Herpes
Q: I am expecting my second child soon and have genital
herpes. I was lucky with my first child and didn't have any active lesions at
the time of her birth and therefore had a normal vaginal birth.
I fear that I will not be so lucky this time around and really do not want to
have a c-section. Is there anything that can be done to shorten an outbreak if
it occurs just before my due date? How dangerous is it to my unborn baby (due
11/01) when I'm suffering from a herpes outbreak? With this pregnancy I have already
had at least four outbreaks in five months and am very concerned about the baby
being affected in utero.
- LW
A: High doses of L-lysine (3000 to 5000 mg daily) will help, as well as using tea tree oil.
- Annette Lewis, CPM, LM
Salmon, Idaho
A: Look into taking a glyconutrient supplement called Ambrotose. It is
the best nutrient supplement available for support of the immune system. It is
entirely safe to take during pregnancy--basically it is just good food that we
don't get in our diets these days. I have taken it for 2 1/2 years and through
both of my pregnancies. Herpes is a virus that will cause outbreaks when the body
and immune system are under stress. Obviously this occurs during pregnancy. Glyconutrients
are the best way to support your immune system. There is a lot of research on
this subject--go to www.glycoscience.com to learn more. Please contact me if you
would like to get on this supplement.
- Dr. Lisa Staudt
ldstaudt@prodigy.net
A: The very first two things: 1. What are you eating? 2. What is your stress level?
My guess is that your life is very stressful at this time with either a move,
a job loss, a change in partners, living with family members, etc. It is important
to address the stress. Herpes outbreaks are usually stress related. Perhaps some
counseling is in order. Please take stock of what is going on inside. Perhaps
persistent worry about a c-section due to a herpes outbreak is the stressor? Work
to change that perception of yourself by hypnosis and/or affirmations such as
"I am healthy and whole." It really is important to change the thinking
patterns that are evident in your letter.
A diet that is out of kilter is the next common cause of herpes outbreaks. Ask
yourself what you are doing to strengthen your immune system. Is your diet nutritious?
Organic? Made of whole foods? Fresh fruits and vegetables? What supplements are
you taking? Red raspberry leaf tea has mild antiviral properties. Transferfactor
(www.4-life.com) is the most immune-building
substance available. It far exceeds echinacea. It is very important to support
your immune system with something safe for your baby. Transferfactor is safe for
baby. Zovirax is not necessarily safe, and it is "suppressive therapy."
But a prescription may be best for you. The majority of women who are pregnant
and seeing a physician have been given a prescription to suppress herpes so they
can have a vaginal birth. It does seem to work. It is an alternative available
for you that has not shown to be harmful to baby.
The next agenda is to look at foods high in L-lysine (an amino acid). L-lysine
seems to decrease herpes outbreaks because it competes with arginine, a substance
the virus feeds on. Foods high in L-lysine are potatoes, meat, milk, brewer's
yeast, fish, liver and eggs. Foods high in arginine (foods to be avoided) include
chocolate, nuts, cola, rice, cottonseed oil and meal. L-lysine has been shown
to have an inhibitory effect on virus replication in vitro. A person may need
to take more than 500 mg twice a day to get that effect in vivo.
A herpes outbreak during birth can cause congenital herpes and a newborn can
die from this very serious consequence. However, research indicates congenital
herpes is generally a sequelae of an initial herpes outbreak (primary). Most healthcare
practitioners are not willing to take the chance with your baby and will offer
cesarean if you have a herpes lesion on the genitals at the time of labor or when
your water breaks. It is thought that when the bag of waters breaks, the infant
should emerge within three hours before the virus moves upward.
- Sandra Stine, CNM
A: I read somewhere that external lesions of genital herpes can be covered
with rubber cement right before birth and the baby can be born over them.
Try to process your fears with someone, preferably trained in "Birthing from
Within" holistic birth preparation. They could help you focus on birthing-in-awareness,
not just looking to the outcome. They can be reached at www.birthpower.com
- Augustine Daniels, CBE, CD
Bordentown, NJ
A: I commonly prescribe acyclovir (taken daily) starting at 36 weeks
to suppress herpes outbreaks. In our practice we have been doing this for about
3-4 years and have seen no adverse effects. We've also had no active outbreaks
during the last month of pregnancy since using this protocol. Perhaps this is
an option you could discuss with your care provider. The company that makes the
drug is maintaining an exposure database and could probably provide useful info
to any provider who is interested.
Regarding your question of in-utero exposure: I can't claim to be an expert,
but my understanding is that outbreaks during pregnancy are not harmful to the
baby. I don't know if this is because the virus does not cross the placenta or
because your antibodies also cross the placenta and provide protection to your
baby. I believe that the most dangerous thing for a baby is to be born during
or shortly after the mother's initial outbreak (before any maternal antibodies
are developed) because the baby's immune system cannot fight the virus.
About 5 years ago we used to do weekly herpes cultures during the last month
of pregnancy to avoid vaginal exposure of the virus in mothers with a history
of herpes. I once assisted a woman in birth who had 3 previous cultures return
negative. She gave birth (vaginally) before the result of the 4th test was back.
We were both very worried when the most recent culture returned positive. Her
baby had no problems, which was a real relief. I have also assisted at a birth
when the mom had a lesion on her labia, but she denied any history of herpes.
At the time of vaginal delivery, we noted the lesion and sent a culture, which
was positive for herpes. Again, the baby had no problems.
I know your concerns are very real and I don't mean to treat them lightly by
sharing these stories. However, I do want to give you some reassurance and some
hope for an effective management. Here are some web sites that you may find helpful:
www.herpes.com/pregnancy.shtml
www.herpescity.com
www.best.com/~falcao/archives/herpes.html#About
- I.R.
A: Acyclovir is the oldest and least expensive medication. An active
lesion on the perineum at the time of labor does expose the baby to disseminating
herpes that can have grave consequences, including death. In the last 20 years
I have been in practice, I have not seen a woman having to have a cesarean for
active herpes. The biggest concern is a primary outbreak at the time of labor,
but having acyclovir around for the possible outbreak at term would be worth doing.
- Peg, CNM
A: I know a few people who have treated their herpes sores with hemp
oil. After the oil is applied directly to the sores, they go away very quickly.
It is good to apply the oil at least once a day until the sore is gone. The brand
we have had the most success with is Hempola--any natural foods store should be
able to special order it for you.
- Bren
A: A book called The
Natural Pregnancy Book by Aviva Jill Romm describes the treatment of herpes.
It is excellent. She talks about all sorts of herbal treatments that strengthen
immunity and purify the blood to prevent outbreaks and help treat any current
outbreaks.
- Anon.
A: Try Lysine 500 mg twice a day for prevention. If you feel an outbreak
coming on, take Lysine 1000 mg three times a day for five days--it will shorten
and sometimes avert the outbreak. Herpes outbreaks are mediated by the balance
of amino acids in food. Choosing foods that are high in lysine and low in arginine
is very helpful. Avoid chocolate, peanuts, other nuts, processed foods including
lunchmeat. Choose fish, fruits and veggies. Limit dairy. Some grains are high
in arginine. This has been very useful in our practice; even the perinatologist
who backs us recommends this to his patients.
- Liza McKinney, CNM
A: I had genital herpes, though not while I was pregnant. I used an herbal
product called Vagistatin (inserted vaginally), along with another product taken
orally to clear heat from the body, from a company called Health Concerns. At
my follow-up visit, the lesion had completely disappeared. I was followed every
six months for two years following and had a negative Pap every time. I'm sure
you could call and ask about the product's safety during pregnancy. Their phone
number is 800-233-9355.
- C.M.
A: My first birth was a c-section because I had an active lesion. My
doctor at that time would not prescribe Zovirax because she felt the risks of the drug outweighed the benefits (yeah, right). My second and third births were
VBACs and my (new) doctor prescribed Zovirax starting at 34 weeks (I think I took
200 mg a day) to keep outbreaks away. This time around she has prescribed Valtrex,
1000 mg day if having an outbreak and then starting at 34 weeks 500 mg day. Valtrex
is a Class C drug and Zovirax is a Class B (I think).
- Jenn D
A: Listen to your body choosing what it needs: Herpes = "her peace."
Get as much rest and sleep as you can, give yourself the gift of lots of positive
self-talk, visualizations of health and successful birth, touch therapy, deep
breathing, meditation. Love yourself and give yourself peace.
- Anon.
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International Connections
Although I do not know what the RAMP maneuver is [Issue 3:28], it is not the English technique for relieving shoulder dystocia! The maneuver we use for this obstetric emergency is based on the HELPERR mnemonic. Here is a definition of the maneuver which is used as an emergency drill for shoulder dystocia by midwives in our region of Britain:
H - Call for help
E - Evaluate for episiotomy
L - Legs into Mc Roberts' position
P - Pressure: apply suprapubic pressure
E - Enter (Perform Woodscrew maneuver)
R - Remove the posterior arm
R - Roll over (roll woman onto all fours) and start again
- Julie
I am 35 years old, fit, healthy and 30 weeks pregnant with my fifth child. I have birthed 3 of the children at home with a midwife, as I will the fifth. I
am experiencing a lot of pain in the uterine ligament that attaches (I think)
to my hip bone and then through my abdomen and into my back. These ligaments regularly
spasm and I experience excruciating pain.
During the last pregnancy the same thing occurred. I managed it using comfrey
gel directly on the area, oral mag. phos., and massage as needed. It helped me
cope but didn't stop the spasms. During the last labour the spasms were with me
almost 100% of the time and worsened as labour progressed. During postpartum the
pain remained off an on for about 4 days and then subsided. I vomited because
of the pain for the 4 days.
I am afraid of things getting worse and am looking for help.
- SB
To tell a woman to push before she is ready is like telling her to poop before
she is ready, while people stand around chanting Poop! Poop! Poop! It just doesn't
work very well!
- Amy Reay, doula
Oregon
Re: the question about radiation and the South Pole [Issue 3:29]: A: While pregnant
with my daughter, I was on airplanes every few days for the entire first 4 months.
With my son we were in the process of moving to Guam from the mainland U.S. so
I crossed the Pacific Ocean via the North Pole, then via Japan, several times
during that pregnancy. Both children are generally healthy, bright-eyed, developing
normally and very smart. If the radiation exposure had any effect on them I cannot
see it.
During the first few weeks of pregnancy the embryo has the amazing ability to
repair itself (to a certain extent), so if there is any damage from exposure to
harmful substances that damage can sometimes be undone. If the pregnancy is not
viable, perhaps a chromosomal abnormality, there is not much that your body can
do to repair and save it and the problem would have probably been present at conception.
No amount of air travel would likely be responsible for that kind of chromosomal
damage.
Flying at high altitudes for extended lengths of time--as in transcontinental
flights--does expose you to more radiation--not a higher dose, just a longer period
of exposure. My pilot husband says it is about the equivalent of several dental
x-rays a day.
I did make it a point to drink some herbal teas and infusions (mostly dandelion
root) that helped my liver function remain strong. My thinking was if my body
had strong cleansing capabilities it would be best for the babies and might help
cleanse them of any inadvertent exposure to harmful substances.
Short of wearing a lead apron over your belly for the entire flight to Brazil,
there is not much you can do to limit your exposure. You could fly another route
that doesn't pass over the South Pole. You could take a flight that travels at
lower altitudes that will further lessen your exposure. Traveling at night also
lessens the exposure to gamma radiation. You could explore the possibility of
taking potassium iodine which is supposed to protect the body from radiation exposure
but I am not sure it is safe to use during pregnancy.
There was a long-term study of the effects of radiation exposure on pilots and
the only significant increase was in skin cancers and neurological disorders (such
as Parkinson's disease), both appearing at late stages in life and most significantly
in men. Your body is working overtime to protect your unborn baby so you were
probably at a greater risk from the exposure than the baby was.
- L.S
Guam
Thank you for your article on folate levels [Issue 3:29]. Our fourth-born child
had a fatal neural tube defect, anencephaly, and died during preterm labor, just
18 hours after diagnosis. Immediately after his birth, I started taking 4 mg of
folic acid in addition to the 800 mcg in my prenatal vitamin. In August 2000,
we were blessed with a healthy daughter.
My concern with the current recommendation for folic acid supplementation is that
it is too low. Most prenatals have 800 mcg, which is not a high enough level to
prevent NTDs, not as effectively as 3 mg or more.
- Ann Marie Henninger
Re: Folate deficiency as a cause of cleft palate, I would like to add that environmental
factors may be involved as well. For more information about research on the effects
of pesticides on fetal development in laboratory animals, go to www.chem-tox.com/pesticides/.
- Rachel Westfall
Re: Inquiry about safety of VBAC article in The Lancet:
"Here's a link to the study:
http://content.nejm.org/cgi/content/short/345/1/3
Basically, it says the risk of uterine rupture in a VBAC woman who goes into spontaneous
labor is 3 times greater than in a woman who never goes into labor and has a repeat
c-sec. The kicker here is that women who are induced with something other than
prostaglandin gel (like Pitocin) are 5 times more likely to have a rupture, and
women who are induced with prostaglandin are 15 times more likely to rupture.
Looks to me like induction is the real culprit of rupture, and that any woman
attempting a VBAC is obviously at risk for uterine rupture, just as any women
having a repeat c-sec is in danger of complications that can be just as deadly.
Women need to weigh the risks of a c-sec against a *natural* VBAC (not induced,
which is too risky, according to this study).
- Angela McLauchlin, aspiring doula
The following link has a wonderful referenced analysis of the study:
http://maccorkl.home.sprynet.com/VBAClash.htm
- Anita Woods
Vice president, International Cesarean Awareness Network
www.ican-online.org
The American College of Nurse Midwives has posted on their website an informative
news release in response to NEJM. It suggests the study left several questions
unanswered, and should not be used to frighten women considering a VBAC, among
other things. Worthwhile read, as the other side of the coin usually is! You can
read it at: www.midwife.org/press/pr01-vbaccall.htm
- Erin Buchanan
In general, the study really showed nothing new, but the press is reporting
it as "increased incidence of rupture." Plus, the ICD9 codes used make
the study confusing because they included dehiscence as an actual rupture. With
all the politics currently going on surrounding VBAC, and as a VBAC mom myself
due in 4 weeks, I was very disappointed in how the press presented this story.
One doctor states his opinion about how VBAC is not safe for babies and that is
what the press picked up on.
- Teresa Jorgenson, BCCE and doula
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