I’m very quick to say, okay, have you had any itchiness in your feet?  How far along are you?  What are we dealing with today?  Because usually it’s nausea, vomiting, cramping, bleeding, pain, that kind of thing and the whole spectrum of the pregnancy.  But I’m always the one to be like, do your feet itch?  And everybody thinks I’m so weird.  I’m like, you think it’s weird, but here’s my story, and then they go, oh, and I’m like, yes.  So now another nurse has been educated on this complication.  Let’s go talk to the patient.  

But then it’s also educating my doctors, too.  We had a patient not even too long ago who I think was 38 weeks and was coming in with nausea and vomiting and couldn't keep anything down.  I was like, okay, well, do you have any itchiness in your feet?  She was like, yeah, a little bit.  Pardon me?  Okay.  And then my doc, because she was having abdominal pain as well, ordered liver function tests, and they were kind of elevated already.  So I’m like, oh, this could be a thing.  So talking to my doc, I’m like, hey, I don’t know if you want to pass this on to OB.  Bile salts isn’t a test we would normally order in the ER because normally results take a good 24 hours to come back.  It’s not something we look into unless we had somebody to follow up that test result, heaven forbid it’s positive. 

So in talking to my doc, he was like, what?  What is cholestasis in pregnancy?  I’m like, yes, here we go again!  So educating my doc, and again, having that personal story to really hammer that message home, to be like, no, this is actually something that can happen.  And it really makes me wonder personally how many late term stillbirths were related to cholestasis and nobody caught it.  And how many of these poor women and poor families are then repeating the process with the same spouse and wondering where that’s going to take us.  So yeah, being able to advocate for that, to have that conversation with my doc, to bring awareness on his end.  How many more people are going to benefit just from me talking about it?  It’s one of those things when there’s somebody pregnant coming into the ER, I’m kind of all over them like white on rice, not only just to be like, I’m going to check your fetal heartrate, A, because I love that sound, and then B, because I need the practice.  I’m sorry.  But we also need a fetal heartrate.  It’s all the things.  It’s one of those things where you don’t think it could happen to you or if you’re even aware of it.  So to all the mamas, if you’ve got really itchy feet and you’re up for an hour every night itching, please talk to your provider because it’s something that is absolutely manageable, and you just need a little bit more monitoring.  We’ve just got to start talking about it. 

Thank you for sharing your story!  I’ve been to some maternal health conferences where that’s been one of the primary topics.  It was interesting.  I’ve not yet had a birth client with it.  Maybe some signs went unnoticed, but I’ve never had one who was diagnosed with cholestasis.  Very interesting stories, and I’m glad that everything turned out well and you advocated for yourself, which is the whole point of knowing your body, even how you were cutting back foods that weren’t agreeing with you and how that made a big difference. 

I can remember, because I’m a huge sweets person, and working shift work, my whole diet is deep fried and sugar.  So then having to go through, like, what else can I eat?  What am I going to be able to tolerate while working shifts and not pass out? 

Yeah, and the cafeteria, there’s a lot of fried food and temptations, and then people bring nurses gifts. 

We appreciate the donuts and the coffee more than you know.  Especially the ER, we run on spite and caffeine pretty much alone, with a little shot of adrenaline here, there, and everywhere.  You want to win your nurse over in 3.2 seconds?  Bring them coffee, or even just ask, or just say thank you.  That’s something that we don’t often get to hear.  I’m thankful that most people who work OB – you get to have that really great connection with the patient, and you grow over potentially a couple of days, maybe even longer if somebody is staying there for a longer period of time. 

Absolutely. 

But most people know their L&D nurse’s name, or at least one of them.  It’s a lovely little world.  Every now and again, I’m like, could I?  Yeah, I could, but would I?  I think I'll stay in the emergency with the air of an OB background, ish, and then be able to teach in the ER and have that access to that education within the ER.  I think that’s where I’ll land, and I think that’s where I will stick for now. 

I love it.  So tell us more about Rx for Growth.  You have books and other projects? 

So many things going on.  Clearly, I’m undiagnosed ADHD, because I can’t stop moving, which also fits with the ER.  Rx for Growth is my love child.  It started out with the book I wrote, Nursing Intuition, which helps nurses to really hone in on that trust your gut feeling.  Most women know that feeling very, very well, but in the context of the creep factor.  Now I’m kind of taking it over to nursing where you’re caring for someone, and there’s just something that says, something’s not right.  I don’t know what’s going on, but something is off.  And pairing that with evidence based science.  So not only have they proven intuition with peer reviewed evidence, but they’ve also specifically done it with intuition in nursing, which is huge for the nursing community.  If that’s the case, if it’s backed up by science, now we need to take it out of the “woo woo” closet and the 3:00 a.m. conversations and take it into education and talking about it openly and sharing our experiences with one another about the times that we did trust our gut and the times we were right.  Solidify that it’s 100% a thing.  Everybody’s got intuition.  It's just a matter of whether or not you actually notice it when it’s happening, and then if you actually do anything with it.  So are you getting that kind of thick feeling in your gut that’s like, I don’t know, and what are you doing with it?  That’s kind of Nursing Intuition.  That started the journey of helping new nurses grow and heal.  

I’ve come out with a couple of journals for nurses.  I’ve got a grief journal so that you can chart and journal.  There are prompts about grief and how you’re grieving.  There are spots to journal about up to 5 patient deaths.  How you’re doing, how you’re coping, what you’ve learned, how you’re changing your practice at all, how it’s affecting you at home, and are you carrying that person still with you?  Many nurses who probably have more than five or six years’ experience already have a death of somebody who sticks with them.  So it’s time we kind of start unpacking that just a little bit and normalizing talking about grief and death and grieving over a stranger. 

There is also the nursing wellness journal, which is more of the day to day.  How are you doing?  Did you sleep?  Did you eat?  What did you eat?  How many steps did you do?  That kind of thing, and trying to very, very gently realize that I know that you’re tired of caring for everybody else and you feel like you don’t have time of you, but we need to kind of switch that paradigm where it is not selfish to put you first.  So let’s kind of take a step back and reassess some stereotypes and kind of put you first. 

Then the 100 Shifts journal is a journal that in the beginning has got a lot of resiliency education and trigger identification and a couple of little things that can help you kind of cope with coming into nursing when you’re brand new and fresh and starting.  And it helps you keep track of 100 shifts.  Was it day shift?  Night shift?  What hours did you work?  Did you stay late?  Did you get any sleep beforehand?  How many steps?  Did you get any water at all?  Did you get breaks?  Were you fully staffed?  What was the best part of the day?  What was kind of a low point of the day?  The ultimate goal is that when the nurse has that moment of having something horrific or super traumatic happen to them, you have that moment of, oh, my God.  What am I doing?  I can’t do this anymore.  I’m an idiot.  I don’t know what I’m doing.  I don’t know any of this.  Why am I doing this to myself?  I have no idea.  And you get all this self-doubt going.  But if you had a journal where you could actually go back into previous shifts, your own shifts, and say, well, look at that day.  I advocated for my patient.  That day, I knew what the medication was for without having to look it up.  The next day, I trusted my gut.  I was able to intervene in a patient who wasn’t doing too well.  And it’s all these little tiny moments of growth that we forget about so quickly because the negative always supersedes the positive.  So when you’re having that moment and you’re just doubting yourself – and nurses recently are lasting a year or two and walking away from nursing completely.  Not even just a change of shift, not even a change of job or going from bedside to policy or some other thing.  They’re leaving nursing completely.  And so this is my attempt at kind of staunching the flow.  Let’s bring this into nursing education.  Let’s bring these into orientation programs.  Let’s try to support people before they need the support.  

So beautiful. 

Let’s build them up so that by the time they have that low – because there will always be a low.  It’s a guarantee, and it’s not just a one and done.  It’s a constant, depending on where you are and what you’re doing, especially a specialty like L&D.  It’s such specialized knowledge that you’re not getting your entire nursing education.  You’re lucky if you have one little six-week chunk of part-time work where you get to work with mom and babes and kind of get a feel for what it is.  Otherwise, you maybe never had access to L&D but you’ve gotten hired here because you feel like that you’re dream job.  Sometimes it is; sometimes it really isn’t.  And realizing that something that you’ve held, a specialty that you’ve held on for so long and an idea that you’ve held on to for so long – maybe it just doesn’t fit right now.  Maybe it’s just not a fit right now; maybe it’s not a fit ever.  But that’s okay.  Everybody’s going to fit in somewhere.  It’s just sometimes it takes time to figure out where you’re going to go and where you’re going to fit.  You are the puzzle piece.  You will fit into a spot.  It’s just sometimes it takes a little bit of time to find that spot.  But please don’t quit in the meantime. 

Right.  We need nurses now more than ever, and I feel like there’s an issue with teachers leaving the profession due to burnout and the pandemic related aftereffects, and then certainly nurses and healthcare professionals. 

Yeah.  It’s not just healthcare.  It is everybody.  We really need to kind of shift paradigm a little bit as to putting ourselves first and really not just making mental health and resilience buzzwords and self-care  being a buzzword.  Like, let’s get some tangible ways that we can care for ourselves.  And then not be met with resistance when we try to take time off for our own well-being, not get hit with guilt left, right, and center.  It takes a lot of courage to step away for a period of time to work on you, and it takes even more courage and self-awareness to figure out that you are more than worthwhile of the time that you spend on yourself. 

Absolutely.  So you mentioned the website, Rx for Growth.  How else can our listeners find your books and find you? 

Books are available on Amazon.  Nursing Intuition is due out October 29th.  It’s on pre-sale for Kindle right now.  You can find me on TikTok and Instagram @ernurse.jenn.  Granted, the TikTok is just usually funny little cuts of the nursing humor, but it’s been a great way to connect with people, and humor is so integral to nursing in itself that if you’re not laughing, you’re crying.  So just me goofing around.  I’m no expert.  I’m not some super hero or anything like this.  I’m a nurse and a mom and a wife, and I’m just trying to help.  And this is just my attempt at trying to help.  So I’m pretty approachable and will probably answer any questions you ever throw at me, which will probably work to my detriment one of these days.  But there’s lots of us out there, and if you’ve got a nurse who’s dedicated to you during your labor and birth experience, ask them all the questions.  They’re not necessarily at your beck and call, but we love to educate and we love to talk to you, so if you’ve got questions about labor, right after, vaccines, anything at all, ask us.  You’ve got us right there, and a lot of people don’t actually have access to a nurse that they can just hit up with a “Hey, what do you think about this?” kind of question.  So take that time.  And it is absolutely golden, especially if your nurse has kind of stuck in there with you because you’re being closely monitored for one reason or another.  Be kind; be nice.  We’re there to help.  We don’t have agendas.  We’re not really there to do anything else but have you have, hopefully, your best and most comfortable birth.  Ask questions.  Advocate, but know that sometimes situations are out of your control.  If you come in with a two-page typed birth plan, I promise you, Murphy’s law, you will have probably an emergency C-section.  It’s one of those things.

Yeah, nurses make jokes about it.  I tell my clients, do a birth preference sheet or use the hospital’s one-page template, but don’t be so focused on things that are out of your control.  It’s up to the mother’s health, how baby or babies are responding. 

That was the one thing.  My midwives were like, do you have a birth plan?  And I’m like, we’re just going to put a cap on that for right now.  Here's my birth plan: skin to skin as soon as possible, if possible.  Breastfeeding started as soon as possible, if possible.  And the biggest IV you can put on me the second my behind hits that bed.  And they pushed back a little bit, like, oh, why would you want an IV?  I’m like, look.  I’m a career ER nurse.  The moment when you have all the time in the world to look for the most beautiful IV placement that’s not going to bother Mom.  At term, your blood volume is up 50%, which makes it so much easier to get an IV.  Let’s have that just in place.  You can leave it alone.  You don’t have to hook it up to anything.  You can just wrap it and forget about it.  But if, heaven forbid, something happens and all of a sudden you need medications in an emergency or you’re bleeding out and you need blood products, having that IV in place is the biggest safety net that you can have.  And Murphy’s law again, if something happens and you don’t have an IV, all of a sudden it is so hard to find an IV.  And then you’re messing around, losing time trying to find an IV when you could have been already being treated. 

And like you said, you can just get it and have it there. 

You can just leave it be.  And with you still having baby in place, your blood volume is up 50%.  That’s why your veins are huge.  It’s because your body is already preparing for that loss of blood that’s going to happen with birth, so why not take advantage of that huge gift where you’ve got all the time in the world.  Do we really need to put it in the hand?  No, let’s see if we can put it in the middle of the arm so you can bend your wrists and use your hands, that kind of thing.  Let’s do that instead of having it be an emergency where we put it in the elbow, which sucks.  It hurts.  It’s annoying.  The alarms keep beeping.  It is what it is, but had we had a chance to have you have that earlier – for me, that was just my birth plan.  And knowing full well that your body is going to take over.  It’s going to do whatever it’s going to do.  Trust me when I say you have no control over what’s going on.  You’re lucky if you can breathe through when you want to push.  Your body is telling you that you want to push, and the staff are telling you just to hold on for a minute so you don’t tear.  It’s so hard because your body is not your own.  So just know that, and truly, the longer and more intricate your birth preferences or birth plan is, the more opportunities you have to be let down.  And not only let down, but then maybe leaning in to birth trauma.  So don’t set yourself up for failure when you’re having all these expectations because really, the less expectations you have, the happier in the birth you will be.  It gives room for flexibility and it gives room for movement and change.  Things happen in an instant that nobody prepared for or that nobody was expecting, so just be flexible and try your best to just go with the flow because it will make it easier on you long term. 

I agree.  Well, thank you for sharing all of your personal journey and your wisdom with us.  I would love to have you on again in the future, Jenn! 

Absolutely.  Any time.  I had a blast. 

Take good care! 

IMPORTANT LINKS

Rx for Health

Birth and postpartum support from Gold Coast Doulas

Becoming A Mother course

Buy our book, Supported