Spotlight On: Perinatal/Neonatal Nurses - Crozer-Keystone Health System - PA

Spotlight On: Perinatal/Neonatal Nurses

Pam Harris-Haman

Pam Harris-Haman, RN, (NNP), always dreamed of working with babies. For the past 27 years, she has fulfilled that dream by caring for the most vulnerable ones in neonatal intensive care. 

As a neonatal nurse practitioner at Delaware County Memorial Hospital, Harris-Haman is involved with babies from the moment they’re born until they go home. During that pivotal time, she deals with many aspects of their care, beginning with deliveries. “Nurse practitioners attend 45 percent of all deliveries on an annual basis,” she notes. “We regularly attend all scheduled and non-scheduled C-sections, and other deliveries when requested.” 

A nurse practitioner is requested most often for deliveries that involve meconium aspiration, prematurity, forceps delivery, vacuum extraction, and changes in heart rate. During delivery, nurse practitioners assist as needed. 

Once the baby is born, he or she is handed to a nurse practitioner or placed on a warmer so that assessments can begin on the baby’s heart rate, breathing and color. Nurses may then stimulate, dry off, provide oxygen, intubate or resuscitate the baby, depending on the situation.

Harris-Haman also assists in the NICU by starting IVs, inserting chest tubes, placing arterial & umbilical venous catheters for fluid management, placing PICC lines, assessing breathing status, placing babies on respiratory supports, and performing spinal taps when meningitis is suspected.

Another important aspect of her work is helping parents. “We spend a lot of time talking with parents - counseling and educating them and keeping them up to date on their baby’s condition,” she relates. “If a mom comes in pre-term, we can also counsel her on what to expect.” 

For Harris-Haman, the most challenging part of her work is helping moms who use illegal drugs while pregnant and caring for their babies who may be suffering from withdrawal symptoms. “We watch the babies closely, using a scoring mechanism to measure their agitation, crying, sweating and breathing rate,” she explains. “If the score is too high, we may be able to treat with medication. If the mom is on methadone or narcotics, we can treat it, but then we may have to wean the baby off those narcotics which could take up to two months.

“If a mom is on cocaine, however, we have nothing similar that we can give to babies except comfort care – swaddling, holding and comforting,” she continues. “In cocaine cases, withdrawal symptoms may appear 48 hours to one week after birth and can last for a couple of weeks to a couple of months. In these cases, there’s always a concern about whether you are sending the baby home to a safe environment.”

Because of her many years of experience, Harris-Haman has also been tapped to help teach other nurses neonatal resuscitation (NRP), which differs from infant CPR. In this rigorous eight-part course, nurses are taught the skills necessary to be comfortable in situations where they may have to completely resuscitate a baby. Labor and Delivery nurses and all Nursery Nurses and NNPs are required to renew this training every two years.

For Harris-Haman, each day is different, yet rewarding. “Watching a baby go home who has been ill or very tiny is wonderful!” 

Mary Jane McDevitt

Mary Jane McDevitt, RN, BS, CDE, nurse manager at the Crozer-Keystone Center for Diabetes at Springfield Hospital, teaches expectant mothers with gestational diabetes how to manage their condition and maintain a healthy pregnancy.

For McDevitt, a certified diabetes counselor and 33-year nursing veteran, education is key. “Small modifications can make such a difference between having a healthy baby versus struggling through delivery,” she emphasizes.

According to McDevitt, gestational diabetes usually occurs in weeks 24 to 26 when hormones elevate, blood sugar goes up and the pancreas is unable to meet insulin needs. If gestational diabetes goes untreated, there’s an increased risk of a high birth weight baby, which could lead to a difficult delivery. 

McDevitt runs weekly gestational diabetes education sessions that reach over 150 expectant moms each year. She teaches them how to use glucose meters, give themselves insulin, and maintain proper nutrition. Once the sessions are over, the Center continues to be available to the moms as a resource during the entire pregnancy. 

Other classes taught at the Center include a “pre-diabetes” class, held once a month for mothers who are at risk of developing gestational diabetes because of their high blood sugar numbers. By changing diet and increasing activity, many of these patients can prevent the onset of gestational diabetes. 

McDevitt also provides “intensive management” sessions that include one-on-one evaluations, training on the use of insulin pumps, and working with patients who had diabetes before pregnancy and may need to be seen more frequently. 

Over the last 15 years, the Center has built a successful track record. Four certified diabetes educators and one nutritionist are currently on staff. “When expectant mothers fully understand how making the right choices can positively affect the baby, most comply,” notes McDevitt. “Eating properly and making minor adjustments to diet can be enough to control diabetes for many pregnant moms.” 

McDevitt is rewarded when she meets a healthy baby after working with the mother. “I love it when patients bring their babies to see us,” she says. “It’s nice to know that we’ve had an impact and that we’ve helped to turn those at risk babies into healthy newborns.”

To learn more about diabetes: For more information about the Crozer-Keystone Center for Diabetes, call 610-328-8920. More information about the Center for Diabetes is also available at http://diabetes.crozer.org.

Carol Messick

Carol Messick, RN, BSN has found her niche in providing home healthcare nursing to expectant mothers and their newborn children. A nurse for 25 years and an early pioneer of maternal home care in the Delaware Valley, Messick believes that providing care to new mothers is essential. As maternity stays become shorter, home care has become even more important.

“I don’t know what we did before home healthcare,” she says. “When mothers are in the hospital, it’s such a whirlwind, and they don’t have the time or energy to focus. When I come to their home, they’re much more relaxed and I’m able to help relieve any fears or uncertainties they may have.”

Messick and her team of home care nurses at Crozer-Chester Medical Center provide a wide array of services to expectant moms as well as new mothers and infants. When Messick visits expectant mothers, she teaches them how to take care of themselves before the baby arrives and how to recognize signs of premature labor and be aware of decreased fetal movement. She also educates expectant moms with gestational diabetes about taking insulin, monitoring blood sugars and proper nutrition.

Once the patient has delivered, Messick and her team provide help with medications, lactation counseling and, in the case of caesarean birth, wound care. They also monitor the baby’s weight, conduct feeding assessments, provide care to babies with jaundice and give special attention to NICU and methadone babies.

“A lot can go wrong in those first weeks home and I’m happy to help get them through it,” says Messick. “Recently, I helped a mother who was accidentally giving her baby five times the prescribed dosage of medication because she misunderstood the directions.” 

Currently, Messick’s team includes one full-time nurse, one part-time nurse and three PRNs, each of whom have at least three years of mom/baby and NICU experience. Together, they see up to 400 patients each month.

For Messick, educating and helping patients is a dream come true. “It’s so rewarding to help so many mothers and their children. I often think about what might have happened if we hadn’t caught a problem in time, and it’s a great feeling to know that I’ve helped people get through the stressful aspects of parenting so they can enjoy the joyful moments.” 

In the future, Messick hopes to share her love of nursing with others as a nurse recruiter, encouraging local high school students to consider a career in nursing. 

Patty Washkalavitch

Patty Washkalavitch, RNC, BSN, brings a breadth of knowledge in the maternal child health arena to her work as a nurse in perinatal testing. A “jill-of-all-trades” in maternity, she has worked in pediatrics, labor and delivery and perinatal nursing at Delaware County Memorial Hospital.

“Working in several areas of maternity gives me an advantage,” notes Washkalavitch. “Because I do perinatal testing, I have a chance to develop rapport with patients before they come to Labor and Delivery.  I see some patients from 32 weeks on, and it’s rewarding to see the final outcome  - a beautiful baby.”

Initially, Washkalavitch worked in Labor and Delivery, Newborn Nursery and Post Partum, but always had an interest in perinatal testing. When she filled in several times for her colleague, Pat Wechsler, RN, she became even more interested in learning about this aspect of nursing. 

Tina Voell

At Crozer-Chester Medical Center, Tina Voell, RNC, branched out from Labor and Delivery to perinatal testing because she wanted to expand her nursing skills. Perinatal testing also gives her the opportunity to teach. “I really enjoy patient education,” says Voell, a 35-year nursing veteran. “We also teach other Labor and Delivery nurses and student nurses how to do ultrasounds.”

“The most rewarding part of perinatal testing is seeing great outcomes,” relates Washkalavitch, who is certified for obstetrics third trimester perinatal ultrasounds. “When parents see their baby on the ultrasound, it brings them great joy.  If they can see the baby sucking its thumb or see it move, it reassures them that everything is okay.  We can send them home with a good feeling.”

If a patient calls the physician’s office to report that they haven’t felt the baby move, they are sent in for perinatal testing to check for fetal well-being. If the fetus is non-reactive, a biophysical profile is performed to check the baby under ultrasound. Biophysical profiles measure five parameters of child health:  fetal tone, fetal movement, fetal breathing, non-stress testing and fluid levels of the baby. Depending on the results, the mother may be scheduled for delivery, sent home, or asked to return within 24-48 hours for another biophysical.

Washkalavitch and Voell also perform non-stress tests and give Rhogam injections to mothers with RH negative blood type at 28 weeks. At DCMH, Washkalavitch performs first-trimester screening and assists physicians with amniocentesis and CVS.

“Many midwives, obstetricians and family health centers send their patients to us for perinatal testing since they don’t have the capability to perform these tests in their offices,” says Washkalavitch. “We also perform all testing on twins because physician groups don’t generally have that capability.”

Voell notes that her involvement with perinatal testing provides an advantage in caring for babies in Labor and Delivery. “When I know that a baby has had issues during the pregnancy, I am especially alert to any problems that could develop and better prepared to intervene quickly,” she observes.

Both nurses agree that perinatal testing has added an important and interesting dimension to their understanding of maternal child healthcare. “We’re introduced to the baby through initial ultrasound testing, then we’re able to see the real baby in the labor and delivery room,” notes Washkalavitch. “It completes the circle – from the initial testing to delivery.”

Tina Voell is a 2008 recipient of the Nursing Excellence Award and a 2008 nominee for the Nightingale Award for Crozer Chester Medical Center. Patty Washkalavitch is the 2009 Nightingale nominee for DCMH. The Nightingale Award recognizes nurses who contribute to the profession or the community, exhibit excellence in professional practice, achieve quality outcomes, and cultivate intentional caring relationships.