|August 28, 2013|
Volume 15, Issue 18
|Midwifery Today E-News|
“Group B Streptococcus (GBS)”
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In This Week’s Issue
Waterbirth is a way for a woman to give birth undisturbed and in dignity. It also has medical advantages for mother and child and can be helpful in the case of breech, OP or twin births. In this class, Cornelia Enning will explore the many benefits and ways of using water in birth and will discuss its unique psychological and physical properties. [photo by Cornelia Enning]
Come to our conference in Harrisburg, Pennsylvania, next April. You’ll meet midwives from around the world while attending classes with teachers such as Gail Tully, Sister MorningStar, Elaine Stillerman, Jeanne Ohm and Carol Gautschi. To receive a printed program by mail when it becomes available, please e-mail firstname.lastname@example.org with your name and postal address.
When faced with bullying, I advise women to say: “Excuse me, but I do not have to do anything. This is my body and my baby and I am the one who decides what I will do. I am paying you to give me the benefit of your advice; whether or not I take it is entirely up to me.”
— Beverley Beech
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I handle group B streptococcus by giving women information on it regarding the risks, treatment, etc., and leave it up to them whether to culture or not. If they choose to culture, I do it at about 35 weeks. If the culture is positive, I give them the choice of herbal protocol and reculturing in two weeks to make sure the herbs worked. Or they can take antibiotics orally when labor starts.
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.
Send submissions, inquiries, and responses to newsletter items to: firstname.lastname@example.org.
Lawyers on Our Side
Midwifery is often at an unfair disadvantage with the law. What I mean is that there are times when, in spite of any birth professional’s best effort, applied skills and care, a baby dies. If that happens at a homebirth, the midwife is often blamed, and punitive legal proceedings unfold. Doctors in hospitals do not face comparable scrutiny following a bad outcome, even though babies and mothers regularly die in the hospital from iatrogenic causes. (See the next issue of Midwifery Today magazine for a scathing account by Ina May Gaskin of the misuse of Cytotec.) The overuse and unnecessary use of Cytotec, inductions, augmentation and other generally inappropriate uses of medical technology cause many problems to mothers and babies. Mothers and midwives are caught in a web of harmful obstetric practices and unjust legal treatment.
We now have help. The joint Midwifery Today/Human Rights in Childbirth conference of April 2, 2013, convened an international coalition of lawyers working for justice in maternity care. The lawyers present at that event included members of Human Rights in Childbirth International, members of the US think tank Legal Advocates for Birth Options and Rights (LABOR), BirthrightsUK, National Advocates for Pregnant Women and individual attorneys who are dedicated to human rights in childbirth.
Since the conference in April, the work of Human Rights in Childbirth (HRiC) network has crystallized. HRiC is a Hague-based organization working to connect and facilitate political activism and legal advocacy for human rights in maternity care the world over, directed by Hermine Hayes-Klein, a US-based lawyer. The US Legal Advocacy Network for Human Rights in Childbirth is a partner organization providing US-based advocacy in matters ranging from the criminal defense of midwives to the lack of informed consent given to women for their birth choices and is directed by Indra Lusero. HRiC Legal Advocacy Networks are also coming into shape in the UK, Ireland, EU and Australia; more are underway.
HRiC is again partnering with Midwifery Today for a one-day summit in Blankenberge, Belgium, on November 4, 2013, the day after the conclusion of our annual conference there. This event will continue to grow the HRiC Legal Advocacy Network by convening the lawyers, mothers and midwives across Europe who are involved in legal actions advocating for the human rights of birthing women.
The persecution of midwives has been going on for decades, if not centuries. For the first time, we have the help of dedicated lawyers on our side. Hermine and the lawyers working with HRiC declare that all birthing women share fundamental human rights to autonomy and authority in childbirth, including the right to choose the circumstances in which they give birth. This fact is one that we acknowledged in the wording of the Human Rights Declaration of the Global Midwifery Council written in Russia in 2010: “The most basic human right for every woman is the right to choose her place of birth and who will attend her.”
The battles waged for control of the maternity care market often have legal significance. Those of us who seek to ensure that birthing women have real options in childbirth need legal advocates who understand the issues and are ready to stand up against perverse market forces and entrenched systems. You can join Midwifery Today in supporting the efforts of HRiC to provide such advocacy by registering for our joint conference on November 4. You can also support HRiC directly at Human Rights in Childbirth and on Facebook at facebook.com/HumanRightsInChildbirth.
Jan Tritten, mother of Midwifery Today
Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.
Jan on Twitter: https://twitter.com/jantritten
GBS, Pregnancy and Garlic: Be Part of the Solution
Group B streptococcus (GBS) has not always been the household name it is today. GBS was proven to be the cause of serious newborn infection only 35 years ago. In 1996 the Centers for Disease Control (CDC) came out with its first protocols to lower the rate of GBS infection in newborns. In 2002 those protocols were changed, as more research has shown that half the 1996 protocols were wrong. In another five years, the field of GBS may change again. In any case, intrapartum antibiotic use is a temporary strategy until a vaccine is tested and proven to work.
The CDC protocols are intended to decrease the incidence of early onset GBS disease. Early onset means that the baby gets GBS infection during the first week of life. Recent data show that in over 90% of infants who get early GBS infections, symptoms occur within the first 24 hours of life. Use of IV antibiotics in labor has resulted in a decrease in early onset GBS disease, but it has not and most likely will not prevent GBS-stillbirths, prematurity or late onset neonatal infections.
Insufficient research exists to suggest a course of management for preterm labor, i.e., labor starting before completion of 37 weeks (three weeks before the due date). Current management of premature labor is based not on research but largely on “expert opinions” of individual physicians or institutions.(1) It is usually suggested that if a GBS culture has not been done in the current pregnancy and there is a considerable probability of preterm delivery, antibiotics should be given to lower the risk of GBS infection until culture results are returned from the lab. If a negative culture result within the previous four weeks is on record, or if the clinician determines that labor can be successfully arrested and preterm delivery averted, antibiotics for GBS prophylaxis should not be initiated. Recent clinical trials suggest that antibiotic administration during pregnancy may be associated with adverse neonatal outcomes, such as necrotizing enterocolitis (a serious infectious disease caused by bacteria, marked by fever and ulcerative inflammation of the large and small intestines) and fetal death.(1) Antibiotics should be reserved for instances in which labor is likely to lead to delivery.
No research has been done yet that can recommend a specific dosage or duration of antibiotics for GBS-positive women with threatened preterm delivery. With no data, management is left up to the discretion of the individual provider. It has been established that recto-vaginal cultures for GBS are only predictive if the cultures are collected within four to five weeks of delivery. Therefore, if the woman is screened for GBS because of threatened preterm delivery but does not deliver within four weeks, she should be cultured again for GBS every four to five weeks and managed according to the last culture.
At the time of the 1996 CDC recommendations it was thought that if a woman cultured positive for GBS, she would always culture positive and should be treated thus. This has now been disproven by research. A culture from a previous pregnancy is not applicable to the next or any other pregnancy. The culture is only accurate for a few weeks. GBS comes and goes, depending on the microbiological conditions, such as availability of nutrients and competition from other families of bacteria. All women should be cultured as close to delivery as possible.
Read this article excerpt from Midwifery Today magazine recently posted to our website:
Q: What are your experiences with GBS or your ideas about it?
— Midwifery Today
A: I can tell you that, as a midwife working in an illegal state, GBS is one of the most difficult issues to deal with.
— Amy Miceli
A: Here in Italy, GBS is a big issue. The hospitals screen for it, but at home we give the possibility to follow UK guidelines: no tampons and look for risk factors. Even though homebirths are legal, it is difficult to find a doctor who allows midwives to use antibiotics during labour.
— Maria Dalle Pezze
A: As midwives, we need to bring awareness to prevention! Have our ladies eat foods high in probiotics, especially in the last trimester. The colon needs to be saturated with flora that prevents this bacteria’s proliferation. Kefir has more and different probiotics than yogurt, but both are good to use.
— Carol Gautschi
A: I have my mamas eating fermented foods. Since I have been doing this, I have a much, much lower rate of GBS. There is a great cook book that just came out with fantastic recipes for fermented foods. Many of my families are using this book: The Essential Book of Fermentation by Jeff Cox.
— Susanna Napierala
[Editor’s note: Look for more of the answers to this question in Issue 108 of Midwifery Today magazine this winter.]
Book Your Room for Belgium!
The Blankenberge, Belgium, conference is now only a couple of months away! We’re getting excited for it and we hope you are, too. If you’re planning on going, have you booked your hotel yet? Well, this is just a reminder that now is the time!
The lovely Duinse Polders, the site of our conference in Belgium, is holding a block of rooms for attendees, but only until August 31. After that, the rooms in this sought-after vacation spot right by the Belgium coast will go like hot cakes! Be sure to book now to ensure you’ll have a wonderful, cozy place to stay while you attend the conference. And remember, delicious gourmet meals are included in the price, so it’s a great deal.
You’ll find more information on booking a hotel room here.
If you have any questions about this conference or any conference, past or future, please feel free to drop me a note at email@example.com and I’ll be happy to assist you.
— Andrea Goldman, conference coordinator
I was a doula for a momma once whose gown kept slipping off her shoulders—it was irritating the heck out of her. I said, “You can take that thing off, ya know.” So she peeled it off and was using the squat bar totally naked when the doc walked in and he said, “Oh! I’ve never seen that before!” (What?! He’s an OB for cryin’ out loud!)
— Jane Crouch
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