|June 4, 2008|
Volume 10, Issue 12
|Midwifery Today E-News|
“Group B Strep”
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In This Week’s Issue:
Quote of the Week
"One of the first duties of the physician is to educate the masses not to take medicine."
— Sir William Osler (1849–1919)
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The Art of Midwifery
I focus on encouraging my clients to improve the health of their digestive flora starting at the beginning of the pregnancy, if not earlier. I believe that increasing the numbers of Lactobacillus in the body may lead to lower levels of group B streptococcus living in the GI and reproductive tracts. Most modern Americans have been exposed to antibiotics and eat a sterilized food supply. We have moved away from the fermented foods that were so prominent in the diets of our grandparents: sauerkraut, live pickles, kim chee, kefir, beet kvaas, etc. All over the world, lacto-fermented foods have sustained our species for millennia. These foods re-inoculated our bodies with friendly Lactobacilli. Today, yogurt is the only lacto-fermented food most Americans eat with any regularity, most often sugary yogurt made from the pasteurized milk of cows raised on a diet of antibiotics and hormones.
We can encourage our clients to take probiotic supplements throughout pregnancy to encourage healthy gut flora. These supplements are expensive and some question whether enough Lactobacilli can survive the stomach acid to colonize the intestines. Instead of pushing expensive pills and supplements, I believe that teaching our clients to change their diets is more empowering. Kim chee, pickles and sauerkraut are made from cabbage, carrots and other cheap vegetables. A week's worth of homemade kim chee costs less than $1.00.
We can show our clients on WIC how to make yogurt from the many gallons of milk they receive each month. We can hold group prenatal visits or practice-wide potlucks and introduce women to homemade pickles and Reuben sandwiches (made with sauerkraut). While most people resist dietary change, with gentle suggestions and guidance many will try new foods. Common folk wisdom tells us that pregnant women are drawn to pickles; my experience confirms that many women especially enjoy the tart and sour tastes of lacto-fermented foods in pregnancy.
ALL BIRTH PRACTITIONERS: The techniques you've perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to email@example.com.
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Research to Remember
New evidence shows that in utero exposure to smoking is associated with attention deficit/hyperactivity disorder (ADHD) in children who are genetically susceptible. The findings related to dopamine pathway genes. Children with these genes whose mother smoked during pregnancy had a three- to ninefold increase in risk.
A related concern is the fact that ADHD increases the risk for later substance abuse, so that the cycle of substance abuse is passed on intergenerationally.
— Biological Psychiatry 61(12): 1320–28, 15 Jun 2007
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Alternative Protocols for Dealing with GBS
Some midwives have been searching for alternative approaches to dealing with GBS. Most protocols that they have developed are based on anecdotal evidence and knowledge of holistic treatment methods. Numerous approaches are being used by midwives and pregnant women—too many to elaborate on with great detail in this article.
Some of these protocols are described in networks such as Gentlebirth (www.gentlebirth.org) and Moondragon (www.moondragon.org) Web sites. Midwives can examine these protocols and determine what information they are comfortable sharing with women.
The basic principle behind most holistic approaches is to provide the mother's and baby's immune systems with the support and strength necessary to combat infection. Garlic, or more specifically the allicin in garlic, has a great reputation for its antibacterial properties. Some midwives are currently developing protocols in which garlic is used vaginally as a nightly suppository to combat GBS colonization.
Another approach is to build the body's immunity. Acidophilus, echinacea, vitamin C, tea tree oil and bee propolis can be taken to boost the immune system which may then keep the GBS bacteria under control. Holistic treatments with antibiotic properties can also be of benefit. These include goldenseal, Oregon grape root, grapefruit seed extract and homeopathic treatments, among others.
Others are looking at the idea of chlorhexidine washes during labour. This antiseptic can eliminate GBS bacteria from the vagina, but not the rest of the body, at the time of birth. This ensures that the baby is not exposed to GBS during birth. The benefits of such an approach are that chlorhexidine does not cause bacteria to become resistant to treatment and the baby's normal colonization of skin and intestinal flora with healthy bacteria is not disturbed. One study has shown the effectiveness of chlorhexidine in reducing the rate of newborn infection by antibiotic-resistant strains of the bacteria. A Cochrane Review of studies regarding the use of chlorhexidine concluded that while it decreased the rate of neonatal colonization by GBS, it was not useful as a vaginal disinfectant in labour to prevent GBS. That review also noted that the results should be interpreted with caution, as the quality of the studies reviewed was poor. Further research may be helpful in determining whether this is an effective prevention tool.
While the approaches mentioned above attempt to eliminate established colonization by GBS, some midwives and other professionals believe that we must first begin with prevention. Caregivers can apply basic principles that will assist in reducing the infection rates of GBS and other bacteria. First, amniotic membranes should remain intact as long as possible. Second, vaginal exams should be kept to a minimum so that bacteria do not get pushed towards the cervix.
If a woman is induced due to premature rupture of membranes, natural methods of induction should be used. Prostaglandin gel should not be used, as the rate of infection is five times greater with this method.
Some midwives believe that if a woman takes good care of herself by eating well, exercising and keeping her immune system healthy, her body will be better equipped to deal with GBS. Others encourage women to be tested for GBS at 35 to 37 weeks gestation. If the result is positive, they recommend using one of the holistic methods mentioned above and then getting retested to see if the colonization has cleared.
While midwives seem to have found a wide range of approaches to dealing with GBS infections, the effectiveness of these methods remains largely anecdotal and not supported by research.
Editor's Note: Read an article online about GBS:
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Question of the Week
Q: Do you think that baby formula milk should be available by prescription, readily available or what? Basically, I mean when breastfeeding doesn't work, and a mom has tried everything in order to be successful at it, or had a medical or other reason for being unable to breastfeed?
— Jessica A Bruno
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Question of the Week Responses
Q: I've been researching natural care practices for c-section recovery, but have come up short in both Midwifery Today and Mothering magazines.
Thus, I have both a comment and a question. First, I am an advocate for homebirths. I planned one for myself with a midwife and a doula, but I ended up having a c-section—my son was 2-1/2 weeks late, my cervix was very firm and did not respond to the castor oil or even Cervitol, and my placenta was calcifying. I am sure that my scenario could have played out differently, but it didn't and I am saddened that all I ever read are negative things about c-sections as if we all elect to have them for vain or fear-driven reasons. It would be great to also find articles that inform women on how to care for themselves after undergoing such a surgical experience. So on that note, do you have articles, suggestions for key word searches or Web information that provide information for women who want natural remedies (herbal, food, homeopathic, aromatherapy) for caring for their bodies/mind/spirit after a c-section? Your suggestions would be greatly appreciated.
A: Many midwives and doulas have knowledge of different therapies, techniques and comfort measures for helping women heal from cesarean birth. Women can contact them for help postpartum.
As a midwife who is also an herbalist, I can offer these suggestions:
Herbs that help heal incisions, comfrey, aloe, shea butter, calendula, heal all, will also reduce scarring. Yarrow is particularly good for fighting infection. St. John's wort can help with nerve pain or altered sensation. Herbs used for sitz baths can also be used. You can use the herbs as poultices or compresses, oils or salves or tinctures. The comfort of a warm compress is my favorite way to apply them.
Lady's mantle helps the uterus' involution and return to its proper position.
After everything is healed, I like to use chickweed or violet leaf oils for massage to dissolve adhesions.
Flower essences are helpful for emotional healing.
The same herbal infusions used to nourish a mother and baby prenatally (nettles, oats, red raspberry, alfalfa, red clover), can be continued postpartum. Taking them daily insures that you will build back your blood supply quickly, have plentiful breast milk and provides your body with building blocks for recovery. They are an easy way to ingest readily assimilated vitamins and minerals.
If you have had antibiotics, probiotics can reestablish the correct intestinal flora thereby helping digestion and preventing yeast overgrowth. Bitter-tasting herbs like dandelion or artichoke aid digestion as well as stimulating the liver. The liver is working hard to eliminate the effects or anesthesia or other drugs so it's good to give it some help. Milk thistle seed protects the liver from any damage these substances may cause.
Bodywork, such as massage, can help release trauma held in your cells, increase circulation and renew your relationship with your body in a nurturing and comforting framework.
As you can see, the alternative or complementary therapies have the most to offer in this regard. Books written by midwives or herbalists will usually have suggestions for postpartum and post-cesarean healing. Robin Lim, Aviva Jill Romm, Rosemary Gladstar, Amanda McQuade are some authors you might look up.
— Helena Wu, LM, CPM
A: Sorry to read about your birth experience not going as planned. Congratulations on the birth. The only suggestion that I have for you at this moment is a recent blog entry that I wrote.
Yay—my search for the right forums for me are over now.
It took a year and a half to find them. They are I Want My Mum—The Progressive Parenting Site (http://www.iwantmymum.com/site/). Basically, it took me a while to finally decide to join here, but I'm glad I did. Now, I wish I'd found these forums a year an half ago when I started the search. Then, I wouldn't have gone crazy with looking at forums or trying them and then finding out they weren't for me in the end.
Good luck with everything.
— Jessica A Bruno
A: I wrote a doc about holistic Caesarean recovery for my clients, both for mama and baby. I'm not sure how this works, but Claudia is welcome to contact me for it.
— Angie Evans, BScHon, MH
Responses to any Question of the Week may be sent to E-News at any time. Write to firstname.lastname@example.org. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.
Think about It
There are a variety of ways to get normal birth into the consciousness of the general public. YouTube is one. Watch this YouTube photo montage on natural births of twins and triplets! http://www.youtube.com/watch?v=7E-wULAaD50&feature=email
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Regarding Midwifery Today E-News Issue 10:11 on "Meconium":
You missed the best one of all, American Journal of Obstetrics and Gynecology (Gray Journal) 188: 153–56, 2003.
Meconium is NORMAL. Not a disease, not a complication, not even a concern.
All normal babies do it. Oh, yes—dying babies sometimes do it too.
Meconium is normal, and the "Munchausen syndrome by proxy" that most obstetricians, medwives and even pediatricians suffer from is a scam. A ploy to up the fees by treating a normal function with terror, fear, surgery and drugs is irrational.
Babies Poop Normally, BIG SURPRISE!
— Jay Hathaway
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