Empowering Birth Blog

Higher perinatal mortality? Really?

I recently subscribed to Essentially MIDIRS.  (Can I tell you how much I LOVE this magazine!)  The April 2011 issue presents the abstract of an in-depth review, "Examining autonomy's boundaries: a follow-up review of preinatal motality caes in UK independent midiwfery" of a study showing a significantly higher perinatal mortality rate for births booked under and independent midwife compared with births in National Health Service units.  Now what would we do if a study showed a similar finding in the United States?  Run articles touting the dangers of home birth (a majority of the births attended by independent midwives in the study were at home) of course.  Interestingly enough, in the UK, they take a different, more evidence-based approach.  They took an in-depth look at the findings for the study.  What did they discover?  According to the abstract, there were 15 perinatal deaths at term with the independent midwives. Seven of the deaths were unpreventable (ie, they would have happened in a hospital with a doctor).  The abstract notes "Elective cesarean may have changed the outcome in eight cases.  However the pregnant women had declinded this option....  Care management was judged to be clinically acceptable within the parameters set by the mother's choices."  The conclusion states, "If reality is to match rehetoric about 'patient autonomy,' such decision making in high-risk situations must be accepted" (emhasis mine). Overall perinatal mortality was low, 1.7% for independent midwives vs. .6% for the births in the National Health Service Units.

So it turns out the higher perinatal mortality rate was not due to a deficiency in care.  Hmm, I can think of similar studies in the U.S. (hmm, can anyone say Wax) that may have benefitted from a careful review of the results.

Maryland Homebirthers Stand Up

As we consider licensing Certified Professional Midwives in Maryland, we are once again discussing the safety of home birth. Numerous peer reviewed, high quality studies have shown home birth with a trained attendant to be as safe as hospital birth for low risk women.  Will we never put the home birth safety discussion to bed?  When another home birth study was published in Britian in November of 2011 showing a slight risk in adverse outcomes for first time moms (there were no differences between second time moms who delivered at home or in a hospital), the home birth debate rekindled.

Let’s pretend for a moment that the results of the British November 2011 study results referenced above are applicable to the United States.  The researchers of that study believe their results support a policy that allows home birth for healthy first time moms.

But it isn’t only first time moms that make “risky” decisions.  Moms and dads make daily decisions that incur a slightly greater risk for our children.  We choose to vaccinate, nudge them out the door on their first solo walk to school, sign them up for swimming lessons, and drive seventy miles an hour with them in the back seat. Why choose activities that bring more risk?  Sometimes we choose increased risk because we are looking at the bigger picture and a better quality of life for our child.  For example, if you are a first time mom, while there may be a slight increase in risk with home birth (according to one study), your chances of cesarean delivery are significantly reduced. There is a much lower risk of maternal death with vaginal birth.  And I think we can all agree that a child’s quality of life is improved when their mother is around to parent them.

 With other choices, such as the decision to vaccinate, we are choosing an immediate increase in risk (the risk of a reaction to the vaccine) in order to decrease future risk (the risk of acquiring a life-threatening illness).  Many moms choose the (potentially) increased immediate risk of home birth as a first time mom in exchange for the decreased future risk of complications in subsequent pregnancies (due to the fact that women are less likely to have a cesarean if they give birth at home).

I am very familiar with this game of trading risks.  When pregnant with our second child, my husband and I decided to attempt a vaginal birth after cesarean (VBAC) at home. Why at home?  Given the high cesarean rate at area hospitals, coupled with the requirement for continuous monitoring (which is linked to a higher cesarean rate), and my inability to feel at ease in a hospital when I am not sick, we thought my chances of vaginal birth in a hospital were slim to none.  I traded the risk of a repeat cesarean section in a hospital for the miniscule risk of a uterine rupture at home.  It is important to note that the risk of uterine rupture, less then .5% in some studies, is not completely eliminated by being in a hospital.  

 My successful VBAC at home greatly reduced the risks of future pregnancies (for example, placental abnormalities and stillbirth increase with multiple cesarean sections).  I realize that IF I had undergone a cesarean with my second, I would most likely have had a cesarean with my third and fourth pregnancies, not at all a safe proposition for myself OR my babies.

Other discussions in the homebirth debate center around certain “dangerous” midwives doing things which the medical community absolutely does not approve.  It is apparently the midwives’ job to ensure patient compliance with the “standard of care,” care which is often not evidence based. This is a patronizing attitude. It is time that women take back their responsibility for birth.  We need to speak up.  This is not about the midwives, this is about real options for women. 

An OB friend informed me that had I chosen a hospital with my fourth child, he would have been born by cesarean.  The rationale was that my fourth was a face presentation, and that I had a previous cesarean (even though it was followed by two vaginal births). The old textbooks say a cesarean is not indicated for a face presentation when the chin is facing anterior (which my baby’s was), and the baby is smoothly navigating the birth canal.  WHY did I need a cesarean?  

I do have a suggestion for Maryland folks who are worried about the moms who will choose to have a VBAC or breech or ______ birth at home.  Legislation for licensure could require a written informed consent process for moms that choose to decline the standard of care. Perhaps legislators will understand, when they have the opportunity to review detailed written informed consent documents, that this is not about the midwives, this is about the moms.  If my midwife had given me an informed consent document to sign when I was in labor with my fourth baby, I absolutely would have signed it.  Pushing my baby out at home was my decision, not my midwives’.  My midwives are the experts, there to guide me through the process, but I am the decision-maker, I am ultimately responsible for birthing and raising my baby.

Women have the right to choose to birth at home, clearly a safe option with a trained attendant.  The problem is that in Maryland, we have few trained attendants offering home birth.  Most Certified Professional Midwives who live in or near Maryland will not practice in Maryland.  And only a handful of Certified Nurse Midwives will attend home birth in Maryland (according to the Feb. 3 2011 ACNM issue brief, only 3.8% of CNMs attend out of hospital birth.) Last summer, I was pregnant with my fourth child at a time when finding a home birth midwife was next to impossible.  Several of my friends, were in their last trimester and scrambling for a midwife.  I know moms who gave birth at home unassisted. Other moms traveled to Va to have their baby.  This is not an ideal situation.  

Enough with the endless banter on homebirth safety.  Home birth IS safe with a trained assistant.  The Certified Professional Midwife is the only midwifery credential that requires knowledge about and experience in out -of-hospital settings.  Maryland families, it is time to stand up and tell our legislators that we want access to licensed Certified Professional Midwives.  It is time to stand up and take back the responsibility for our births.  Together, let’s support HB1056 and license Certified Professional Midwives in Maryland.  Please visit Maryland Families for Safe Birth and get involved.  Donations are welcomed and can be made on the Maryland Families for Safe Birth website.

 

Delayed Cord Clamping

A MUST READ article with all the evidence you need to support delayed cord clamping:

http://academicobgyn.com/2009/12/03/delayed-cord-clamping-should-be-standard-practice-in-obstetrics/

Written by Dr. Nicholas Fogelson.

Thaddeus Arrives Face First

If my 37^th year had a theme, it would be the year God reminded me at every turn that I am not in control; the birth of Thaddeus was no exception.  Thankfully I had gotten the message loud and clear and so while I had a pretty clear picture of his birth (middle of the night, in the birth pool, easing baby out and catching him/her myself, surrounded by family with my fellow student midwife/future midwifery partner quietly in the corner and supervising midwife nearby) as I neared 40 weeks I also knew that birth, like life, cannot be controlled.   And so I made sure to double make the bed, placing my extra polk a dot shower curtain for protection underneath the top sheet, just in case I had the baby on the bed.

The first surprise was that I did not go into hard labor after the kids were neatly tucked into bed, as I did with my second and third babies, but in the early evening.  I hoped for a Sunday birth.  It was the last chance my baby had to meet my sister as a newborn.  My sis was coming up Monday morning in order to say goodbye before flying back to New Mexico.  She was in Williamsburg on Sunday celebrating my Dad’s 75^th birthday.  Since it was HOT and I had a baby that kept trying to slide into a posterior position (swimming helps encourage an anterior position) I decided to spend Sunday afternoon at the pool with the kids.  At the pool, I noticed that my warm-up contractions (I had been having strong warm up contractions from about 34 weeks on) were 8-10 minutes a part, but this was nothing new for this pregnancy.   Swimming, I palpated my relaxed belly and confirmed what I suspected, baby was definitely facing posterior (also known as sunny side up). After the swim, it became slightly uncomfortable to walk through contractions and, though this wasn’t new either, it was time to go home.  We gathered the kids, and climbed in the car.  In the car I had a contraction that was very uncomfortable in my sitting position and I thought, hmm, tonight is the night.  It was 5pm and I texted my midwives, to let them know that if this labor was anything like my last labors, baby was coming tonight.

We arrived home at about 5:15pm.  Dinner wasn’t made, the kids were starving and tired from sun and swimming and the birth pool needed filling.   Before we could get started, Matt announced he needed to go to the hardware store to buy an extra connection in order to fill up the birth pool. Things were chaotic and at 5:50pm, realizing that Matt could not get everything done by himself and realizing that I needed to make space for active labor to start, I called Mimi and asked if she could come over to help Matt.  She came over shortly after 6, and together Matt and Mimi were able to feed the kids and get the birth pool set up while I moved into active labor.  I am not sure when that move came, let’s say 6:15pm.  By 6:35pm, when Liz called to see if she should head up to Baltimore and drop off her partner or come straight to my house, I was no longer interested in talking to anyone and had shut myself in the basement bathroom.   Thankfully Mimi took the call, updated Liz on the situation and they decided Liz should come right away.

Liz arrived at 7pm and mentioned she wanted to start setting up so I asked her to call Mairi.  Mairi, who lives in Takoma Park as well, was quickly on her way.  At some point things became more intense and it was time to turn on the CD of gospel music I had prepared for the birth.  I headed upstairs, where I would remain for the birth. The music deepened my connection to the spiritual nature of birth and opened my awareness of the unfolding miracle.  I am again and again awed by the spiritual power of birth and felt my body flood with the intense energy of the Spirit.  I needed all the help I could get as this was my hardest labor, probably because it moved so quickly.  In barely over an hour I went from thinking I might be in early labor to having intense ctx 3 minutes a part. 

As soon as the tub filled up I climbed in (7:45pm) and sang and labored, grateful for the water’s soothing warmth.   Sometime after 8pm I checked myself and felt a very bulging bag of waters and a very soft and stretchy cervix.  It is hard to check yourself when you have short fingers so I have no idea how far dilated I was nor did I care.  Sometime later I felt the need for a position change and climbed out of the water thinking I might go downstairs and sit on the toilet.  Standing by the side of the tub, my water broke and I stood frozen for minutes watching the spreading pool of fluid, unsure of what to do next.  I climbed back in the tub and noticed that my uterus was pushing; I watched it rise up and move down with incredible force, encouraging baby to move on out.  I felt baby wiggling and squirming and kicking inside me. The thing is, while my body was pushing, something didn’t feel right and I was resisting.  I didn’t have trouble pushing with Nettie or Fen and even enjoyed second stage…  Since I had checked myself only a little over 30 minutes ago and felt cervix, I thought, I must not be fully dilated and that is why this feels so different from pushing Fen and Nettie out.  I called Liz to check me but realized “I can check myself.”  I slipped in a finger to feel a hard palate, then a mouth sucking on my finger!  Imagine my surprise! 

I asked Liz to check me to confirm a face presentation and she thought she felt a nose but couldn't be 100% sure (Is anyone 100% sure when they feel a face?  Our fingers expect to feel heads...).  I called “Mairi!” and Liz and I agreed I would get out of the tub so that Mairi could check me on the bed. (Mairi had been just downstairs listening and holding the space, ready to help if needed, as I wanted as few people upstairs as possible until the birth.  For much of the labor it was me with Liz quietly sitting nearby).  I asked to hear to heart tones (my request had been no heart tones unless necessary knowing that if mom knows baby is moving well, baby is ok) because I was concerned by a face presentation and I felt a change in baby's pattern of movement.  I thought baby was posterior and remembered something that was not at all good about the combination of posterior and face (in labor, your brain doesn’t work so well, after birth, I remembered that it is a posterior chin that is not good, not a posterior baby, a baby with a posterior chin should not be born vaginally while a posterior baby with an anterior chin can).  The pain was too much to bear for a vaginal exam on my back so I asked Mairi to check me on all fours, half leaning on the bed.  

Heart tones at some point dropped.  While I didn’t have a watch, as a student midwife, I know the sound of poor heart tones.  I looked at Liz and Mairi, unsure of what to do next.  This is why we have midwives.  When you are in labor land, things can get very fuzzy.   A woman in labor shouldn’t have to think and I needed direction. Mairi said “I think you need to push your baby out now, it would help if you got into McRoberts to flex the head,” and my body moved quickly into McRoberts where I started pushing with all my might.   (While I started pushing, my husband quickly ran downstairs to get the kids.) I think I had about one contraction the entire time I was pushing.  The rest of the time I was bearing down, thinking of the thunk, thunk, I heard on the Doppler and knowing it was time for baby to come out.  I moved Thaddeus swiftly under my pubic bone and heart tones came back up and he started to pink up.  I took a breath and continued to push him out, giving an extra strong push to birth the shoulders.   I didn’t catch my baby as planned.  The effort required to push my baby out without contractions while lying on my back required one-pointed focus.  I paused a second to touch his emerging face but I wasn’t able to focus on how my pushing was progressing and when I would need to catch him.  At 9:06pm, a short 16 minutes after I first felt him sucking on my finger inside me, Thaddeus was born.  He was caught with lots of love and by my request, no gloves, by my future midwifery partner, my loving preceptor midwife standing by and surrounded by the love of my life and our three amazing kids.  My friend Mimi, who was such a help to Matt during the birth, was an incredible help to me during pushing and immediately after the birth. 

Pushing Thaddeus out was HARD and having a circle of support while doing it made it easier.  Thaddeus arrived, face first, with only a bit of bruising around the eyes.  Mimi, a gifted cranio-sacral therapist helped Thaddeus release the intensity of the experience caused by his unusual position and helped me relax my sacrum so that I could eventually sink back into pillows with Thaddeus resting on my chest.  While the birth of Thaddeus was certainly a surprise, I think the biggest surprise came at the end of the newborn exam.  Thaddeus weighed in at 8 pounds 9 ounces, a full 1.3 pounds bigger then my biggest baby!  Not to mention that the presenting diameter of his face was not small at all.  And I thought I made small babies!  

There is much more to the story, this is only a small snap shot.  There were friends downstairs that I was not aware of, silent helpers, there to be with the kids, to hand off from one friend to the other as needed, so that Matt was always free to be with me if called, my unseen village supporting me.  But I have gone on long enough.  Much love to you Thaddeus from your mom, dad and three siblings!!!!

*A note on face first babies, Anne Frye (Holistic Midwifery Volume II, pg. 121) notes that they are unusual, averaging about 1 in every 545 births.

 

 

 

I saw my midwife in chains

Seeing a loved one shackled is probably the worst nightmare of many and something I had hoped never to see.  Isn't it enough to shoulder the burden of awareness that women, men and children are unjustly hauled off to jail on a regular basis in the U.S. and worldwide?

And then it happened.  I stood in the courtroom and watched my beloved midwife enter in a pink jumpsuit.  I don't know why I expected them to make an exception for her...  I suppose that is what every parent/friend thinks as they watch a loved one enter in shackles, not my baby/friend/lover...  But there she was, handcuffs around her wrists, ankles, and a rope of chain around her waist...  Hands that had helped so many babies safely enter this world, hands that reassuringly stroked and held women in the throws of doubt during a long labor, a waist often seen from behind as Karen kneeled next to an emerging baby, feet that slipped quietly out of bed in the middle of the night, on their way in service to women...

My midwife is being prosecuted for manslaughter. A disheartening investigation ensued after the tragic death of a client’s baby. Karen is being charged with involuntary manslaughter and other felonies for her role as a homebirth midwife.  She will be on trial for these charges beginning June 7^th and is facing up to 30 years in jail.

Did you know that charges are regularly brought against midwives in the United States?  Charges are often brought because it is illegal for them to practice the profession they are thoroughly trained to practice (see The Big Push, an organization working to change this).  I have noticed that charges are also brought when, instead of following the medical model, the midwife honors the informed choice of a family (even when the informed choice is evidence based). If you have ever been urged to be induced or scared into a c-section for a "big baby" or heard of court-ordered cesarean-section (see National Advocates for Pregnant Women, for example), you know that the medical community is not always a strong supporter of informed choice in practice, even when it is evidence-based.  

In 2005, I was pregnant with my second and hungering for a vaginal birth after cesarean (VBAC).  I was told that if I gave birth in a hospital, I would need to be hooked up to a continuous fetal monitor.  As someone who believes firmly that hospitals are only for the sick and is a do it myself/on my own terms kind of girl when it comes to birth, I knew that being tethered to a monitor in an unfamiliar, rather then intimate, environment, would mostly likely lead to a second cesarean.  I was told I was not a birth center candidate since I had had a cesarean with my first baby and a recent insurance change prohibited birth centers from attending VBAC clients.  

I had done the research and understood the evidence concluded that a vaginal birth after cesarean was safer then a repeat cesarean, especially if more children were planned (see, for example, Childbirth Connection).  As an informed consumer, I chose my best chance for a vaginal birth, a home birth with Karen Carr.  Karen put her neck out there for me and as a result, I found my full power as a woman and as a mother. As a result of that VBAC, I had a much higher chance of a healthy pregnancy and safe birth when I found out that I was pregnant with my third and now, with my fourth.

Karen needs your help.  Please visit In Service to Women and donate what you can, even if it is only $5. Please, join your local midwifery organization, if your state has one, or join Citizen's for Midwifery or the MAMA Campaign or...  Midwifery needs you.

 

Listen to Your Body!!

It is so important to listen to your body when you are pregnant, it will let you know if you are overdoing it.  Last week I went to two births, one of which was very long (I was at the long birth for 40 hours), and ended up sleeping only one night out of four nights.  Needless to say my body was screaming loudly.  I had a very crampy uterus and would have been more concerned if I didn't know that lots of rest should fix everything.  I put everything on hold except taking care of the kids and slept twelve hours at night with an hour to two hour nap during the day. It took me almost four days to fully regain my energy but I did!  That long birth was a good reminder for me in many ways.  One it reminded me that you can do EVERYTHING right and still get a doozy of a labor.  I think that sometimes I think that the natural birth world suggests that if you do the right things, you will have an easy (maybe even pain-free) birth.  NOT TRUE.  It also reminded me that you have to take excellent care of yourself as a midwife (student midwife) if you are going to be inflicting that kind of abuse (regular mostly sleepless nights) on your body.  And finally, it reminded me that I am NOT willing to be away from a little one for a long birth until he/she is at least 18 months.  That means I need to be ready to take it slow when the baby comes and leave a birth if necessary to go home and take care of my family.  One day at a time, that is my current mantra...

Sacred Mountain Midwifery

There is more news on the midwifery studies front.  I recently decided to attend Sacred Mountain Midwifery School in order to complete my didactic training as a midwife.  Over the past five years I have been reading midwifery texts and attending study groups and conferences, but when it was time to plan the completion of the PEP process for my CPM, I realized I wanted a concentrated review of all the skills I need to become a midwife, the things I have been studying on my own for the past few years.  I considered several programs and in the end chose Sacred Mountain Midwifery because I wanted extensive hands on experience (that is how I learn) and because I have been attending their yearly Women Helping Women Retreat and really enjoyed the teaching style of the co-founder Dr. Sarita Bennett (Ruth Ann is fabulous as well!).  In my search, I realized that I wanted to learn from a midwife who had been practicing for years and years (Sarita has almost thirty years of experience as a midwife) and (since my husband and I still plan to return to West Africa, hopefully Mali or Senegal) I wanted to learn from a midwife who practiced in a rural setting where immediate hospital transport was not always possible.  Sacred Mountain Midwifery seemed the perfect choice for me and after my first session there in October, I can hardly WAIT to go back.

Having a baby in May will make things a bit tricky.  I will be 38 and 1/2 weeks pregnant when I attend the May session and unless the baby comes early, I will most likely miss the June session.  My whole family will come for subsequent sessions and camp so that my husband can grab the baby if he/she is being fussy.  But it is a fabulous school and we are committed to working it out.  Anyone want to join me?  It isn't in the most practical location (a good four an a half hour drive from my house, a good bit winding through the mountains) but the setting is BREATH-TAKING and cell phones don't work (you can receive calls if you are on call and use their phone) which makes my weekends there a retreat as well as a learning experience.

Baby on the way!

It has been ages since I've blogged.  I took July and August off to focus on family, and then in September our family had some surprising news, and I didn't really feel like blogging until it was time to share the news.  You guessed it, we are expecting our fourth!  

Quite a surprise I must say.  I've been using Natural Family Planning, and apparently didn't realize the effects of possibly being close to Menopause (I am 37) and throwing my schedule off so drastically by attending births.  I hadn't had any real signs of Menopause, maybe a tiny variance in one cycle, but I know it can strike at any time.  It isn't like you get a notice in the mail announcing "Heads up Menopause is around the corner, expect cycle variations!"  When we had sex I had ZERO fertility signs, plus it was six days before the earliest I've ever ovulated.  I know NFP says seven days to be safe but I had been charting for quite awhile and never ovulated before day 19, and usually not until day 21, so I felt safe.  And six days should be ok, I mean sperm only lives 5 days (at best!).  But then I went to two crazy births, back to back, one of which was very long, and I noticed a shift in my cycle. This little person was determined to come into our lives, and we are excited to become a family of six!

Looking back, I think this baby has many lessons for me, the biggest being that I can't plan everything.  I had neatly planned out the completion of the PEP process and the latest date I would take my NARM exam (I had planned to take it by August of 2012).  I was also going to finish my Birthing From Within certification.  Now everything is up in the air, and that is ok.  While I can, I am plowing full speed ahead with the PEP process.  I have been on a roll with daytime births (five in a row!) and at 13 weeks on Wednesday, I am feeling like I am about ready to handle an all-nighter again.  Finishing up the PEP process will depend on whether or not families are willing to let me attend their birth with a newborn for part of their labor.  I am just not willing to be away from a newborn for any length of time until they are at least 9 months.  And of course I will be taking four months off (my last 4 weeks of pregnancy, and the first three months).  So I might not take the NARM exam until February of 2013, and that is ok.  It is good to be forced to be flexible, I am learning my lesson (smile).

So I am "due" end May (my third May baby, although this one might come in June) and I am using my good friend and fellow student midwife as my midwife (with preceptor present of course so it counts!).  I think it might have just been my husband and I (with a knowledgable friend nearby if needed) if I wasn't a student midwife and 110% committed to students.  We NEED more midwives in our area and I will be honored to be submitted as a "Continuity of Care" birth (at least 3 of the births attended by CPMs need to be women that have been seen by the student over the course of a pregnancy for at least 4 prenatal visits).  Oh and of COURSE we are having the baby at home.

Last week I attended the birth of a ten pound baby, no suturing needed!  I have been at quite a few births with nuchal hands (left or right hand up by the face), in fact, I have been wondering what is up since we are not the only ones seeing so many nuchal hands.  Each birth I attend blows me away and reminds me how incredibly amazing women and their partners are.  It fires me up that CPMs are legally authorized to attend home births in only 27 states.  Women NEED access to midwives and home birth should be an option, in EVERY state.

Well, my little one calls so I must run.  We are in the process of weaning (she is two and a half, and I have a hard time nursing while pregnant), down to three nursings a day.  So I need to help her work through the fact that we no longer nurse after nap...  I hope that IF I have any regular readers left, that all are well.

Peace

 

Why I Need to be a Midwife

Hello all, I thought I would share a piece that I just wrote about why I need to be a midwife...

Revised 7/24/10 After a week in New Mexico

Why Do I Want to be A Midwife?

Why do I want to be a midwife?  How many times have I thought or written about this, each time going a bit deeper, peeling the layers of an onion, one thin and translucent layer at a time.

On a trip to New Mexico, standing half in the hot sun at Ohkay Owingeh festival, watching the Dance of the Deer, I achieved clarity on what I had always known but had not yet spoken or written.  I need to be a midwife because it is my connection to that which is sacred.

I thought being a midwife was about empowering women, or about organizing in my community, the community of women, (rather then as an outsider, organizing in another community), or about creating peace on earth.  It is about all those things but there is something deeper.  Being a midwife is about following my bliss, connecting to the sacred, a connection I believe every individual must find in order to be fully alive.

During the three years I spent in West Africa, I felt as close to God as I had ever been.  I  initially thought I was called to West Africa because I was angry with “white culture,” but now I know it was God calling me to truly taste what is sacred, in order to make me hunger for it in the years to come.  I think cultures closer to the earth embrace the sacred in daily moments, moments which can be few and far between in the U.S.  So few and far between that I had to travel to Mali to really understand the sacred.  Admittedly I caught the sacred here and there, a Cathedral in Paris, a sunrise on the Gulf of Mexico, and in Gospel Music (which is why I continue to sing and feel unrooted when I am not singing).  But standing in the half sun in New Mexico, I acknowledged that I find the sacred in every birth.

But there is more.  At the Georgia O’Keeffe museum in Santa Fe I read, “Singing has always seemed to me the most perfect means of expression.... It is so spontaneous....Since I cannot sing I paint.” (Georgia O’Keeffee 1922).  And my soul said YES and because I cannot sing or paint, I will midwife.  I do sing, with my gospel choir, but I don’t think that anyone will hear my voice, and soar to the heights that I have soared in Mali at a drumming circle, or at a birth, or when I listen to Kirk Franklin.  But maybe, just maybe, if I can hold the sacred space when I midwife, then the family will connect to the sacred, and then in the U.S. our connection to the sacred will deepen, one family at a time, one birth at a time, and there will be healing.

Part 2: So you've decided to test for GBS, you still have options

If you haven't already, you may want to read Part I of this post, which includes a fabulous article by Judy Slome Cohain, CNM.

***REMEMBER THAT NEITHER ANTIBIOTICS NOR HERBS, NOR CHLORHEXIDINE/HIBICLENS WILL GUARANTEE THAT YOUR BABY WILL BE GBS FREE.*** 

Babies born with GBS (from mom) have been shown to be protected from antibodies passed on by mom¹ (Please read this footnote.  It is very informative and also mentions that babies have less protection from E Coli then GBS.  Read below on why we should be concerned about E Coli).  Babies who get sick are babies whose moms lack the antibodies to the GBS bacteria. Even if you are treated with antibiotics in labor, your baby may still develop GBS disease (click here for a brief discussion of late-onset GBS disease including a potential connection between intrapartum antibiotics and increased rates of late on-set GBS).  In other words, there is no easy answer to the question, "I am positive for Group Beta Strep, what should I do?"

If you plan to test for GBS, you still have options...

The goal of treatment with antibiotics is to reduce the colony count in the vagina.  So why not try alternative methods to reduce the colony count before testing? Below are some options...

Option 1: Understanding that GBS comes and goes, you might follow an herbal regimen hoping to restore balance to your body (i.e. reduce GBS colonization) and then test, hoping for negative results. You continue  to maintain a diet that optimizes a healthy gut throughout the remainder of your pregnancy.  

Option 2: You can choose to wash with chlorhexidine/hibiclens and then test.

Option 3: Do nothing and test.  Understand that GBS comes and goes.

If You Test Positive:

You can take antibiotics (or use hibiclens) while in labor. Understand that neither of them completely remove the risk to your baby, that antibiotics are not without risk, and that hibiclens is a harsh substance.

If you test positive and are birthing at home with a midwife who will support your choice, you can repeat option 1 or 2 (above) and retest, hoping for a negative result. 

If you test positive you can do nothing, understanding that the risk to your newborn will increase with prolonged rupture of membranes and repeated vaginal exams.  

If you test positive, you can wait to use antibiotics or hibiclens after prolonged rupture of membranes.

Why Would You Want a Negative Test?

Why you may ask, is a negative test important?  A negative test means that if you birth in (or are transferred to) the hospital, your newborn will not be required to undergo a septic work up.  AND (perhaps more significant) a negative test means that if you are transferred to the hospital in labor, you will not automatically receive antibiotics.  Why should we be concerned about antibiotics?  Because research has shown that with the increase of intrapartum antibiotic prophylaxis (IAP) for GBS, there has been an increase in neonatal gram negative (e coli) sepsis which has led to an over all UNCHANGED rate of neonatal sepsis.  In addition, with the increase of IAP, there has been a corresponding increase in ampicillin resistant e coli (not a good thing!). As mentioned here, babies have less protection against E Coli. And remember, the Cochrane review has found no conclusive evidence to support giving antibiotics.

Herbal Protocols for Reducing GBS Colonization:

Midwife Judy Slome Cohain uses a Garlic Protocol.  If you are interested in garlic (and/or would like to learn more about GBS), it would be worth paying to download and read this research on GBS and garlic. Or read Judy's article on treating vaginal infections with garlic. 

From Midwife Maria Iorillo as found in Elizabeth Davis' Heart and Hands, 4th Edition:

Twice a day, with breakfast and dinner:

2 capsules lactobacillus acidophilus (2 billion per capsule- try Natures Plus)

1 capsule echinacea 350 mg

1 capsule garlic, 580mg

1 capsule or gel vitamin E, 500 mg

Also place one clove peeled, unnicked garlic in vagina every other night, remove in the morning

From midwife and herbalist Helena Wu:

I don't follow a specific herbal regimen but choose herbs that are mentioned in the books (Aviva Romm, Rosemary Gladstar, Amanda McQuade Crawford, Kathi Keville- well known experienced herbalists who have women/herbals written) for vaginal infections. Different ones work. I usually put in at least one that is anti-microbial, one to soothe. Also have mom eat yogurt with living cultures and put some in the vagina. You can make boluses (vaginal suppositories). It is messy but so far it has worked. On retest they are negative. Mom also should cut out sugars (simple carbs, juice, fruit). Do this for a week or two and retest.I give them all the options, antibiotics, hibiclens, herbal and let them choose.

Other Things You Can Do:

Avoid Vaginal Exams! 

Avoid hospital bugs (and frequent vaginal exams) by having your baby at home.

And of course the real question is why do we have such a high rate of GBS disease (as opposed to other countries) in the U.S?  Could it be that the American diet leads to low rates of antibody production in moms?  Of course that is another can of worms and not my area of expertise but as a huge fan/consumer of probiotics, I am a firm believer in maintaining a healthy gut.

1 Maternal Fetal & Neonatal Physiology A Clinical Perspective, by Susan Blackburn  http://books.google.com/books?id=2y6zOSQcn14C&pg=PA504&lpg=PA504&dq=GBS+mother+protection+antibodies+newborn&source=bl&ots=yHGbs78PKl&sig=4e9mDFgnBjEc0l-EzrpW3CZ4t2k&hl=en&ei=OEo-TN7rDcP88Aauq_SyBA&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBYQ6AEwADgK#v=onepage&q=GBS%20mother%20protection%20antibodies%20newborn&f=false

2 Current Controversies in Midwifery Care, by Saraswathi Vedam, CNM, audio from 2009 MANA Conference