Group B Strep and birth. 

                     Group B Strep-                       10/01/2019

 

30% of women expose their babies to GBS at the time of birth. GBS is a normal intestinal bacteria. But in 3 of 100 babies born to women who test positive for GBS can become very sick. GBS illness includes a blood infection, spinal cord infection, and possible meningitis. A baby can die from GBS, and or have brain damage from a serious infection.

 

The CDC recommends Penicillin in labor for mothers who test positive for GBS.  There are babies who will become sick from GBS, who have received antibiotics. There are babies who will become sick who have not received antibiotics. Antibiotics are currently our best tool for prevention of GBS transmission during labor. It decreases a baby's risk of getting sick from GBS by 1%.

 

Prolonged rupture of membranes increases the risk for baby to become ill from GBS. Meaning the longer your membranes are ruptured, the bigger the risk for any  infection.

 

 

Breast milk breaks down the GBS colonies. We strongly encourage breastfeeding.  A true GBS infection will require a NICU stay and antibiotics for up to 10 DAYS for your baby and a possible bad out come.  The risk is small but real.

 

If your water breaks and you are not in advanced labor, and you are GBS positive, Penicillin is indicated.  A TRANSFER TO THE HOSPITAL FOR ANTIBIOTICS IS ABSOLUTELY INDICATED if you are one of the 10% of women whose water breaks before labor and you are allergic to penicillin. The longer the exposure the more likely a baby is to get sick.

 

If you are allergic to penicillin or do not want antibiotics in labor, we strongly suggest you begin taking probiotics in your first trimester of pregnancy.

 

Start immediately in the first trimester of pregnancy;  and by 28 weeks start inserting a lactobacillus probiotic in your vagina once a week.  IT TAKES TIME TO CHANGE THE  BACTERIA LIVING IN YOUR INTESTINAL TRACT. IT IS IMPORTANT TO START ONCE YOU KNOW YOU ARE PREGNANT.   The goal is for the probiotics to grow in your vagina and intestinal tract to prevent the GBS from being dominant at the time of birth.

 

Vaginal washes in labor with hibiclense have not been shown to decrease the risk of GBS transmission according to studies.  We encourage all women to start taking the probiotics in their first trimester.


 

 

 

 

Post Partum Depression-What can I do to offset depression after my baby comes?                                                                       4/28/18

 

The actual act of giving birth is the easy part of parenthood.  Once you have a beautiful baby in your arms there are a myriad of changes.  Some women have longed for a precious baby, or are " natural" mothers.  They flow with the changes in their sleep patterns. Seem to revel in having a little human that can't be left alone, and tends to cry a lot.  They breeze through the sore nipples and are seemingly over the moon in love with their baby.  Happy to be a mother.  Smiliing all of the time!  Not everyone has that experience.

 

It isn't easy adding a new family member to the household wether this is your first or your fifth baby.  While there is something magical, and beautiful of holding and nursing your little baby, the lack of sleep and the feeling you must be there constantly because baby needs you can cause some post partum blues.  Not to mention the hormonal shifts happening right after birth.

 

Feeling a little blue, or even like the world might cave in on you in the first week or so is somewhat normal.  These blues should generally be gone by six weeks.  You feel a little sad, a little isolated, but no thoughts of harming your self or baby.  You might be irritable.  

 

True post partum depression makes it difficult to get out of bed and begin your day.  Symptoms range from depression and irritability to just plain old feeling miserable, and hopeless.  This type of depression is long lasting and worsens over time.  Seek Medical help.  Tell your care provider.  Seek a counselor.  

 

There are several things you can do to help mitigate the feelings of post partum blues.  Join a parenting group, seek out other mothers and make friends. Talk about what you are feeling.  Start an exercise regimen.   Get out in the sunshine.   Most of us in the South don't really get outside enough to get the correct amount of vitamin D, so talk to your health care provider about vitamin D supplementation. Continue to take your Omega 3's especially in the form of krill oil and or fish oil's.  Eat a healthy well balanced diet.  Eat!  Not eating for 6-8 hours can cause energy levels to plummet and create a metabolic shift that leans toward "crying spells".  Placenta encapsulation appears to help with the irritability and moodiness that hormonal shifts can cause.  Other modalities:  Accupuncture, massage, warm baths, taking time for yourself and letting a friend, or your mother, or your significant other watch baby for short periods so that you can have free time is essential. 

 

While these are suggestions- if you feel your feelings are getting more hopeless, sad and blue Please tell your provider and seek out counseling from a professional.  

 

Molly Crenshaw  is available for counseling 512-864-4216 

See her web site at  Deepcounselinggeorgetown.com

 

Sandra Tallbear-

 

 

 

 

 

If we have a doula, what does the midwife do?                   2/7/2018

 

 

A husband and wife came to interview for the possibility of a birth center water birth from  Burnet, Texas.  Toward the end of the interview the husband asked, "if you have a doula, what does the midwife do?"  Well perhaps that husband was from Killeen or Temple, I can't quite remember. His questions was inspiring and had me thinking.  What is the difference between a midwife and a doula? 

 

The midwife is the guardian of a safe happy home birth.  A midwife isn't magic and can't change karma. She can't eat for you.  She can't  exercise for you.  She can't change your behaviour. She can't even get in your mind and change how you feel about your birth. But she can walk beside you and help you create your healthy birth experience. She can offer healthy choices for your particular circumstances. It's up to you to follow through.

 

If you aren't healthy, or if your baby is born with issues that require hospitalization...then the home birth experience might not be the best outcome.  That is what the midwife seeks to avoid, a bad outcome. A doula doesn't have that knowlege.   

 

Your midwife is walking beside, guiding you on healthy choices.  For example-  The placenta delivers oxygen and nutrients to your baby.  Where do these nutrients come from?  For good oxygen exchange between you and your womb, it requires iron rich blood.  Iron creates the hemoglobin that carries the oxygen molecules to your baby.  Hence why the midwife offers the testing of your hemeglobin and hematocrit and may suggest iron rich foods, or even iron pills. For a healthy oxygen echange.  A doula supports that, but it is not her primary role.

 

Placenta's require protein, antioxidants, and various vitamins for health.  For instance, the placenta is mostly vascular.  Baby's blood vessels form a beautiful tree that intersperse through the protein material interacting with layers of tissue.  Collagen and vitamin C make up strong healthy membranes  to prevent premature rupture of the membranes.  Bioflavanoids and vitamin C make for strong healthy blood vessels for the baby.  

 

A strong healthy placenta makes for a healthy growing baby.  The goal is a strong heart beat in labor. No fetal distress.   And there fore no transport.

 

But, your midwife can't eat for you.  All she can do is guide you to healthy choices. She has to guide you into changing habits. Prenatal care is about choices, and a healthy life style.  It's also about developing trust in the birthing process and trust in the one holding the space for you during labor.

 

As a woman lives, so shall she give birth.  If there are issues in the marriage, if your husband isn't as supportive as you wished he was, or if he is having an affair, this adds up to a long hard labor.  Many women don't want to talk about these issues, but they are important to talk about before the birth.  Or if you had an epidural with your first birth, and "it didn't take well"... the midwife encourages you to prepare for the sensations of birth which can be very intense, maybe even painful. So the midwife is like a counselor all the while assessing your health because after all we want a beautiful, easy, healthy birth for mother and baby.  This is why prenatal visits last about an hour.

 

This all weighs heavily on the midwife.  Each woman is going to have a unique experience. The midwife keeps guiding you toward health. 

 

During birth, the midwife's primary responsibility is the health and safety of mother and baby.

We listen before during and after two contractions to be sure baby's heart beat is strong and healthy duriing the "stressful" part of labor i.e.the contraction.  We listen for the pattern of the FHR.  Does baby move and the heart rate raise 15 or more beats.  That tells the midwife that baby is well oxygenated in this moment.  In otherwords, the midwife has specialized knowlege that she is using to assess mother's health and that of baby through out the birth.  That is a knowlege the doula does not have.  The doula is working toward a comforable, beautiful birth, but she doesn't have the health knowlege the midwife has.  In partnership a doula and midwife meet all of a woman's needs in labor along with her partner whom whe loves. 

 

The midwife uses her knowlege to prevent tears of the perineum during the birth process, or to sew them up.  Yes, your husband can catch your baby, but he doesn't know how to prevent tearing. In otherwords the midwife does everything to help mother be happy, to heal well, initiate a good breastfeeding relationship... and she continues that guardianship into the post partum for the next few weeks. 

 

The doula is a great adjunct. The doula is supportive. She offers emotional and physical support that is always available to mom.  I used to believe that I was a good doula and a good midwife.  However, while rubbing  mom's back, I  would  get interrupted to listen to baby's heart beat or give a homeopathic remedy.  I couldn't do everything. When I worked in the hospital as midwife, I could doula really well, because the nurses were monitoring baby... or there was continuous monitoring and I could continously hear the baby's heart beat while I rubbed a back or gave a reiki energy session. But, at home, that is not the case.

 

That very mistaken dad has no idea that the role of the midwife and the role of the doula are not interchangeable. The doula is there for mom's and dad's physical comfort, because birth is NOT  always easy.  Dads work hard too at comforting mom.  Birth is a beautiful, intense moment of greeting a brand new baby who is transitioning from breathing through a placenta to breathing air. The midwife is there for medical and health reasons so that birth is healthy.  The midwife is watching for medical issues in both mother and baby in the first few post partum days. A midwife is trying to prevent or treat any excessive bleeding in mome if it happens. The midwife is the guardian on so many levels.

 

 

The midwife's goal is something Reba Rubin coined back in the 1950's:  " Safe Passage"  for mother and baby while supporting a joyous beautiful birthing.  

 

Yours in wonderful waiting....

 

Sandra Tallbear  2/7/2018

nt.

 

 

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