Q & A: Group Beta Strep (Part 2 of 2)

So, you have GBS, along with 30-50% of other women (rates vary around the country, it seems to me about half my clients have had it). You of course have the option of getting IV antibiotics if you so choose, but only if you are having your baby in a hospital. (Side note: If you are giving birth in a hospital, and are GBS positive or GBS status unknown, ask your provider if not getting antibiotics is even an option. It has been my experience that most hospitals have a very strict policy of requiring the IV antibiotics, or rather, their malpractice insurance companies do. But that is a whole other topic.)

If you choose to give birth at home or a birth center, you will not have the option of IV antibiotics. Your options are:

1. Other forms of antibiotics: If you have read the literature and decided that you want antibiotics, you can have your doctor prescribe oral antibiotics that you would start taking at about 37 weeks. You can also get an IM dose (an IntraMuscular injection), which is effective for 10 days and then must be repeated. The effectiveness of these treatments have not been evaluated. Some of the severe risks of the IV antibiotics are lessened, but the more commonplace problems (vaginal yeast infections, thrush leading to breastfeeding problems) still exist.

2. Hibiclense douche: This is the standard of care for GBS treatment in many European countries (that have infant mortality rates better than ours). At the beginning of labor, you douche with chlorhexidine gluconate (brand name: Hibiclense). This product is available over the counter at the drugstore. For more info, read this study from Norway's Aker Hospital, or this study from Italy that found it to be equally effective as IV antibiotics! Of course, not all the studies showed it to be as effective.

3. Herbal Treatments: These vary far and wide; I have heard great success stories from using herbal vaginal suppositories, but have not personally had great success with this treatment. It's not that I believe they aren't working for others, I just don't think they are all created equal, and I haven't found the right one. (If you have, let me know!) I think the problem is that the vaginal suppositories need to have boric acid in them to be effective - and boric acid burns, so many don't include that ingredient anymore. What I have seen is a reduction in the colony level (ie: bacteria still there, but less of `um) from herbal treatments, which is a good thing. If you want to try these herbal treatments you can do at home, they likely won't completely rid you of GBS, but they will generally improve your immunity and perhaps lower the number of bacteria. (Of course, talk to your care provider first.)

4. Risk Factor based care: If you develop a risk factor, you transfer care to the hospital and get IV antibiotics. If you don't develop any risk factors, you proceed with your out-of-hospital birth.

5. Watching and waiting: Proceed with out-of-hospital birth, and if the baby shows signs of infection, admit the baby immediately for early treatment. Many GBS cases can be treated if caught early, but not all can be caught and treated in time.

All births, regardless of GBS status or choice of birthplace, carry some risk. Risks can never be eliminated - it is simply a matter of choosing which risks you feel most comfortable with.

Q & A: Group Beta Strep (GBS) - Part 1 of 2

Question: I had a question about home birth. My husband and I are considering home birth for our next child. My last pregnancy I had tested positive for Group b strep. I was wanting to know how safe it is to give birth
at home being a carrier of this? I was also curious of how commom this
is and the dangers that may come from the baby contracting this from
me? Thank you, Angela

Answer: First, let's start with a brief history of medicine and how progress is made. 1. We realize something bad is happening. 2. We try to find a way to prevent it from happening or cure it once it happens, usually with a lot of trial and error. Eventually, we find a way to prevent or cure. 3. If it's a prevention, we often start applying that prevention to everyone. (After all, if we can stop something bad from happening, why wouldn't we?) 4. We evaluate the prevention technique: Is it working? It is causing other problems?

Now, let's apply that to GBS:

Step 1: Out of every 10,000 babies, 2 are so severly ill that they often die from an infection found to be caused by Group Beta Strep.

Step 2: The source of this infection was from the mothers - depending on the area of the country you live in, between 25% and 50% of women have this bacteria present in their vaginas. Aside from an occasional urinary tract infection, the bacteria presents no problem in the mothers. It is not an STD, it is just part of what is normal flora for that woman. But sometimes this bacteria is passed on to the babies. And of those babies, every once in a while, one gets sick. And a baby who is sick from GBS is REALLY sick.

Step 3: In the 1990's, doctors in the US started administering IV antibiotics during labor to all women who were found to have GBS present in their vaginas during the third trimester.

Step 4: According to the CDC, for every 2 babies we are saving from a death due to GBS, we are running the risk of killing one mother. We are also exposing 25% to 50% of all babies born to antibiotics they likely don't need. This is contributing to the widespread problem of antibiotic resistant infection.

So, what are the alternatives? I'll tell you on Monday!

Morning Sickness: Pills, Pills, Pills

When you've tried all the easy fixes, it might be time to start popping some pills. These fall into 3 catagoris: Vitamins, OTC Meds, and prescriptions.

Whatever catagory you try next, the same principal applies: Use the smallest dose you can to elicit the desired response. Start with a quarter of the recommended dose - if that works, try an eigth the next day. If it doesn't work, try half the recommended dose. Each day, if it works, try half the amount the next day; if it doesn't work, try double the amount the next day, until you reach the recommended dose. Do not, of course, exceed the recommended dose without consulting your healthcare provider.

Vitamin B6 (pyridoxine): Recommended dose is 10-25mg, 3 times per day.
Vitamin 12: Injections from an N.D. or M.D., once weekly.
Vitamin K and Vitamin C: There is a "study done my midwives in the UK" that I've heard a lot about, but I have searched and searched and never found the actual study. If anyone can send me a link to it, please do! The study is famed to be based on 5 mg per day of Vitamin K and 25 mg per day of Vitamin C. However, that is an extraordinary amount of Vitamin K to be taking daily, and a wimpy amount of Vitamin C. My friend Karli found results with 100mcg of Vit K per day - which is equal to only 0.1 mg! If you want to try this, I would recommend starting with 100 mcg/day of Vitamin K and 500 mg per day of Vitamin C.

Unisom TABLETS (doxylamine): Recommended dosage is 25 mg per day, but I have seen as little as a quarter tablet work. Best results are when used in conjunction with Vitamin B6. This is available at any drugstore.

Presciption medications: If you've tried everything else, it may be time to move to the hard stuff. The most common presciption drug is called Phenergan (promethazine), which is an anti-histamine that also works well for nausea. I have seen one baby who had seizures (that were annoying and frightening but not dangerous), and the mother thinks it was from the Phenergan she took in early pregnancy, but we don't know. No major infant problems have been attributed to it's use; but mothers often find themselves so drowsy from it that all they can do is sleep. For a complete list of available presciption drugs, their side effects, etc., click here. For an article that remembers the thalidomide babies, click here. In the end, no one really knows the risks of most medications in pregnancy. You must balance for yourself the potential risks versus the reality of a mother who can't keep food down. To be a mother is to make the best choices you can with the information you have, and without the benefit of knowing what the future will hold.

Morning Sickness: The Easy Fixes

Despite the benefits of morning sickness (see below), most women say they want it gone. Actually, they rarely tell me they want it gone...it's usually more of a cry, plead, whine, beg, or frustrated shout.

Remedies abound, but different ones work for different women and for different pregnancies. I always advise women to start with the ones that have no adverse side effects (or even beneficial side effects), and go from there. The other end of spectrum is using prescription anti-nausea drugs, which for some women do become necessary.

Try these things first:
1. Eat small, frequent meals. Never go more than two hours without having a bite of something.
2. When you go to bed at night, leave crackers or nuts on your nightstand. Set your alarm for an hour before you need to get up. Eat a few bites, go back to sleep. When you awake, your stomach won't be empty.
3. Stop taking your prenatal vitamins, especially if they are high in iron. You can start again when you have your morning sickness under control. Your baby will be fine in the meantime.
4. Click on this checklist of things to try for morning sickness. Print it out and check the remedies off as you try them...you may be surprised at what works!
5. Try herbal teas: red raspberry leaf (make sure you are not buying raspberry flavored tea), nettle, peppermint, and ginger teas all can be effective on morning sickness. In a clinical trial published in the medical journal Obstetrics and Gynecology, ginger was found to be very effective. Red Raspberry Leaf, Woman To Be, Pregnancy Tea, and Ginger tea can be found at local health food stores, the nutrition center at Fred Meyer's, or online at this website. Nettle tea is harder to come by, but has the "side effects" of being high in iron and one of the best herbs there are for pregnancy. It is easiest to buy in bulk at Limbo.

And if these things don't work? Part 3 will have Pills, Pills, Pills.

Morning Sickness? It's so GOOD for you!

No one likes vomiting. And really, nothing will change that - but understanding the reasons why it is a good thing can make those urgent trips to worship to the porcelin goddess a bit more sensible.

The Good:
1. In a not-so-recent, but very good, study, Cornell University researchers found that morning sickness is nature's way of protecting the baby.
2. Morning sickness indicates high hCG (IE: main early pregnancy hormone) levels, which means you are less likely to miscarriage.
3. It will pass: By 12 weeks, most women find their symptoms decreasing in frequency and intensity. By 16-18 weeks, very few women have any symptoms left at all. (Those who do may have a condition called hyperemesis gravidarum.)

"Great," you say, "so it's good for me. But I want it GONE."

For that, stay turned tomorrow for Part 2...

Welcome!

Why the move from OregonLive? OregonLive really wants at least 4 posts a week, if not more. My schedule just doesn't accommodate that. They have been very nice about letting me get away with less - often WAY less - but it isn't really how they want things. Why now? OregonLive was switching their blog software, and it would be a lot of effort on both their part and mine to switch my database over. I figured I might as well just switch it elsewhere, since that would probably be happening someday anyway.