Antepartum nurses help write happy endings to stories
By Parker Herring
Prior to her first delivery at Duke, an
obstetrical patient confided to a nurse
that she was apprehensive because she
had heard negative comments about
Duke.
The mother-to-be confessed that she
had serious doubts about delivering her
first-born here.
The story has a happy ending,
however, because the woman's delivery
went comfortably well and she chose to
come back to Duke for her second
delivery.
Part of the reason for the woman's
change in attitude was because she was
aided through delivery by a member of
the antepartum nursing team.
Antepartum nursing team members
work with obstetrical patients to provide
continuity in prenatal care and delivery.
Adapted in 1975
The antepartum nursing concept was
adapted at Duke in 1975 under the
direction of nursing supervisor Ruth
Bowers. A workshop speaker from the
University of Colorado spurred Bowers'
interest in the antepartum nursing team
approach.
Currently there are two antepartum
teams, with two registered nurses on
each team.
Approximately 30 percent of the public
obstetrical patients (excluding high risk
patients) are seen by a member of the
antepartum nursing team. The RNs see
obstetrical patients at the clinic in the
Hilton Inn and occasionally contract with
a patient to be with her during delivery.
If there is a need
A contract with an obstetrical patient is
a professional agreement on the part of
one of the antepartum nurses to be
present at the delivery.
"We try not to foster a dependency
with the obstetrical patients," Judy
Hayes, antepartum team nurse, said. "But
if we see there is a real need, we'll agree to
be on call so we can be present at the
delivery."
Members of the antepartum nursing
Sigma Theta Tau
gathering planned
Beta Epsilon, Duke's chapter of the
national nursing honorary society. Sigma
Theta Tau, is having a coffee Wednesday,
Sept. 20.
The coffee will be from 8:30-10:45 a.m.
in the Medical Center Board Room and all
Sigma Theta Tau members are invited to
attend.
"The coffee is a good opportunity for
Sigma Thetil Tau members from any
chapter in the country to meet members
of our chapter," Virginia Lang, president
of Bela Epsilon, said.
Lang said Sigma Theta Tau members
who are new to Duke are encouraged to
come to the coffee and learn about Beta
Epsilon's activities.
For more information contact Rita
Monahan; Rankin Ward, or Susie Beck,
CCU.
teams contract for about three deliveries
each month.
Because delivery is not always the
happy experience that some mothers
expect, the antepartum teams spend a lot
of time teaching obstetrical patients
about the birth process.
"Prenatal contact is as important as the
contact we have during delivery," Hayes
said.
There are question-and-answer
sessions at the clinics and obstetrical
patients are encouraged to tour the
facilities on Carter Suite.
Continuity in care
Chte of the main ideas behind the
antepartum nursing concept is to provide
continuity in care to obstetrical patients.
This continuity is of crucial importance in
a major teaching medical center such as
Duke, where a woman may not actually
see the house staff obstetrician who will
deliver her baby until she comes to the
hospital in labor.
"We try to build the patient's
confidence in the house staff physicians,"
Dale Eastman, another antepartum team
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were told that it might be possible to
transplant one of her toes to make a
thumb. Two similar operations — the
first in North Carolina — had already
been performed successfully by
orthpaedic surgeons here.
"We thought it would be a good idea to
try it next year, but we left the final
decision to Trudy," the child's mother
said. "She told us she was scared, but
wanted to have it done. She also said,
'Let's go ahead and do it this year.' "
Dr. Donald Serafin, associate professor
of plastic surgery, led a team of six
surgeons who performed the operation
on July 26. Division chief Dr. Nicholas
Georgiade served as an advisor.
Two weeks later, Serafin changed the
cast that held the transplant in place and
said the thumb looked good. By the end of
August, he changed the cast again, saying
the operation looked like a complete
success.
"We have every indication that Trudy's
thumb will work well," he said.
Vessels as small as .04 inch
The procedure lasted 14 hours, the
physician explained, because all the tiny
arteries and veins had to be attached so
that blood could flow through them
freely. Some are as small as one
millimeter in diameter, about four-
hundredths of an inch.
The surgeons also had to attach two
nerves so the thumb would have feeling
and three tendons so it could move. To
member, said.
Because expectant mothers are familiar
with the antepartum nursing team
members, they are more likely to confide
their fears and apprehensions.
"Because they know us, they'll come to
us in a crisis and we can help them work it
out," Eastman said.
Concerns that are important to the
mother are brought to the surface
through these confidences, and the
mothers are made to feel more
comfortable and secure because there is
someone around they know cares.
"We provide a familiar face to many of
the patients," Hayes said.
Filling the gaps
And the antepartum nurses fill in the
gaps in care for their patients.
"We often put into laymen's terms
what the physician has told the patient,"
Hayes continued. "And we reinforce the
physician's instructions so there is no
misunderstanding."
The antepartum nurses pave the way
for the "coach" during delivery. The
coach is a person close to the woman in
join the bones together, the team drilled a
hole in the end of the phalanx or toe bone
and secured it like a cap over the
sharpened remnant of the bone in her
thumb.
Serafin said he and his colleagues had to
be very careful in removing the toe from
Trudy's left foot so as not to damage the
nerves or blood supply to the other toes.
They were also able to preserve the
epiphysis or "growing center" of the bone
so that the new thumb can grow.
Microsurgical technique
"I think one of the significant things
about this kind of operation is that it
shows how far plastic surgery has come in
the past few years and how much the
operating microscope has helped us,"
Serafin said.
"It's now possible, through what we call
microsurgical composite tissue
transplantation, to move entire blocks of
labor — husbands usually opt most
frequently to be coaches, but another
relative or close friend can be present
during labor and delivery. Each woman
can have one person accompany her
through labor and delivery.
"You might say that we 'coach the
coach' during delivery," Eastman said.
Patient advocates
The nurses function as patient
advocates during delivery, offering
practical suggestions to the coach such as
suggesting he or she rub the patient's
back, etc.
Eastman said most physicians have
accepted the role of the antepartum
nurses although "there are a few
physicians around who don't recognize
our role," she said.
Supervisor Ruth Bowers said the
nursing staff members on Carter Suite
play a significant role in the operation of
the antepartum nursing teams.
"The rest of the staff is very
supportive," Bowers said. "There is a total
staff commitment to the antepartum
nursing team concept."
tissue including skin, bone, muscle, blood
vessels, nerves and fatty tissue from one
part of the body to another all in one
operative procedure."
By reducing the number of operations
required, he explained, the technique
reduces costs and possible complications
to the patient. It also improves function
and appearance of the transplant in
almost every case.
Didn't waste time
Mrs. Howie said Trudy was very brave
during the weeks following surgery,
despite the pain of healing, and "hardly
cried at all."
By Aug. 22 — the day before she was
first allowed to walk again — the child
insisted on staying up until a few minutes
past midnight.
"She didn't want to waste any time,"
her mother said.
PR office wins academy award
The medical center's Office of Public Relations has earned a first-place national
award from the Academy of Hospital Public Relations.
In competition with hospitals throughout the country, Duke was judged a
Citation winner and received the 1978 MacEachern Award in the category of total
public relations programming.
The award, established in 1944, is named for Dr. Malcolm T. MacEachern, a ,
physician, administrator and educator who was a president of the American
Hospital Association and fostered principles of professional public relations in
hospitals.
Joe Sigler, director of public relations, received the award for Duke at the
MacEachern Awards Luncheon Tuesday as part of the American Hospital
Association's annual meeting in Anaheim, Calif.
ANTEPARTUM NURS
ING - RNs Dale
Eastman (left) and Judy
Hayes, shown with
patient Melody Stanley
of Durham, are mem
bers of one of two
antepartum nursing
teams here. The
concept was adapted at
Duke in 1975. IPholo by
Parker Herring)
Successful transplant third performed at Duke