Search for tag: "nurse"

Dr. Jones: Getting let down. Getting let-down. The first is a psychological consequence and the second is about breastfeeding. How are they connected? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health, and this is The Scope.

Announcer: Covering all aspects of women's health. This is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: There's a world of data that suggest for newborns "Breast is Best." That puts a lot of pressure on new moms to be successful breastfeeders. In the days before formula, a newborn's life depended on a mom's ability to provide breast milk, and a mom's health might already be precarious after what might have been a dangerous delivery. For this reason, many cultures have a time after delivery, several weeks or a month, to allow moms to heal and breastfeed.

Okay. That's all good. But after that in the US of A many moms have to go to work. That means if moms are still going to provide breast milk, that breast pumping pump at work becomes a reality. Now, to provide breast milk, a mom has to be at least moderately well-nourished and well-hydrated. But almost all American moms can accomplish that in the workplace. Then, there's the problem of let-down.

To make milk, moms need to be in reasonable health. They have to be breastfeeding, meaning they have to suckle. When the infant suckles, their nerves on the chest wall and the nipple feed information back to the brain to release the hormone prolactin from the pituitary gland. This hormone helps the breast make milk. But the milk just doesn't come out in a continuous dribble. It's made in the far parts of the breast called the alveoli and collected in tubes or ducts in the breast waiting for, you got it, let-down.

When the infant suckles, nerve fibers in the nipple cause the posterior pituitary to release oxytocin, which stimulates myoepithelial cells. These are little muscular cells to squeeze milk from the milk producing part of the breast called the alveoli so it can drain into the lactiferous ducts and then squeezes the milk down the pipeline to the nipple. It takes less than a minute from the time when the infant begin suckling -- the latent period -- until the milk is secreted -- the let-down. But what happens if the baby isn't there?

You're in your office or you're in the ladies restroom with your breast pump or if you're lucky you have a private room with a lock and an electric outlet and an electric breast pump and a rocking chair. Nice, but you still have to get let-down. Many experienced breastfeeding moms know that just the sound of their baby giving a hungry cry can begin let-down and that could be embarrassing if the baby isn't close and you start to leak through your clothes. However, for new moms, pumping at work let-down can be difficult to get started.

If let-down is a neuroendocrine reflex from the brain, many things can get in the way of timely let-down. Anxiety, pain, embarrassment, stress, stimulants like caffeine and nicotine, too much alcohol gets in a way but a little bit of alcohol might be relaxing, but not in the workplace. Acute fear or anxiety can suppress let-down. The fight or flight mechanism inhibits let-down, as it should if you're running away from tigers or something else.

Many years ago, when I was a young obstetrician back at work shortly after the birth of our son and pumping when I could find the time, my residents gave me as a joke, I think, a pager duct taped to a breast pump. Now, there isn't anything less conducive to let-down in my world than my beeper going off and a disaster happening to some poor laboring woman on labor and delivery. What a let-down.

So what's a new mom at work to do? Some suggestions include bringing a picture of your baby to look at when you're pumping. Bring something like a little t-shirt that smells like your baby with you. Try to get your head in a calm space before you put the breast pump to work. Deep breathing, focused visualization of having your baby at your breast and instead of that pump can be useful. Turning up the vacuum on the breast pump or just pumping harder with the hand pump won't do. The problem is let-down, not suction.

In an effort to increase the success at milk production and future breastfeeding for moms of very premature infants, some research has been illuminating. You can imagine that having a very sick newborn that you've never been able to nurse because they're too little and you're sitting in a pumping room next to the intensive care nursery might not be conducive to let-down.

A paper published in advances in neonatal care took 162 mothers of premature babies who were trying to provide breast milk for their babies and divided them into four groups. One group had standard instructions in a breast pumping room. The other group was taught guided imagery, imagining their babies and imagining themselves in a safe, warm, quite place with their newborns. Another group was given soothing music. And the fourth was given imagery and soothing music.

Women who were taught guided imagery or given soothing music had more output of milk. And the women who had music and guided imagery together has the most milk of all. Now, this wasn't just a little difference. Moms who had the interventions had two to three times more milk than moms who didn't. Mothers who had interventions to decrease stress also had more milk fat, had richer milk in the first days of the study.

So what else is out there? Last year the annual Make the Breast Pump, Not Suck Hackathon -- isn't that a great meeting -- awarded the Technology Frontiers Award to group that were testing out virtual let-down by transforming pumping rooms at work and in public places into a nursery decorated with pictures and videos and sounds of their babies by using a virtual reality headset.

So what do you do? For a new mom committed to breastfeeding and is returning to the workplace or needs to travel away from their baby, what do you do? Practice using your pump at home in your baby's room before you take it to a strange place. Get your head in the right place. This can take time and practice before you're rushing into a pumping place or a bathroom in the airport or your workplace. Get some soothing music and, yes, there are YouTube videos with music and guided imagery and meditation that you can use. You can just power it up on your phone, put in your headphones.

But use these first with your baby so the association can be stronger. Stay well-hydrated. And if you're struggling, get a coach through your hospital nurse lactation specialist or a La Leche League. This is hard, but you can do it. Don't get let down.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Interviewer: Do you love science and medicine but you don't necessarily want to become a doctor or a nurse? Well, maybe a degree as a medical technologist and working in a laboratory might be for you. We'll get the inside from somebody who's chosen that as their career path next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Kristen Case is a medical technologist, also known as an MT, who specializes in parasitology and fecal testing at ARUP Laboratories which is one of the top labs in the country that specializes in identifying parasites so doctors know how to treat them. Today I want to find out more about what you do and how you got your training to do what you do. So first of all, what kind of experience do you have to have to do what you do?

Kristen: It's a specific major. It's called clinical laboratory science or medical technology. There's a program at Weber State, at BYU, and here at the University of Utah. You take specific courses about microbiology, virology, blood bank, chemistry, so it's a really fun major because you learn about all different types of things. If you like science, it's a perfect major.

Interviewer: Is this an undergraduate major?

Kristen: Yes, undergraduate major.

Interviewer: And it's called what, again?

Kristen: Medical technology.

Interviewer: Okay, medical technology.

Kristen: Or clinical laboratory science.

Interviewer: Okay, so then when you got your job at ARUP Laboratories, then that's when you started specializing in what you specialize in?

Kristen: Yes.

Interviewer: You could have done a lot of different things with this degree, so why did you choose to specialize in parasitology and fecal testing? I mean, that sounds gross to me.

Kristen: For me it's gross but it's also fascinating. It's really fun. We get to see a lot of different organisms, do a lot of different things throughout the day. I learn something new every day, and that's what's so fun about my job.

Interviewer: So help me understand how you end up with the specimens you end up with? So a doctor has a patient that comes in and the doctor is led to believe on some level there could be a parasite or what else going on. What would they do at that point?

Kristen: Usually a person will go to the doctor because they're having some type of intestinal problem. So the doctor is going to start doing a panel of testing, and testing for parasites probably is just one of those tests that they're going to order. Because we're in the United States, parasites aren't super common but it's still on the panel of tests so we get a lot of specimens in our lab. We look at them in the microscope, looking specifically for parasites. We can identify them microscopically or even using some other methodologies.

Interviewer: So usually you are looking at fecal tests? Is that what you primarily would look to find these parasites?

Kristen: Yes. The majority of our specimens are fecal specimens, but parasites are really sneaky critters and so they actually . . . we get eye specimens, pleural fluid, urine, all different types, skin scrapings, all different types of specimens in lab. And again, that's something that's fun to me is a lot of different sources.

Interviewer: Okay, so parasites can live in a lot of different places in the body. I think we tend to think of in the stomach probably most of the time, or a tick on your skin. That's a parasite. So you get the lab sample. What do you call it when the doctor sends it to you?

Kristen: A test order, or we get the order.

Interviewer: Yeah, you get the test order, you put it under your microscope, and you start looking. That's how you find it. You don't conduct some other chemical test or anything like that?

Kristen: There are some chemical tests. One of them is called an ELISA, enzyme-linked immunoassay, and that's a test that uses the specific interaction of an antigen and an antibody. Antigen is a protein that's going to be on the organism's surface somewhere, so the surface of the cell, and then antibodies are produced by animals, humans, specifically matched to that antigen. So we use those antibodies in a controlled environment, and if the specimen has a parasite like Giardia, cryptosporidium, or even Entamoeba histolytica, the test would be positive.

Interviewer: So for those ones that you just mentioned, you use a chemical test. What are some that you just have to use a microscope for?

Kristen: So the less common ones we have to use a microscope because there haven't been tests developed yet for those less common parasites. For example, dientamoeba fragilis, it's a trophozoite that lives in your intestine. Some of the tapeworms they don't have any chemical tests. We have to look at those under the microscope or even macroscopically look at the tapeworm segments to figure out what the patient has.

Interviewer: And when you're looking through that microscope you know what you're looking for. When you see it you're like, "Ding! Ding! Ding! That's it."

Kristen: Yes, because we receive a lot of training on the job and in school, but more so on the job because we're so specialized in the lab. There's a lot of training that we get. So anything that's potentially there, we can identify it.

Interviewer: Yeah. So with this undergraduate degree that you got, medical technologist, it sounds like you get to do some pretty exciting things?

Kristen: Yeah. I really love my career. I think it was one of the best decisions I made to study medical technology. And then I was lucky enough to get hired on ARUP. To me it's the best place to work. They value their employees, there's great benefits, there's tuition reimbursement, and then as a reference lab we receive specimens from all over the United States and so we get to do really specialized work. It's really fun.

Interviewer: And it also sounds like, for your investment in education, you had the four years as opposed to needing to take 10, 12 years of education and you're already helping people.

Kristen: Yeah, I think it was a great return on investment and the major is, and the classes you take, are very hard. It's a very rigorous course no matter what university you go to. But it really pays off because I'm doing something that helps people. It has value in the community and then it's also fascinating.

Interviewer: If somebody was considering this as a career, what would you say to them?

Kristen: I'd say do it.

Interviewer: What kind of person would be a good fit for this?

Kristen: The best fit for someone who wants to work in the lab is someone who likes attention to detail, likes to work with their hands, likes to problem solve. A lot of us are kind of science nerds and so we enjoy being behind the scenes rather than right there with the patient like a nurse or a doctor. We have a really big hand in healthcare. Doctors depend on the results that we give them. We're behind the scenes, though.

Interviewer: Yeah, that must be really rewarding.

Kristen: It is. When I go home every day I feel like I've done something good. I've helped somebody, whether I've seen their face or not.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.