March 5, 2003
Volume 5, Issue 5
Midwifery Today E-News
“Group B Strep”
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THIS WEEK’S ISSUE

Quote of the Week

"If you want to know what has gone wrong in obstetrics, read the pediatric journals."

Doris Haire, 1977


The Art of Midwifery

I use a children's fitted plastic sheet with elastic edges at homebirths. I find that at the last minute, the birthing woman may choose to deliver in a place that is not protected. Right before she delivers, I spread my fitted plastic sheet under the Chux pad, and it catches nearly all of the blood and water and makes cleanup a very easy task.

Judy

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 mtensubmit@midwiferytoday.com.


News Flashes

Simple maternal hydration can increase amniotic fluid volume, a study has shown. A search of the Cochrane Pregnancy and Childbirth Group Trials Register and the Cochrane Controlled Trials Register were searched to compare maternal hydration with no hydration in pregnant women with reduced or normal amniotic fluid volume. In two studies, 77 women were asked to drink two liters of water before having a repeat ultrasound examination. Maternal hydration in women with and without oligohydramnios was associated with an increase in amniotic volume (weighted mean difference for women with oligohydramnios 2.01, 95% confidence interval 1.43 to 2.56; and weighted mean difference for women with normal amniotic fluid volume 4.5, 95% confidence interval 2.92 to 6.08). Intravenous hypotonic hydration in women with oligohydramnios was associated with an increase in amniotic fluid volume (weighted mean difference 2.3, 95% confidence interval 1.36 to 3.24). Isotonic intravenous hydration had no measurable effect. Controlled trials are needed to assess the clinical benefits and possible risks of maternal hydration for specific clinical purposes.

- Cochrane Database Syst Rev. 2002;(1):CD000134

Treating Group B Streptococcus

Raw Garlic Kills Streptococcus
I suggest that someone research using raw garlic either orally or vaginally for a night or two to change the bacterial flora and eliminate Strep B before birth. Until such time that research is carried out regarding the treatment of Group B streptococcus (GBS), there is clear evidence that garlic definitely kills strep. It is not harmful, so it may help decrease the incidence of GBS-positive test results before birth.

submitted by Judy Slone

Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi 1985 Aug;18(3):190-5

Antibacterial properties of some spice plants before and after heat treatment [Article in Chinese]

Chen HC, Chang MD, Chang TJ.

This study was carried out to understand the antibacterial properties of some spice plants before and after heat treatment in boiling water. The samples included the core and the outer layers of onion, the white and the green parts of green onion, garlic bulb, ginger, ginger root, sweet pepper, chili pepper, brown pepper, and mustard. The test microorganisms included Escherichia coli, Salmonella typhimurium, Vibrio parahaemolyticus, Pseudomonas aeruginosa, Proteus vulgaris, Staphylococcus aureus, Mycobacterium phlei, Streptococcus faecalis, Bacillus cereus, and Micrococcus luteus.

Raw garlic bulb could inhibit all of the test strains. The antibacterial activities of green onion are slightly weaker than that of onion. However, green onion could inhibit P. aeruginosa and M. luteus, but onion could inhibit E. coli, P. vulgaris, S. faecalis, and B. cereus. Ginger and ginger root could only inhibit M. luteus. Chili pepper could inhibit V. parahaemolyticus and P. vulgaris. Brown pepper could also inhibit P. vulgaris. Sweet pepper and mustard showed no antibacterial activity toward any of the test strains.

In general, antibacterial components in the spice plants were heat labile. All the spices tested lost their antibacterial activities within 20 min at 100 degrees C.


Mother's cultures at 36 and 38 weeks showed 2+ colonization. I had her take 500 mg vitamin C every 4 waking hours, 1 EHB (NF Formulas) capsule every 4 waking hours, Propolis 4 times daily, and she inserted a tampon soaked in 2% tea tree oil solution (2% tea tree essential oil, 98% olive oil). She left the tampon in for 4 hours each day for 6 days. Culture at 39 weeks was negative for GBS. She had a long labor, a high leak for 72 hours, then a rapid active phase and second stage, healthy baby, normal placenta, and normal recovery.

— Thanks to: gentlebirth.org/archives/gbs.html#Alternative


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Forum Talk

I have just had three births in a row with three anterior lips. They lasted three, four, and eight hours. We tried numerous different positions, pulsatilla, evening primrose oil, and time. (Obviously giving it time worked for each birth.) What other ways do midwives use to avoid cervical lips, and what are some tried and true ways of getting rid of them?

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Question of the Week

Q: I am searching for information about the diagnosis of polyhydraminos for one of my students, i.e., the accuracy of diagnosis, implications for the condition, statistics regarding outcomes, and options for families, etc. The family in question wishes to have a homebirth even if the prognosis is bad, but they are concerned about the implications for a care provider attending such a birth.

— Amy V. Haas, BCCE

Send your responses to mtensubmit@midwiferytoday.com with "Question of the Week" in the subject line.


Question of the Week Responses

Q: A client having her first baby has a vaginal septum (one cervix and uterus). Does anyone have home- or hospital-birth experiences with this? I know what Williams says, but I want to hear from midwives. We are trying to assess the risk of homebirth in relation to bleeding and the possible need for sutures to the septum.

— Keta Johnson

A: I have come across this several times during birth because as a rule we do not do vaginal exams before active labour. I have found that one of two things may occur: either it is in the way or it isn't. If it isn't, you simply hold it to one side. If it is, you'll find it is fibrous tissue that you can easily snap with your scissors. It will not bleed. Afterward you may check the area, but 9 times out of ten it seems to simply have withdrawn. If not, you may perform some neat plastic surgery. In either case, I would not consider it a reason for going to hospital: what's the gain?

— Annemieke van der Peet, after 25 years of experience, the Netherlands

A: Having delivered a woman with a rather thick septum and two cervices, my experience was that the septum tore quite a bit, and because of swelling the appearance and shape was distorted. It was difficult to reapproximate, but I did it. Bleeding was nothing dramatic, but I chose to repair rather than remove the septum to avoid more bleeding. I am very confident with suturing and anatomy and feel that if a homebirth is planned either somebody with amazing suturing skills be available or the client may need to be willing to transport for the repair.

— Anon.

A: Does the septum travel up distally? If it does not, here are some ideas about what to do; if it does, this is not applicable. Is she experiencing any bleeding with this septum? If she is, you must be watchful that it does not tear. If it does tear you will have a problem on your hands if you don't know where the bleeding is coming from. My recommendations for this situation if it is not distal are: as the head descends and gets to station 3-4, numb up the area anterior and posterior of the septum. Use two hemostats to clamp off the bleeding, then clip the middle of the septum and let the baby pass through the septum and be born. We like to use less hardware on the perineum, so we use a metal cord clamp for the posterior part of the septum. Then when all is done and the placenta is born, you can clip the septums both anteriorally and posteriorally and suture the bleeding stopped. Figure 8 works nicely if you like. Then if there has been any tearing, be sure to fix this at this point. Most women do just fine as long as this problem is not distal.

— Anon.

Re: interstitial cystitis (IC) [Issue 5:04]:

Years ago I delivered a woman who developed IC after birth. I went on to deliver five more babies for her without incident. She delivered at home and the last three I delivered were waterbirths. I know that she had at least one more baby after she moved from my area. That would have been baby number nine!

Carol Severson

Re: Itching during pregnancy [Issue 5:01]:

Itching is the result of an imbalance of yeast in the body. Take probiotic and even oil of oregano to introduce good bacteria such as acidopholus into the system as well as other positive bacteria. I have severe itching too right now, and this course of action was recommended to me as an alternative to taking Benadryl. I haven't yet tried oil of oregano (systemic, not topical).

Anon.


EDITOR'S NOTE: Responses to any Question of the Week may be sent to E-News at any time. Please indicate the topic of discussion in the subject line or in the message.


Exclusively on the BirthLove site: Gloria Lemay, celebrated midwife and teacher, is offering advanced online doula education. She covers a vast amount of topics that today's doulas and student midwives need to know: herpes simplex II, medical terminology, pediatric exam of the newborn, prenatal diagnostic tests, business and professionalism, pregnancy-induced hypertension, gestational diabetes and so much more. The course is free for all BirthLove members.

Check it out! www.birthlove.com


With Woman: “Dangerously High” Blood Pressure before Birth

by Gloria Lemay, compiled by Leilah McCracken

"Dangerously high" blood pressure (BP) is a term that a doctor might use to shut a woman up and make her do whatever she's told. If a woman's blood pressure is elevated before birth, you would want to know:

  • What was the starting baseline in this pregnancy?
  • What is the BP now?
  • Who's taking the BP reading, and is the mother in the same position (sitting, side lying, standing) each time?
  • Does the mother have a fat arm and is the cuff long enough for her?
  • Is she on any medication right now?
  • Is she spilling any protein in the urine?
  • Does the baby seem to be growing appropriately - i.e., is it the right fundal height for dates or close to it?

One of the good things that doctors learn to do is ask a lot of questions. If a midwife phoned a doctor and said "I have a client whose BP is dangerously high" the doctor would ask the midwife every one of those questions before jumping to any conclusions. The thing to remember about high blood pressure is that the body is trying to protect the baby and the mother by sending the BP up. Why it does this we don't know, but even the doctors don't want to bring it down to "normal" 110/70 levels. They are happy if they get it down to 140/90 and they stop medicating there. Many obstetricians around the world will not treat any hypertension which does not include proteinuria (protein in the urine).

The treatments have dangerous side effects, especially to the liver, which is the organ that is having difficulty in the first place. If the client had a diastolic reading that was more than 15 higher than her initial BP, protein in the urine, and swelling in the face, hands and feet, this would be of great concern. If increasing her protein, salt, and rest did not turn it around very quickly, I would definitely want her to seek medical advice. Dr Brewer recommends intravenous serum albumin therapy.

I helped one woman who got into this scenario, and her baby was removed from her body by cesarean at 32 weeks gestation. The baby was small for dates. The woman did a fantastic job of persevering with breastfeeding against all odds, and her daughter is a big healthy girl now. That is one case in more than 1000 women I have worked with, so it should be a very rare occurrence.


Gloria Lemay is a private birth attendant in Vancouver, BC, and is a contributing expert at BirthLove, www.birthlove.com
Read more from Gloria on Midwifery Today's website: "Pushing for First-Time Moms"
Note: This article is also published online in French and Spanish.


Feedback

Advice for helping moms who have been physically, emotionally or sexually abused [Issue 5:04]: Moms who have been abused often have big emotional burdens or "charges." Sometimes the moms are consciously aware of their emotional charges, but often these charges are held on a subconscious level. These moms need help to bring their emotional charges to a conscious level where they can be acknowledged and released. This kind of work requires the assistance of a professional experienced in accessing the subconscious, including specially trained psychologists, hypnotherapists, Healing Touch or energy practitioners, rapid eye-movement technique practitioners and such. When the mom is brought to an awareness of the emotional charges she is holding onto and then she is helped to release those charges, she is then able to experience more self acceptance and loving feelings toward her unborn child. Books that explain these approaches include "Feelings Buried Alive Never Die" by Karol Truman, "Getting Through to Your Emotions with EFT" by Phillip & Jane Mountrose, "Waking the Tiger: Healing Trauma" by Peter Levine.

Kathleen J.

Phyllis H. Klaus, CSW, MFCC, teaches and practices psychotherapy at the Erikson Institute in Santa Rosa and practices in Berkeley, California, working especially with the concerns of pregnancy, birth, and the postpartum period. Together with Marshall Klaus, she is co-author of "Your Amazing Newborn." She is the person you want to contact regarding this question.

At a local Southern CA/Nevada LLLI area conference last May, she gave three sessions about this topic:

* The Impact of Childhood Sexual Abuse on Pregnancy, Labor and Postpartum: Its Effects and Management
* Possible Impact of Childhood Sexual Abuse on the Postpartum Period
* Counseling Strategies and Help around Breastfeeding for Women with a History of Childhood Sexual Abuse

Otherwise, contact Ms. Klaus for more articles/information.

I also found a lot of info online. I did a search for "Helping survivors of sexual abuse through labor" in quotes. Here are a few links:

Childhood Sexual Abuse and the Potential Impact on Maternity Andrya Prescott, Independent Midwife
www.gentlebirth.org/archives/abuselbr.html
www.geocities.com/virtualbirth/archives/abuse.html
www.grrlsurvivors.org/body/pregnancy/childbirth.htm

Tanya

I have found that an herbal tea called Mothers Milk helps, along with relaxation and plenty of water and fluids. Feeding frequently also seems to bring milk down and produce more in the long run.

J.C.

It is natural for milk production to decrease during pregnancy because the mature milk for the nursling will change to colostrum sometime after the third month. If the nursling is still dependent on mamma's milk for full nutrition, this change has serious consequences for the nursling because colostrum doesn't have the same nutritive value to support growth in the older baby as mature milk does. It isn't realistic to boost supply in this case. Best to nurse and supplement.

Nikki Lee RN, MSN, Mother of 2, IBCLC, CIMI, CCE, craniosacral therapy

I am breastfeeding Lorien (2 yrs 4 months) and Noah (7 months). I have used no formula for either of them. Noah has just started to eat other foods. Breastfeeding through my pregnancy went through cycles: early on my milk supply seemed to have dropped off by how it felt when Lorien sucked. My nipples were more sensitive, and sometimes it didn't feel great, but with time it got better. My breastmilk seemed to have increased again toward the end of my pregnancy. I was prepared that Lorien might have weaned herself because I had heard that sometimes babies don't like the taste during pregnancy, but she seemed to enjoy it more. My most amazed moment came when Noah was born and I saw my milk turn back to colostrum and my mature milk return a few days later. Lorien seemed to like that too, although I did put her off having too much of it. I had also worked during the pregnancy to cut her night feeds down to only when the birds sing.

Since Lorien's and Noah's births I have also been expressing because I continued throughout with my midwifery studies and now have a full-time midwifery caseload. I have used homeopathics at times as well as galactalogue teas, herbal lactation tinctures when time has allowed. Mostly I just try to get them to feed as often as possible, and this works best. I work on eating well, and drinking to thirst. Mentally/physically/emotionally and spiritually I don't fall into thinking that my babies are 'draining' me of my energy. I see it as an energy/white light that passes through me and keeps me connected to them and the universe.

Anon.

Re: pelvic floor dysfunction [Issue 5:03]: I am a physical therapist who specializes in treatment of pelvic floor dysfunction, including treatment of joint dysfunction in pregnant women. Many physical therapy clinics now have someone who specializes in this type of treatment. For a list of local physical therapists, contact the American Physical Therapy Association.

Becca Reisch
Portland, OR

Nutrition does indeed play a major role in the synthesis of prostaglandins [Issue 5:04], in particular essential fatty acids (EFAs). Hemp oil is a good source of well-balanced omega 3 versus omega 6. Flax is a good source of omega 3, and you could also mix virgin olive oil (omega 6) with either flax or hemp for a more neutral taste. Bad saturated fats, mainly from animal sources or fast food, is also to be avoided because it counteracts the action of EFAs. I recommend the excellent book "Fats That Heal, Fats That Kill" by Udo Erasmus (Alive Books) to find out more about that subject.

Chantal Ann Dumas ND Montreal, Canada

I am very interested in training to be a midwife. I am presently in a completely different line of work but have thought long and hard about changing my direction. I don't know where to get the correct information about training, qualifications, and so forth. Does anyone have addresses or contacts to help me start my search? I am based in Whitley Bay, in the Newcastle [UK] area.

Lisa

Do you know how to become WIC certified and are there are any midwives who are WIC certified? I have recently been asked by the state of Montana to tell my clients that they can be screened and become enrolled by me for WIC. They asked if I was WIC certified and if not, told me I could become WIC certified. I have asked other midwives in my area and no one knows what I am talking about.

Sarah Boartfield


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