Group B Strep in Pregnancy

Group B Strep (GBS) in Pregnancy

Pregnancy is a time of anticipation and preparation, but it's also a period when healthcare considerations are of utmost importance. Group B Streptococcus (GBS) is a common bacterium that can affect pregnant individuals and their newborns. In this blog post, we'll delve into the significance of GBS testing during pregnancy, the standard treatments available, potential complications for newborns, and the implications of GBS disease.

The Importance of Testing

Group B Streptococcus is a naturally occurring bacterium that can be present in the genital or gastrointestinal tracts of adults. While it doesn't usually cause problems in healthy adults, it can pose a risk to newborns during childbirth. GBS testing during pregnancy, typically conducted between weeks 35 and 37, helps identify whether the bacterium is present in the mother's body. This information is crucial in determining the best course of action to prevent its transmission to the newborn.

Standard Treatments and Interventions

Intravenous Antibiotics During Labor: If GBS is detected, the standard approach is to administer intravenous antibiotics to the pregnant individual during labor. This treatment helps prevent the transmission of GBS to the baby during birth.

Risk Factors and Considerations: The decision to administer antibiotics also takes into account risk factors, such as preterm labor, prolonged rupture of membranes, and fever during labor.

Possible Complications for the Newborn

GBS infection in newborns can lead to serious health complications, including:

Early-Onset GBS Disease: This occurs within the first week of life and can lead to sepsis, pneumonia, and other life-threatening conditions.

Late-Onset GBS Disease: This occurs between the first week and the third month of life and might result in sepsis, meningitis, and related complications.

Signs and Symptoms: Newborns with GBS disease might exhibit symptoms such as fever, difficulty feeding, breathing problems, and lethargy.

GBS Disease and its Implications

While GBS disease in newborns is relatively rare thanks to effective testing and preventive measures, it underscores the importance of early detection and treatment. Left untreated, GBS infection can lead to severe health consequences, making timely testing and administration of antibiotics during labor vital.

Group B Streptococcus is a prime example of the critical role that prenatal testing plays in ensuring the well-being of both pregnant individuals and their newborns. Testing for GBS during pregnancy, along with standard antibiotic treatments during labor when necessary, can significantly reduce the risk of GBS transmission and associated complications in newborns. By staying informed, seeking regular prenatal care, and discussing GBS testing with your healthcare provider, you're taking proactive steps to ensure a healthy start for both you and your baby.

Empowering Your Birth Experience: How Home Birth Midwives Can Make a Difference

Empowering Your Birth Experience: How Midwives Can Make a Difference

Bringing a new life into the world is a transformative journey that holds immense significance for expectant parents. As the birthing landscape evolves, more individuals are seeking ways to take control of their birth experiences, embracing options that align with their values and desires. Midwives have emerged as key figures in this movement, offering a unique approach to childbirth that empowers parents and celebrates the natural process of bringing a child into the world. Let’s explore how home birth midwives can make a profound difference in empowering your birth experience.

Personalized Care and Relationship Building

Home birth midwives prioritize building strong relationships with their clients, cultivating an environment of trust, comfort, and respect. Unlike the often impersonal setting of a hospital, midwives take the time to understand your personal preferences, concerns, and aspirations for your birth journey. This personalized approach ensures that you are an active participant in every decision, fostering a deep sense of empowerment.

Education and Informed Choices

One of the remarkable aspects of home birth midwives is their commitment to education. Throughout your prenatal care, midwives provide comprehensive information about various birthing options, potential interventions, and the natural progression of labor. Armed with this knowledge, you are empowered to make informed choices that resonate with your values and wishes. This educational aspect of midwifery care enables you to approach childbirth with confidence and a clear understanding of what to expect.

Honoring the Natural Process

Home birth midwives have a profound respect for the natural process of childbirth. They believe that birth is not just a medical event but a deeply transformative and emotional experience. Midwives work with your body's innate wisdom, allowing labor to unfold naturally whenever possible. This approach minimizes unnecessary interventions and medical procedures, allowing you to embrace the innate strength and capability of your body.

Creating a Supportive Environment

The familiar surroundings of your own home can significantly contribute to a positive birth experience. Home birth midwives curate a calming and supportive environment that promotes relaxation and confidence. You have the freedom to move, eat, and labor in ways that feel most comfortable to you, enhancing the natural progression of labor. Additionally, having your loved ones close by can provide invaluable emotional support, further enriching the experience.

Empowerment Through Active Participation

Home birth midwives encourage active participation in the birthing process. They guide you through the stages of labor, offering encouragement, comfort measures, and various positions that can facilitate labor progression. This hands-on approach empowers you to be an integral part of your birth story, creating a lasting sense of accomplishment and pride.

The role of home birth midwives goes far beyond providing medical care; they are champions of empowerment, education, and holistic experiences. By choosing a home birth attended by a skilled midwife, you are embracing an approach that values your unique needs and desires, while celebrating the beauty of childbirth. The empowerment you gain from actively participating in your birth journey, supported by the expertise of a midwife, can set the tone for your parenting journey ahead. As this trend continues to grow, more individuals are discovering the transformative impact that home birth midwives can have on the sacred journey of bringing new life into the world.

BRAINED: Decision Making for Labor (and Life)

Labor can be an intense, stressful time. Many people go into the birth process with a "birth plan," or a list of ideals they wish to stick to. These are often well researched ideas the family is comfortable with. But what happens when suddenly your doctor comes in and says those ideas need to change? Whether the doctor suggests additional interventions or even talks about changing the type of delivery, sometimes births do not go as planned. How can you make such a potentially huge decision during a high-stress, vulnerable time? 

We like to use the BRAINED pneumonic to talk through these situations. It can be helpful to have a neutral third party (like a doula) to help walk through these steps, but it can be a handy tool for anyone to use for any decision.

So what is BRAINED?

B: Benefits

What are the benefits of the suggested choice? Are there more benefits than there would be with the current plan? Are the potential benefits worth changing plans?

R: Risks

What are the risks of the suggested choice? Does the risk level increase or decrease with the new choice? Do the benefits outweigh the risks? How severe are the potential risks?

A: Alternatives

Are there any other alternatives to consider? What are the alternatives? How do the alternatives compare to the current options?

I: Intuition

What does your gut feeling say? Intuition can be a powerful thing, and it is there for a reason.

N: Nothing

What happens if we decide to do nothing or stick with the original plan?

E: Evaluate

Evaluate these considerations as well as any other questions you have.

D: Decide

Decide what is the best option for you.

The BRAINED tool is most often used for labor decisions, but it's also great for really any life choice. Using this tool helps prevent making quick, emotional decisions by breaking down different considerations logically. 

Labor Inductions: What to Expect

Your doctor may recommend scheduling an induction of labor for many reasons. For some this can be a welcome suggestion; you get to know more definitively when you will meet your new baby! For others, induction can be a scary or unwanted option. No matter how you come to the decision to induce, there are a few things to consider.

1. Methods of induction

There is no one-size-fits-all approach to induction. Multiple different methods may be used based on your personal history, any medical concerns, and your doctor's preference. There can be pros and cons for each method, so it can be helpful to talk through your options in advance with your doctor. Here are some of the most common methods:

Pitocin
Pitocin is the synthetic form of the hormone Oxytocin, which helps trigger contractions during spontaneous labor. Pitocin is given through an IV line in labor, and the hospital staff may adjust the dose as needed throughout the induction. Sometimes Pitocin can cause contractions longer and stronger than spontaneous contractions would be, but it is often an effective method of induction. 

Cervidil
Cervidil is a medication that helps soften the cervix. This preparatory softening can help stronger induction medications be more productive, so many doctors will recommend Cervidil overnight the night before an induction is officially set to start. Cervidil is applied right by the cervix on a cloth tape and can be left in for many hours. Many people find this no more uncomfortable than a regular cervical check. One of the good things about Cervidil is that if the contractions are too strong or if there is a problem, the tape can be removed, limiting further effects. 

Cytotec/Misoprostil
Cytotec is a brand name of the drug Misoprostil. This medication can help soften the cervix and bring contractions, so it is often used during labor inductions. Use for inductions is actually an off-label use not recommended by the FDA, but it is often very effective. Cytotec is packaged in tablets that can be given multiple ways, but it is most often placed internally by the cervix for induction. Although it is effective, Cytotec can be a bit controversial when used for labor induction since it can produce contractions so long and strong that baby becomes distressed. Unlike Cervedil or Pitocin, Cytotec cannot just be removed or turned off if there are complications; once it has dissolved, it's gone. 

Foley Bulb/Cook Catheter
Foley Bulb Catheters and Cook Catheters are very similar options that both function the same way. Both of these options can be used to manually dilate the cervix without the use of medications. These work like balloons; a long balloon-like tube is inserted into the tip of the cervix. Saline is then used to inflate the end, which begins to wedge open the cervix. You do need to be at least 1cm. dilated for this to work, and it may not work for everyone if your cervix isn't ready. The level of discomfort this procedure causes varies person to person, but it may not be comfortable to have the cervix physically stretched. Some providers will require the patient to remain in hospital once a bulb is placed. Others will place the bulb and ask the patient to come back when it falls out, which would mean they should be 3-5cm dilated. If there are problems, the bulb can be deflated and removed quickly and easily. 

Homeopathy and Natural Induction Methods
Homeopathic remedies and herbs are not frequently recommended by OB/GYNs, but they may be a good option for some. There are multiple homeopathic remedies that may be effective to nudge someone into labor. As with any other intervention, we always recommend you speak with your doctor or midwife about what options may be best for you. 

Acupuncture is a centuries-old practice that may be used to start labor. There are specific pressure points a knowledgeable acupuncturist may use if the goal is induction, although it may not work for everyone. Sometimes multiple treatments are needed, but acupuncture can be a good option to try if one wishes to avoid a more medicalized induction. 

Chiropractic care from a Webster-certified provider does not directly start labor, but it can help align the pelvis properly so that baby can find the best position. Sometimes labor doesn't start because a misalignment doesn't allow baby to drop or sit properly; a good adjustment may help with that. 

Breast pump and/or nipple stimulation can be used to naturally produce oxytocin that may trigger contractions. It can be possible to overstimulate the uterus if this is done too frequently, so it is often recommended to stop the stimulation once contractions are established. As with anything else, it's best to check with your provider if there are concerns. 

2. What are the chances an induction will be successful?

The Bishop score is a test that looks at multiple aspects of your history to estimate if an induction would be successful. This scoring system looks at cervical position, cervical consistency (softness), cervical dilation, cervical effacement (thinning), and fetal station (how high baby is in the pelvis). These aspects are rated on a scale of 0-3, and a score of 8 or above is believed to mean that either the body will begin labor spontaneously or that an induction would be successful. Low scores often correlate with unsuccessful inductions, and the doctor may move to recommending a Cesarean birth. 

3. We've started an induction; now what?

There is no hard and fast rule about how an induction will proceed. A lot depends on how ready your body was at the beginning. For some people, a little nudge is all that's needed to push them into full blown labor. For others, the body needs a bit more coaxing, and the induction may take a bit more time. Sometimes an induction can be a lengthy process; some inductions may actually take multiple days. 

It's normal to not feel much at the beginning; depending on your personal tolerance, it can take hours for the medications used to produce uncomfortable contractions. If this is true for you, that can be a good time to rest while you can. Inductions can become very intense suddenly, so taking every chance you have to just rest and take it easy can pay off in the long run. 

Once contractions are strongly established, some providers will lower or disconnect the medications. Often the body will take over and continue contractions. Others may leave the meds running throughout to make sure contractions stay strong. If you would wish to cut the medications as soon as contractions are established, we recommend you discuss this possibility with your provider in advance. 

4. Can a doula help in an induced birth?

Yes! Doulas can be wonderful support for any type of birth, including inductions. Our support in an induction changes very little and is tailored to each client. Often, we accompany you as you get settled in to start the induction. Some clients then choose to send us home until things ramp up, but that is totally up to the client. We can stay with you, or we can return whenever you're ready. From there the support is the same as any other birth; we can help with comfort measures, talking through upcoming options, and whatever else you most need. 

Throughout the whole process of induction, communication with your provider is important. A birth plan can be a great way to go over your thoughts with your provider, but it is always important to remember that nothing with labor is ever set in stone. 

If you would like to meet to discuss how we can support you through your upcoming birth, please let us know! We'd be happy to schedule a consultation or a phone call to answer all of your questions. 

Affording a Doula

Having personal, in-person doula support through your labor is an investment, and people may be surprised at cost of hiring a doula. The prices doulas charge varies widely, often anywhere from $350 to $1,200 or more. With such a wide range of prices, many families may feel that they cannot afford a doula. While the total cost might seem daunting, there is a variety of creative options you may be able to draw from to cover the fee. 

We rarely hear anyone say they regret hiring a doula, but so often we hear from many who regret not hiring one. Your baby will only have one birth; while costs are eventually forgotten you will always remember if you felt supported through that experience.

Before we talk about how to pay for a doula, I think it is also important to think about what that fee really covers. Every doula should be able to clearly lay out how many meetings and what labor support is included in their cost. Beyond that, there are still multiple other commitments a doula makes to support you. 

1. Accepting a client means that your doula is willing to be on-call 24/7 in the weeks around your due date. This means that your doula will drop everything, day or night, at your call. This means that the doula will not go too far away and will keep their cell phone handy and audible at all times. If the doula has children, this also means that they will have a solid plan for childcare for any time you go into labor. This can mean that the doula may have to cancel their own appointments last minute or miss holidays and birthdays. 
2. Doulas are unregulated, so their training may vary. At Little Orchids, our standard is that every one of our doulas is certified or trained and working towards certification as a doula with their choice of professional doula organizations. These trainings, certification, and continuing education to maintain certification and remain up-to-date can all add costs for the doula. 
3. Your doula is agreeing to support you during your labor- no matter how long that takes. Whether your birth takes 2 hours or 30 hours, your doula is there. At Little Orchids, this is one reason we work in doula teams. If you do have a longer labor, your doula can bring in their doula partner when needed to make sure you have a fresh doula to continue supporting you.
4. In many (if not most) cases, your doula is self employed. This means that your doula pays taxes and fees associated with owning a business. 
5. The cost of fuel and car maintenance can be expensive, and doulas often have to travel frequently. Although driving to and from consultations, prenatal visits, births, and postpartum visits are  the travel time associated with initial consultations, prenatal and postpartum home visits are all included in the cost of doing business, these expenses do add up.
6. Being a doula can be a physically demanding profession. Your doula may miss nights of sleep and skip meals during births. Your doula may get physically exhausted from massaging, providing counter pressure, or otherwise supporting you for hours on end in whatever position is most comfortable for you. 
7. Your doula gains experience with each birth they attend. Working with different doctors and nurses and in different hospitals and birth locations gives your doula a unique perspective that allows her to understand current policies and options. 

So, how do you pay for these services?

For some families, payment is not an issue. That’s great! For others, it can be more difficult. If you do need a bit of a boost, here are a few ideas:

1. Payment Plans
   Many doulas accept payment plans, so ask if this is an option. Generally, the fee for your doula is not due all at once, and payments can be made over time. 
2. Baby Registry
   Did you know that many doulas offer gift cards or gift certificates? Add these to your shower registry to see if family and friends would like to help chip away the cost. 
3. Health Savings Accounts and Insurance
   While many health insurance companies do not directly cover doulas, it never hurts to ask. Your doula may be able to provide a superbill for support and any classes taken with which you can request at least partial reimbursement. 
   Some doulas are able to accept payment through HSA cards. If you already have funds set aside in one of these accounts, that may be a good option for some. 

In the end, doulas are human. If you have questions or concerns about the cost of services, please ask! Many doulas are able to work with customized payment plans, and some doulas may offer occasional discounts. While we do need to make doula-ing a sustainable way to support our families, most doulas are not in it purely for the money. We truly love what we do, and we want every family to be totally supported through their birth experiences. 

Fear and Birth

There are many fears associated with pregnancy and birth. One of the most common fears is the fear of pain. Will birth hurt? What happens if I can’t deal with the contractions? For some people this fear impacts their decision of where to give birth.

     To some, home birth sounds like a nice, peaceful plan. But there is no medical pain management available at home. Another common fear is the fear of messing up. There is a lot of responsibility needed to bring a new life into this world and raise him to adulthood. This can be a scary realization, and many parents initially feel self-doubt that they are worthy of this responsibility. It can take time for the parents to finally understand that they are exactly the parents this baby needs. The fear of changing plans is also a common fear. Mothers and partners can do everything in their power to plan and prepare for their birth. They can find the best provider, the best support, the most informative childbirth classes, and the safest car seat. They can have a birth plan describing in detail how exactly they expect labor to proceed. What happens when the baby becomes distressed and a Cesarean birth is necessary? What happens when the mother fatigues and is unable to continue with her plan? Sometimes plans need to change, and this can introduce some fear. Hopefully having the understanding that births cannot be completely planned out in advance can help ease some fear.

       Fear can have detrimental effects in labor. In some ways, labor requires the mother to let go, both mentally and physically. The mother must allow the body to take over and do what is needed to dilate and help get the baby out. Fear can block this necessary and instinctual action. Fear can cause the mother to experience “psychological dystocia” which is a term used when labor slows or is inhibited by a non-physical issue. Fear can cause the mother to clench and fight contractions, which can affect the speed and ease of dilation. Many mothers have reported that contractions are more painful if the mother tries to clench or fight them. Thankfully, women have multiple ways to deal with this fear response. Women can try meditation, breathing exercises, or having an Epidural as means to aid in relaxation.

          Fear does not only impact labor psychologically, but it can also affect the hormones of labor. Oxytocin, known as the love hormone, is the hormone that is needed for labor to progress. Oxytocin stimulates the uterus to contract. These contractions cause dilation, and they eventually help push the baby down and out. After the birth, these contractions help clamp the uterus and prevent hemorrhage. Oxytocin also helps initiate a type of natural pain relief as it blocks some of the pain signals during labor. Another hormone, Adrenaline, has more negative effects. Adrenaline is the stress hormone involved with the fight-or-flight response. Fear can trigger Adrenaline to be released during labor. Adrenaline does not help labor; Adrenaline inhibits the release of Oxytocin. This effect can slow or completely stop labor, which can necessitate the use of augmentation measures. This can also lead to longer labor.

         To some people, fear is a motivator to get an unpleasant task over with. But fear can impede and negatively impact labor. Babies are born every day, so try to push the nagging fears away!