Sarah Lavonne: Hi, I'm Sarah Lavonne, and I'm so glad you're here. Here at Bundle Birth, we believe that your life has the potential to make a deep, meaningful impact on the world around you. You, as a nurse, have the ability to add value to every person and patient you touch. We want to inspire you with the resources, education, and stories to support you to live your absolute best life, both in and outside of work. Don't expect perfection over here. We're just here to have some conversations about anything birth, work, and life, trying to add some happy to your hour as we all grow together. By nurses, for nurses, this is Happy Hour with Bundle Birth Nurses.
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Sarah: Bre, we haven't had a conversation since going back and forth with 7,000 comments and Slack messages and WhatsApps about this pocket guide in collaboration for the last-- how long has it been? Two years?
Breanne Clinger: It's been so long. Two years.
Sarah: I know.
Breanne: Yes, I was looking back. I think it was August, not this last August, but the prior. That's when we began.
Sarah: Oh, my gosh.
Breanne: That's when I reached out and was like, "You need this. The world needs this."
Sarah: I said yes, but then I put you on pause and have really taken you through the wringer. I want to say, first and foremost, thank you for being patient with us. With this coming out, which, by the way, everyone, welcome back. You're in on the insider conversation. I told Bre as we were going into this, I texted her and was like, "I'm just going to start record because I want to catch all the candid," which I'm just so excited to see your face, and for us to celebrate together this-
Breanne: Yes, I know.
Sarah: -crazy launch.
Breanne: It's been so back-and-forth.
Sarah: It has been so back-and-forth. It's been so fun to collaborate with you. I think I also want to say for those of you that are like, "What are they even talking about?" Bre's Emergency Pocket Guide is finally out in the world. It is available. Your baby has been birthed, the longest gestated baby of all time. I doula'd together with you.
Breanne: Yes, we did.
Sarah: We breathed and we pushed.
Breanne: You pulled me through the images that you made. Oh, my gosh. I would write, Sarah, the comment back like, "Oh, my gosh, it's like Christmas morning." I wake up early and pull up our document and be like, "Oh, my gosh, it's so great. It's perfect."
Sarah: Yay. It's so fun.
Breanne: I would literally draw it out on my notepad, take a picture, send it to Sarah, give her all my ideas, and she'd make it come to life with the images. You're so fun, a woman of so many talents.
Sarah: Honestly, I hadn't ever drawn, drawed, drew. I never drew anything hardly for my--
Breanne: Drawn.
Sarah: Drawn, I don't know, until Bundle Birth. I remember I bought my iPad. I had seen this girl, Holly Nichols. If anyone follows her, I think she's so brilliant. She draws pictures and outfits and does it on Procreate. She films herself on Procreate on an iPad. I was early Bundle Birth days. I didn't have any money, but I was like, "I really want this iPad and Apple Pencil thing, and I want to try." I want to draw. That sounds so therapeutic.
I remember I bought it while I was on a trip, and I was like, "I just spent money on a trip. I don't have the money for this, but oh my gosh, I really want to." I felt so guilty about the purchase. I considered returning this iPad for weeks. It was down to the last day that it could be returned, and I was like, "I'm just going to go for it. It's going to be okay." That was the start of it all.
Now, I think about, we have hundreds of assets of things that I have drawn to help support things. I will say, secret sauces, I start with a trace. Then I remove the background, so it gives me an outline, because I cannot free-draw like that. Then a lot of times, I'll be like, "I like components of this and this and this," and I'll put them all on the page, and then I'll combine them. Anyway, it's done.
Breanne: I sent you a few different images, and you merged them together.
Sarah: So fun. Yay, so congratulations, Bre. Those of you listening, we're going to talk about the pocket guide, but I want to talk about diabetes. We're going to give the analogy that's in the book, because I think it's like the one thing. A pocket guide is so interesting. We went back and forth through the creative process. We're going to hear the story behind where this came from and how it all came together, because I think that behind-the-scenes of the business side of it, I think, is really interesting. I hope you find that too.
Also, we went back and forth with a couple of things, because a pocket guide is a very unique resource, that it's different than a textbook. A textbook has every detail. There's lots of room, a class. You can share stories, and you can expand. You can really build on things, whereas this was, my guess is, and you can tell us the biggest challenge, but my guess is part of the challenge is, how do I get it down?
How do I weed it down? How do I get it to the bare minimum of what's absolutely necessary to put on one page that's 3 x 5, that also offers so much value? We went back and forth. I think this one that stayed, I found super helpful as a frame of reference for gestational diabetes, so we're going to talk about that. Before we do, tell us who you are, Bre. How did you get into Bundle Birth, and where did this pocket guide come from?
Breanne: Yes, okay, so I'm Breanne Clinger. I found Bundle Birth, or Bundle Birth found me in 2021. I'd put out a hypertensive emergencies graphic on Instagram. Justine reached out to see if we could use it in the-- I say "we" like I was already part of the team, "If you guys could use it in the mentorship manual book," and I was thrilled. I told her, "Yes, and let me help more. I really wanted to be in on Bundle Birth's mission and felt drawn to you guys."
I was so excited to jump in on the team. I became a mentor and have learned so much from our mentees all over the world. Really, this pocketbook, I've gotten ideas from-- we have a scary things module where we go through scenarios and what the scariest things are for nurses, and pulling things from that to put into this pocketbook. Thank you to all the mentees who also contribute to this and all the resources.
This pocket guide has 200 references. Really, it's a collaborative work of everyone who's been working to help because of maternal mortality. Thank you to everyone, all of the resources that we have utilized. I got into Bundle Birth with mentorship and then brought this to Sarah. My mission, my zeal comes from maternal mortality, and how I want to better that in the United States, and then also globally.
My zeal, my passion, my heart on fire comes from-- I feel like it comes from, I grew up in a mixed family where my stepfather lost his first wife to what I believe was sepsis. It's a little unclear, but in childbirth with my stepsister, Julie. I grew up with my stepsiblings witnessing really their grief throughout the life, our life together. Then also, my great-grandmother passed in childbirth, giving birth to my grandma. She was a nurse. I felt especially close to her, especially while I was going through my master's program and diving into maternal mortality.
Her name is Emma Harper. My second daughter is named after her. I was pregnant with her during that time period. She's been like an aide to me, a guide. I have that zeal. I have that compassion. It's not just me, my family, because so many people are influenced by this maternal mortality. Obstetric nurses are pretty much well aware that we have the highest mortality rate of all of the developed countries in the United States. Granted, the last report came out in February of 2025. We have decreased a tiny bit.
Yay for that, but we still have so much work to do. If we take a step back and look at it globally, even in 2022, I should pull that up, or it was 2020, but almost 800 people died every day for preventable causes of maternal mortality, from pregnancy-related deaths. We have such a long way to go. When we compare our mortality rate to the developing countries, if we look at the rate, they're 218 while we are at 22.3. That's deaths per 100 live births. We're so blessed to be living in America, yet we still have so much work to do.
Also, there's so much work to be done globally. Maternal mortality is such a big problem with lots of puzzle pieces. Where we can pick up what we have control over, us labor nurses don't deal with emergencies every day. It's usually pretty few and in between. We don't have a ton of practice. That's where we can really refine our skills, practice, and become confident, and what we take ownership of what we need to know and how to protect our birthing patient.
Sarah: The work that we can do is own your practice and know your ish. Enrollment for our next mentorship cohort opens soon. Now is the perfect time to enroll because mentorship is better than ever before with our new Bundle Birth mentorship app. Yes, we created another app. Complete modules faster by watching or listening anytime, anywhere, right from your phone. You can leave comments and chat with your cohort in real time as you absorb what you've learned and then learn together.
Enjoy easy access to share resources, chat about content, and connect with your mentors directly through our app. One of my favorite features is that you can snip and save your favorite clips and takeaways in your modules and then create your very own personalized library of key things you want to remember and come back to. You can even track your progress through the program and set up alerts for our mentorship calls so that you never miss a moment of learning.
The mentorship app makes it easier than ever to digest the 12 months of essential OB learning you get through our mentorship program and helps you feel confident, connected, and empowered in your job. Fill yourself with all of the tools you need to avoid burnout and feel inspired, grounded, and ready to change the game through our 12-month mentorship program. Enrollment opens a few times a year for only two weeks, so check out the show notes below to learn more.
One of the things I love about what you did with this was you ordered the emergencies, or we'll call high-risk diagnoses, for lack of a better word, but in the order of incidence. The highest incidence, it starts with preterm labor, if I remember right. That's because preterm labor has the highest incidence of all the complications of pregnancy, and then it goes down from there.
Breanne: Yes, and disclaimer, when you look at different populations, it's going to be a little bit different, right? Rough incidence level, that's around 10%. That's pretty close with hypertension and diabetes. There's little niches in each category, so you could argue which one has a higher incidence level. We put preterm labor at the top. We could go over. Do you want me to go over everything that is in the pocket guide?
Sarah: Yes, and then let's talk about the creation process of what it took, because I think when I-- so this is my backstory. We, around here at Bundle Birth-- and I'm saying "we," but it's mostly my psycho brain that has an extra brain cell when it comes to aesthetics. If you've done any of our programs or bought any of our stuff, the look and feel for me is so important and more important probably than a lot of things.
I'm very picky. Working with me from a design standpoint, we've gone through a lot of designers. We've tried to work with lots of people and we did. We'll shout out Julia for her hard work. She set me up. She really set me up for this. You work directly with her as a designer for months to get this thing wed down to what fits on a little 3 x 5, y'all. It's still six to seven-point font, which is very legible for what you could imagine it could be.
A lot of the ones that we looked at, or I have a lot of little resources like that. I bought a lot of those early on in my OB days. Those texts are really tiny. I'm really proud about how we, "we" meaning you and her, organized everything on the pages. It's 60 pages front and back. Like I said, 3 x 5. When we have been going through this process, I think that the ability to summarize and be brief and be concise is the most underrated skill of all time. I am the most long-winded person. I could have never done this project. Never.
Breanne: I'm long-winded, too. My summaries and mentorship, when we go over, I'm like, "Let me talk about it."
Sarah: "Let me paint the picture." [chuckles] I know. What an amazing practice for you to start really saying, "What's the most important? What is the most impactful?" For those of you especially starting out, I think what's so helpful is we've done that work for you rather than reading the whole chapter. It's like, "Here's the nitty-gritty. Here's what you need to know. Here's what you need to memorize. Here's what you need to keep in mind related to all the things coming up."
Through that, you went through months and months and months of research and reading and compiling information and weeding it down. Then finally, we got it to Julia to help condense onto the page. I went into it honestly being like, "Okay, another high-risk reference. This is super cool. We'll have our own. It'll be the Bundle Birth way," and all of that, and then I got my hands on it.
Breanne: I was so excited to finally have you really look at it.
Sarah: Yes, and I was like, "First of all, I got to go get my hands on these designs, and I'm just going to do it myself," which I'm really trying to let go, but I'm not quite there yet. I'm an evolving human. I took over the designs and moved it into a shared document so that we could both work on it, which I think has been really helpful. My process of going through it has just been like every page I have as I'm editing, I am like, "Oh, my gosh, what I would have wished to have with this as a resource." So many of the-- No, go for it.
Breanne: Yes, we didn't have anything like this. Some things that I would learn like stories that were so scary, I'm like, "Wait, what? That could happen? Why didn't I learn that in nursing school? Where do I learn more about this?" What do I really need to know about this if it happens? What do we do besides press the call button or the code button? What's my next steps? Put her on her left side. What else? Oxygen? Some of those things of like, what's really going on in her body? I need to know what's really going on. What do we really need to do in this? Some are really rare. We have our acute fatty liver. So rare.
Sarah: Still, it happens. If you're going to be in and you have a long career, you will see it eventually. It's like being aware, first of all, that they exist, but then knowing exactly what to do and being able to reference it so quickly is like-- Honestly, as I was going through it, I was like, "Oh, I get it now." You had the foresight, the vision. I was like, "I believe in it. Sure, it sounds amazing. What a cool resource for these nurses."
Now, I'm like, "Oh." Especially looking at the other pocket guides that are out there, I'm like, "What's it going to be different?" They're so long. They're so long. When you go in, as I was editing, I remember us having the conversation of like, "I want them to be able to look at the page and find what they need." It'd be so obvious while also then having enough that it actually impacts their care.
I really agree with you. I appreciate your foresight in terms of what we need and why it would be so important. Of course, I believed it was going to be important, but I didn't really get it until I got my hands into it. I'm like, "Oh, my gosh, to have one page of hypertension," and like, "What's my reference point? What are my meds? What do I do here? When does it matter?" NRP tips, and what do I set my flow meter at or whatever?
For whatever it is, it's like having that as a quick reference in your pocket, not only helps you feel more confident, which I love the title Confidence in Crisis that you came up with, but that's how we own our care and how we change outcomes one patient at a time. We as nurses are the ones to me that have the most influence on our morbidity and mortality crisis in the US.
When we level up our care, that's going to save lives. How good does that feel? How do you know how to save lives? You have to be able to reference your resources and have access to them rather than lugging around the AWHONN textbook. This to me is like, "Let me just take a quick peek at the bedside, or let me just cross-reference myself and make sure I'm not missing anything." There is no other resource potentially that we offer at Bundle Birth more valuable than what you've done here. Thank you for all your hard work.
Breanne: Thank you for believing in me, and when you are not quite sure of how great this would be.
[laughter]
Sarah: I knew it would be great.
Breanne: I saw it and I knew it. Worthwhile maybe, like worthwhile good.
Sarah: Yes, I'm like, "It'll be such a cool resource to have." Now, I'm like, "Oh, my God, everybody needs one of these."
Breanne: Invaluable.
Sarah: Invaluable. It's the combination of brief but dense that there's nothing else out there like it. I'm just so proud of you and you should be so proud of yourself.
Breanne: Thank you.
Sarah: Let's go back to the story. You have your grandmother, great-grandmother?
Breanne: Yes, great-grandmother.
Sarah: Great-grandmother.
Breanne: Great-grandmother, Emma Harper.
Sarah: Emma Harper. You were going through your master's program. You said that she was your guide along the way. What got you to pitch the idea?
Breanne: The story with my great-grandmother, Emma Harper, she was a nurse as well, died in childbirth with my grandma. My grandma didn't find out actually until she was 16 years old. Side note, how crazy would that be? Anyways, I was given her nursing handbook, her pocket guidebook, because I was the first female nurse in that line that I'm aware of. I've kept it on my shelf in my room.
It's gone different places actually as I have been working on this pocketbook like, "Give me strength," I feel like just to feel like maybe she's close next to me. Sometimes I've had it in my side drawer. Sometimes I've had it on my shelf, just feeling her closeness in that, and feeling inspired that we can do something, where we're at as nurses, what I could contribute to decrease the maternal mortality, and my niche at this time of my point in my life where I have my own babes at home.
I felt like Bundle Birth was really my avenue to create this pocket guide to go out to all of the nurses that they could have that confidence in their pocket and pull it out in any emergency, or when they start feeling scared on the unit, and not knowing, maybe their blood pressure, they can't get down, what they need to do next if they're-- Also, you have your policies to fall on, but sometimes your policies stop, and you're like, "Well, where do I go next?"
That's climbing the ladder of calling your charge nursery and getting MFM involved, and maybe transferring them to ICU to getting them on a drip. Just opening up your horizons, opening up your toolbox to have more resources in your pocket when you're scared, when you need to show up as your best self for that patient. We begin with the necessities, which includes the physiologic changes of pregnancy.
It includes the warning signs like the early warning signs, but you may already have in your computer, but brief right there, segment, fetal heart rate categories, labs. That's my favorite. We added that in at the last, which I'm so glad we did. It's so cute the way that it's ordered because it has the order and what she should draw. That's super helpful. Cord gases, super helpful. Thank you, Sarah. She helped with that one. Way to go. That's like the necessity section goes over some bias, how we can evaluate our own bias. That snippets all the nitty-gritty. I've been feeling like this would be a good guide for ER nurses to just have a base of what they need to get started before they ship them off to L&D.
Sarah: We actually just had an email from someone that wrote us in from some hospital in a rural area. They closed their L&D because so many of these hospitals with OB deserts like in rural areas--
Breanne: Which also is contributing to our mortality rate.
Sarah: Yes, yes, and so they just closed it, and all these L&D nurses are all very displaced. There's still an ER, ED. This ED nurse wrote in and was like, "We're now having to handle these OB either emergencies, or just precipitous births, or just people that need assistance. They're like, "We're so overwhelmed. Would you have any resources for us?"
Breanne: Oh, my gosh. This is it.
Sarah: I know. We said that. I said, "Just stay tuned because--" Actually, we're recording this during Nurses Week. By then, I was like, "It's coming up for sale, and it's going to be on sale for a day," and all of that. We gave the resource out, but that literally is perfect for them.
Breanne: Yes, and then we go over emotional care for the nurse and the patient because we're Bundle Birth nurses. Mental health has become one of the top reasons for the high mortality rates, so addressing that within each emergency so we know how to debrief with our patients and talk about the hard things with them, and help them put pieces together.
Sarah: I think it's natural. Maybe this is a medical thing. This might just be a human thing. When you see the emotional care page in a book like this, you're like, "Ah, skip," and like, "Oh, that's there." Some of us are like, "Oh, I love the emotional care stuff, but I want to know about preterm labor and hypertension." I think that's a really good call-out of like, there's some legitimate resources that are, to me, you've heard me say this before, higher-level skills that those that are slowing for the emotional care, those that are doing the therapeutic debriefs that have taken our trauma-informed classes, which if you haven't, you need to, that is the level-up that is prevention for potential postpartum mortality related to particularly what you're referencing, suicide rates. We are prevention. Our care on an emotional standpoint contributes to helping set the patient up for long-term-
Breanne: -resilience.
Sarah: Thank you. That's a great way to put it.
Breanne: Yes. Yes, we are. Some people may think that's pretty drastic, being like, we have such a small moment in their labor and delivery. This day is so big for that patient, especially if they have an emergency, and how that's handled. If someone does sit down with them after and has a debrief, or if someone on the way to the emergency looks them in the eye, put their hand on their chest, and said, "I'm here for you. You're not alone," just those pivotal moments.
Did the ACE note, which is our emergency consent with them, so they felt like they had some control. Those small things that we teach and are also in the guide can help them set them up for resilience. Doesn't negate how hard that was, but we can be a tool in their healing and not make that situation worse. Mental health conditions is at the top at 22.7% of the maternal mortality deaths in the United States. It's up there. That's why emotional care is right at the top. We have emotional care, preterm labor, hypertension disorders that covers all of them. Postpartum hemorrhage, diabetes. You want to stop there.
Sarah: What's our little analogy? We have a very cute, little drawing in here. Tell us your analogy for helping us understand diabetes.
Breanne: Absolutely. Okay, so diabetes, the essence, it's the inability to make enough insulin or use it as well as we need, which results in hyperglycemia. The analogy is that there's a truck, okay? The truck is going to be insulin. Insulin is driving the streets of our serum, of our blood. We have one home, or we have lots of homes, but the home is the cell. The insulin is the truck, and it's carrying the glucose. In type 1 diabetes, we have-- Does, so far, it make sense?
Sarah: Yes.
Breanne: Truck, insulin. Glucose is the packages that are being dropped off.
Sarah: Insulin carries the glucose to the cell, which is the house.
Breanne: Yes, and then the house takes the glucose in. That's how it normally works, and it works well. When we have a problem, type 1 diabetes is an autoimmune reaction that stops the body from making insulin. You think you don't have enough truck drivers in the streets to deliver your packages of glucose into the home or the cell anymore. Glucose is getting dropped off in the streets because it no longer can get into the house because there's not enough insulin. Type 1 diabetes, autoimmune reaction that stops the body from making insulin, which results in hyperglycemia or too many boxes in your blood.
Sarah: Extra packages that can't get to your cell, aka, your house. They're just thrown out into the world and stuck.
Breanne: Then type 2 diabetes is, you think of the house resident who gets tired from answering the door over and over again, just tired. The glucose starts piling up right at the doorstep along the serum. That's what happens in just-- or sorry, in type 2 diabetes. For type 1, autoimmune, not enough trucks. Type 2, house resident doesn't want to open the door anymore. The glucose boxes stay in the streets.
Sarah: The cells are resistant to receiving the glucose. It's like my door is shut, and I'm just going to leave it out there because I have this insulin resistance.
Breanne: Yes.
Sarah: Okay.
Breanne: Thank you for that clarification. Gestational diabetes occurs when there's too little of an insulin response or because insulin resistance or a combo of both. You can think either there's not enough trucks or the house resident is resistance too. It's a combo of both that ends in a big amount of muck. Although in pregnancy, your insulin responds by increasing its amount, even by three times, but it's just less efficient.
It's not working as well due to the placental hormones. You can think of the trucks having leaky tires. They're not efficient in getting the glucose to the doors, but they've increased in amount. You have more insulin in the streets, more trucks in your streets driving the glucose around, but they're less efficient because of the placental hormones, or you can think leaky tires. During pregnancy, insulin increases. During labor and postpartum, the need for insulin decreases. Then if you're sick because of the stress, it also increases.
Okay, so from there, we have the assessment of diabetes. All of our categories will go through what the emergency is, if there's major risk factors, what the assessment would look like or the symptoms, and then the management. Let's go on with our diabetes example. Assessment, our target labor blood glucose runs from 70 to 120, depending on when they last ate a meal, right? Then we have a nice visual on there on what hyperglycemia looks like to hypoglycemia with the osmolarity in the blood and what symptoms of that looks like.
If we think that hyperglycemia, you're going to be thirsty. It's an osmotic diuretic. You're going to be thirsty. You're going to be peeing a lot. Then if you are hypoglycemic, it's going to trigger the epinephrine response, which causes the fight-or-flight symptoms, which is being hungry, pale, nauseous, anxious, lightheaded, sweating, confusion, tachycardia, those. Then we're going to go on to the treatment. What was that?
Sarah: I said that's a good way of putting it. I never thought of it as a fight-or-flight response.
Breanne: Yes, because our brains are glucose-dependent. Then we go on to the treatment. Our first-line therapy is insulin because it does not cross the placenta. That is something that I learned. Metformin does cross the placenta. The best first-line therapy is insulin. People will get on metformin and glyburide for different reasons, but insulin is our first-line therapy. We have clear. Do you remember nursing school, clear, cloudy/clear?
Sarah: Yes.
Breanne: Clear is the rapid-acting ones. We have the ones that end in "log," which are the Humalog and Novolog. On here, we have a beautiful chart that shows the onset, the peak, and the duration. Then we also have some insulin tips. Making sure that your gentle rotation of the vial, mixing insulin, you do clear first, then cloudy. Then when you're doing IV insulin, this is where I got nervous too. As a nurse, sometimes insulin, IV, I get a little nervous.
Here are some quick tips. Only regular insulin premixed by the pharmacy. Two intravenous lines run on piggyback with the pump. Connection closest to the port. Prime tubing with the insulin mixture, label tubing, just like you would for Pitocin. Then know your location of glucagon and D5. Those are the quick hits on the insulin tips. Then we go over metformin, glyburide, and what to do if the patient is hypoglycemic.
There's the rule of 15 for a patient who is hypoglycemic. We give 15 grams of fast-acting carbs, which is a 4-ounce juice. That should raise the glucose by 15 in 15 minutes. If the patient is severely hypoglycemic, like unresponsive, then you're giving glucagon, which would look like 1 milligram, which would be subQ or IM. Then we get to our emergency, which is DKA. These patients need to be continuously monitored in ICU level of care. D stands for diabetes. K stands for ketones. A, acidosis. That gives us pretty much our definition.
Diabetes, it rarely happens, the sugar level under 200 outside of pregnancy, but there's no diagnostic level inside of pregnancy because of what's happening with our insulin. Our insulin is not as effective as usual. It can happen at lower levels. More common for type 1 diabetics. D stands for diabetes, which is elevated blood glucose. K, it's ketones. It's going to be in the blood, but first seen in the urine. To be diagnosed, it needs to be ketones in the blood. Then acidosis, the A, it's a metabolic acidosis. That's due to excessive keto acids combined with dehydration. That can cause the severe acidosis.
Sarah: Leads me to our treatment.
Breanne: Did that make sense with the etiology?
Sarah: Yes.
Breanne: Okay, good. It predisposes a patient with diabetes to DKA. Usually, there's a precipitating event like even betamethasone injection or terbutaline because that can raise glucose levels, or a hyperemesis gravidarum patient, or even a trauma victim can raise the glucose levels.
Sarah: That would be in a person with already existing diabetes?
Breanne: Yes.
Sarah: Right, so if you have any diagnosis of diabetes, type 1, 2, or gestational, you are at risk for DKA based on some of those other things?
Breanne: Correct. If we get into the etiology behind the DKA, the lack of insulin causes hyperglycemia, but they have these starving tissues still, because the hyperglycemia is not getting into the cell. The muscle and fat are then broken down to create more glucose, so you have an even greater problem.
Sarah: Yes, it's perpetuating. It's like the non-helpful response, even though it's trying to be helpful like, "So sorry."
Breanne: Then you get further hyperglycemia, hypokalemia, hypovolemia, and acidosis. That is what we're going to be treating. The first line of treatment is your insulin. Treating the underlying cause, too, like if there's an infection, sepsis, we're treating that because that can throw a patient into DKA too. Correcting the volume and the potassium. Acidosis fixes itself once you stop the process of the anaerobic metabolism. You continue the insulin until the serum ketones clear. That's the treatment in ICU care, continuous fetal monitoring.
Sarah: Cool.
Breanne: The rest of the sections include neonatal care, which are NRP tips, what to do at a nurse delivery, and when you don't have your provider in the room, shoulder dystocia, placental emergencies, which include the accretas or retained placenta. We have anesthesia complications with a dermatomes-level chart, which is super helpful. Cord prolapse, peripartum sepsis, coagulation problems, peripartum cardiomyopathy, cardiopulmonary arrest, and resuscitative hysterotomy. A learning point there. I guess I've been involved only on one resuscitative hysterotomy. It's a dry field. I was all worried about suction, getting all that. It's a dry field because the patient is not being profuse. You don't have to worry about the suction. That's not a priority.
Sarah: Interesting.
Breanne: Uterine emergencies, which are our prolapse or our rupture. Anaphylactic syndrome of pregnancy, AFE, and acute fatty liver pregnancy, and then a critical-event debrief for the care team. So much in there and all quick hitters. My goal is that we're moving nurses from being driven by fear to being driven by a calm confidence that's rooted in compassion and empathy for their patient.
The true confidence comes from feeling the fear, analyzing it, asking what's the truth behind it, seeing what areas we need to grow in and learn, and then proceeding with humility and preparation. This pocket guide is a tool to help with that. We have the quote in the pocket guide. It says, "When adequately prepared, fear takes the back seat, and the joy of childbirth rides shotgun."
Sarah: Bre, why don't you leave us with your dedication that you wrote that is the start of the pocket guide, which I just think is so lovely?
Breanne: Absolutely. When I feel so deeply about things that I can't put into words, I'll put it into a poem. I put this into a poem. The dedication is, "To the birthing people who have lost their lives or now have a chronic condition, who may have felt cheated out of living their mission, to the parents who have lost their baby, who live with the what-ifs and maybe, to the children who have lost their parent and feel an empty sorrow at every life event, to the providers, nurses, and the care team whose grief may go unseen, to humanity who may feel a lost sense of entirety, we honor you."
Sarah: Thanks for spending your time with us during this episode of Happy Hour with Bundle Birth Nurses. If you like what you heard, it helps us both if you subscribe, rate, leave a raving review, and share this episode with a friend. If you want more from us, head to bundlebirthnurses.com or follow us on Instagram. Now, it's your turn to go and take ownership of your practice, understanding the risk factors, etiologies, symptoms, preventions, treatment, management, and how to level up your care so that we, together, can save lives and change this mortality crisis in our country. We'll see you next time.