Gestational Diabetes…
Optional Testing During Pregnancy
By Valerie Jacques, RN, CPM, NHCM
This is the second in a series of articles exploring testing procedures available for you and your baby during pregnancy.
Gestational diabetes is a form of the disease, which manifests itself in 2% to 5% of pregnant woman (only occurring during pregnancy). As with other forms of diabetes, the body is unable to effectively use glucose (a simple sugar that your body converts into energy). Normally, glucose is used by the cells of your body with the help of insulin (a hormone produced by the pancreas).
In the case of the pregnant Mom, insulin is blocked from doing its intended job by certain pregnancy hormones. When this happens, glucose builds up in Mom’s blood, and if not treated, can harm both Mom and baby. The risks associated with gestational diabetes include:
· Newborn hypoglycemia - low blood sugar in your baby
· Jaundice - your baby has a yellowish skin tone, which is associated with a buildup of red bile pigment (bilirubin) in his/her bloodstream.
· High blood pressure (Mom)
· Premature birth
· Macrosomia - birthing a very large baby (10 pounds or more), which occurs because your baby was exposed to high glucose levels in your body and has stored the glucose as fat.
· Birth trauma (for Mom and baby) – due to birthing a large baby
· Miscarriage
· Birth defects (rare)
· Stillbirth (rare)
Gestational diabetes usually manifests itself about halfway through the pregnancy, therefore the test for the disease is generally administered between 24 and 28 weeks into the pregnancy. The test requires Mom to give a blood sample, which is analyzed for glucose content. If the initial test is positive, it may be necessary to conduct a second, more sensitive test for the disease.
There may be no apparent symptoms prior to testing for the disease, therefore it important to have screening. If symptoms do occur however, they may include the following: increased thirst, increased urination, fatigue, nausea, vomiting, blurred vision and frequent infections (especially bladder, vaginal and skin infections).
Risk factors for gestational diabetes include: history of diabetes in your family, a previous pregnancy with gestational diabetes, age (Mom is over 25 years old), weight (Mom was overweight before becoming pregnant), having glucose present in Mom’s urine (glucosuria), hypertension, having too much amniotic fluid (polyhydramnios), having given birth previously to a very large baby, stillbirth, and race (Black, Hispanic, and Indian women are at more risk…the reasons are yet unclear).
Treatment consists of controlling the level of glucose in Mom’s bloodstream, and is essential in order to keep Mom and her baby healthy. The good new is that most Moms are able to control their blood sugar with diet and exercise. In some cases, however lifestyle changes and/or medication may be necessary in addition. If Mom is diagnosed with gestational diabetes, it will be necessary to monitor the level of glucose in her blood closely for the balance of the pregnancy, assuring that levels are staying in the normal range.
The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional. Knowledge is power.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at www.coastalfamilybirthretreat.com.
Friday, October 10, 2008
Optional Testing During Pregnancy
Optional Testing During Pregnancy
Group Beta Streptococcus
By Valerie Jacques, RN, CPM, NHCM
This is the first in a series of articles exploring testing procedures available for you and your baby during pregnancy.
There are many decisions to be made when you become pregnant; one of the most important is the continued health of your baby. This article (and others to follow) will help explain the various testing procedures, when a particular test should be run (if at all), and what the benefits and drawbacks are.
Group Beta Streptococcus (GBS) is a common strain of bacteria found in about 4 out of 10 adults. Ordinarily, GBS does not cause a problem; in fact it is considered a normal organism. However, it does cause a potential problem for pregnant women. It is possible to pass the GBS organism from Mom to baby during birth, and it can be fatal in itself to your newborn (5%-15% fatality rate despite antibiotic treatment). Sepsis, serious infection throughout your baby’s body (also referred to as GBS disease) is the culprit. GBS can also be the cause of other potential life-threatening trauma such as pneumonia and meningitis. Permanent neurological damage to your newborn is also a possibility.
Babies who are most likely to develop GBS disease are born of mothers who are carriers of the GBS bacteria AND have one or more specific clinical risk factors. Those factors are: Previous baby with GBS disease, urinary tract infection during pregnancy (with GBS), onset of labor before 37 weeks, rupture of membranes before 37 weeks, rupture of membranes more than 18 hours before birth, and fever over 100.4 degrees Fahrenheit during labor. Other risks of GBS include: Urinary tract infection (Mom), and pre term labor.
GBS resides in the vaginal and/or rectal areas, and is tested for by a simple swab at or about 36 weeks of pregnancy. This is the best time in the pregnancy to get the most accurate prediction of whether or not Mom is a carrier of GBS. However, GBS can be erratic, appearing and disappearing without treatment. If the test is positive, relatively simple protocols of herbs, oral antibiotics, or intravenous antibiotics administered during labor are available.
But not all interested parties agree on who should be tested or if antibiotics should be administered. Some (the Group B Strep Association, for example) advocate universal testing for all pregnant women and antibiotic treatment for those who test positive for GBS. Others (The Centers for Disease Control and others) recommend one of two strategies: (1) universal testing followed by antibiotics for those testing positive, or (2) no universal testing but antibiotics for those with clinical risk factors (paragraph 3).
So why not test all Moms to be, and administer antibiotics to those who test positive, and be done with it? Because, of those Moms testing positive for GBS, about 95% of their babies would not get GBS even if not treated….and there are risks to administering antibiotics. Risks include: allergic reactions (from mild to possibly fatal…1 in 10,000 for penicillin, even for those with no prior known allergy to penicillin) and the fact that wide spread use of antibiotics can increase the chance that drug resistant strains of an organism will develop. Furthermore, even if Mom’s allergic reaction is not severe, dangerous complications sometimes resulting in permanent disability can occur in the baby.
So, here are your current choices (1) GBS culture and antibiotics during labor if positive for GBS (2) No GBS culture and antibiotics during labor if you have clinical risk factors (3) GBS culture and antibiotics during labor if positive AND you have clinical risk factors (4) No GBS culture and alternative or no treatment.
If you birth your baby at home or in a birth center, your midwives will review signs of infection that you should watch for in your baby. If any signs begin to occur, you or your midwife will need to contact your pre-arranged physician. Regardless of whether you had a GBS culture, or what the results were, if your baby shows signs of infection, the baby’s doctor will probably recommend lab studies and antibiotic treatment for your baby in the hospital.
If your baby is delivered in a hospital, treatment depends on whether you had a previous GBS culture, what the results were, and if you have any clinical risk factors. If your baby shows any signs of infection (as above), lab studies and treatment will likely follow.
If you had a positive GBS culture and received antibiotics for at least 4 hours during labor… with no signs of infection (in your baby) and no clinical risk factors, standard protocol in many hospitals is to perform a blood culture on your baby and observe for signs of infection for 48 hours (in hospital). Antibiotics will not usually be given to your baby unless symptoms occur.
If you had a positive GBS culture and received antibiotics for less than 4 hours during labor (or no antibiotics at all)… protocol in many hospitals is to perform a blood culture on your baby, and begin antibiotics immediately. If the culture comes back negative, the antibiotics are stopped and your baby is discharged.
If you had a negative GBS culture… there will be no prolonged observation, and your baby will usually be discharged when you are.
Knowledge is power. The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at www.coastalfamilybirthretreat.com.
Group Beta Streptococcus
By Valerie Jacques, RN, CPM, NHCM
This is the first in a series of articles exploring testing procedures available for you and your baby during pregnancy.
There are many decisions to be made when you become pregnant; one of the most important is the continued health of your baby. This article (and others to follow) will help explain the various testing procedures, when a particular test should be run (if at all), and what the benefits and drawbacks are.
Group Beta Streptococcus (GBS) is a common strain of bacteria found in about 4 out of 10 adults. Ordinarily, GBS does not cause a problem; in fact it is considered a normal organism. However, it does cause a potential problem for pregnant women. It is possible to pass the GBS organism from Mom to baby during birth, and it can be fatal in itself to your newborn (5%-15% fatality rate despite antibiotic treatment). Sepsis, serious infection throughout your baby’s body (also referred to as GBS disease) is the culprit. GBS can also be the cause of other potential life-threatening trauma such as pneumonia and meningitis. Permanent neurological damage to your newborn is also a possibility.
Babies who are most likely to develop GBS disease are born of mothers who are carriers of the GBS bacteria AND have one or more specific clinical risk factors. Those factors are: Previous baby with GBS disease, urinary tract infection during pregnancy (with GBS), onset of labor before 37 weeks, rupture of membranes before 37 weeks, rupture of membranes more than 18 hours before birth, and fever over 100.4 degrees Fahrenheit during labor. Other risks of GBS include: Urinary tract infection (Mom), and pre term labor.
GBS resides in the vaginal and/or rectal areas, and is tested for by a simple swab at or about 36 weeks of pregnancy. This is the best time in the pregnancy to get the most accurate prediction of whether or not Mom is a carrier of GBS. However, GBS can be erratic, appearing and disappearing without treatment. If the test is positive, relatively simple protocols of herbs, oral antibiotics, or intravenous antibiotics administered during labor are available.
But not all interested parties agree on who should be tested or if antibiotics should be administered. Some (the Group B Strep Association, for example) advocate universal testing for all pregnant women and antibiotic treatment for those who test positive for GBS. Others (The Centers for Disease Control and others) recommend one of two strategies: (1) universal testing followed by antibiotics for those testing positive, or (2) no universal testing but antibiotics for those with clinical risk factors (paragraph 3).
So why not test all Moms to be, and administer antibiotics to those who test positive, and be done with it? Because, of those Moms testing positive for GBS, about 95% of their babies would not get GBS even if not treated….and there are risks to administering antibiotics. Risks include: allergic reactions (from mild to possibly fatal…1 in 10,000 for penicillin, even for those with no prior known allergy to penicillin) and the fact that wide spread use of antibiotics can increase the chance that drug resistant strains of an organism will develop. Furthermore, even if Mom’s allergic reaction is not severe, dangerous complications sometimes resulting in permanent disability can occur in the baby.
So, here are your current choices (1) GBS culture and antibiotics during labor if positive for GBS (2) No GBS culture and antibiotics during labor if you have clinical risk factors (3) GBS culture and antibiotics during labor if positive AND you have clinical risk factors (4) No GBS culture and alternative or no treatment.
If you birth your baby at home or in a birth center, your midwives will review signs of infection that you should watch for in your baby. If any signs begin to occur, you or your midwife will need to contact your pre-arranged physician. Regardless of whether you had a GBS culture, or what the results were, if your baby shows signs of infection, the baby’s doctor will probably recommend lab studies and antibiotic treatment for your baby in the hospital.
If your baby is delivered in a hospital, treatment depends on whether you had a previous GBS culture, what the results were, and if you have any clinical risk factors. If your baby shows any signs of infection (as above), lab studies and treatment will likely follow.
If you had a positive GBS culture and received antibiotics for at least 4 hours during labor… with no signs of infection (in your baby) and no clinical risk factors, standard protocol in many hospitals is to perform a blood culture on your baby and observe for signs of infection for 48 hours (in hospital). Antibiotics will not usually be given to your baby unless symptoms occur.
If you had a positive GBS culture and received antibiotics for less than 4 hours during labor (or no antibiotics at all)… protocol in many hospitals is to perform a blood culture on your baby, and begin antibiotics immediately. If the culture comes back negative, the antibiotics are stopped and your baby is discharged.
If you had a negative GBS culture… there will be no prolonged observation, and your baby will usually be discharged when you are.
Knowledge is power. The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at www.coastalfamilybirthretreat.com.
Sunday, October 5, 2008
Nuchal Translucency Screening.... Optional Testing During Pregnancy
Nuchal Translucency Screening …
Optional Testing During Pregnancy
By Valerie Jacques, RN, CPM, NHCM
This is the seventh in a series of articles exploring testing procedures available for you and your baby during pregnancy
This test, also called the Nuchal Fold Scan, is a prenatal screening test designed to help your healthcare professional access your baby’s risk for chromosomal abnormalities such as Down Syndrome. The test can also be used to detect major congenital heart problems. Testing must be performed when you are between 11 and 14 weeks pregnant (if you want the test performed, the last day that you can have it done is the day you turn 13 weeks and 6 days).
Nuchal Translucency Screening is painless, and poses no risk to you or your baby. However, it does not provide definitive diagnostic data, but is much less invasive than other tests such as CVS (testing a sample of Mom’s chorionic villi cells from her placenta), or amniocentesis (testing a sample of Mom’s amniotic fluid), and it can help you to decide if you want to have additional testing performed.
Ultrasound is used to measure the translucent space in the tissue at the back of your baby’s neck… that measurement is the key to determining risk. Babies with more fluid in the translucent space described above (during the first trimester), cause this space to be larger, indicating potential problems. Babies accumulating more fluid at the back of their neck during the first trimester are more likely to have abnormalities, although this test is not conclusive.
To begin the test, the sonographer confirms your baby’s gestational age. This is done by measuring the length of your baby from head to rump and comparing the measurement to standard data to determine if he/she is about the right size for his/her age. Next, a sensor (transducer) is positioned over Mom’s abdomen so that baby’s nuchal fold area shows up on the monitor. Finally, the sonographer uses a caliper (measuring device) to measure the thickness of the space in the fold.
Your baby’s nuchal fold measurement (which normally gets thicker every day) will be used in a formula (which includes your baby’s gestational age and your age) to determine your baby’s chances of having a chromosomal abnormality. Previous data gathered from this test (from thousands of babies) have allowed researchers to build a statistical database, which makes this possible. In general, the thicker the nuchal fold measurement at a given gestational age, the higher chance for chromosomal problems.
Knowledge is power! The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at http://www.coastalfamilybirthretreat.com/.
Optional Testing During Pregnancy
By Valerie Jacques, RN, CPM, NHCM
This is the seventh in a series of articles exploring testing procedures available for you and your baby during pregnancy
This test, also called the Nuchal Fold Scan, is a prenatal screening test designed to help your healthcare professional access your baby’s risk for chromosomal abnormalities such as Down Syndrome. The test can also be used to detect major congenital heart problems. Testing must be performed when you are between 11 and 14 weeks pregnant (if you want the test performed, the last day that you can have it done is the day you turn 13 weeks and 6 days).
Nuchal Translucency Screening is painless, and poses no risk to you or your baby. However, it does not provide definitive diagnostic data, but is much less invasive than other tests such as CVS (testing a sample of Mom’s chorionic villi cells from her placenta), or amniocentesis (testing a sample of Mom’s amniotic fluid), and it can help you to decide if you want to have additional testing performed.
Ultrasound is used to measure the translucent space in the tissue at the back of your baby’s neck… that measurement is the key to determining risk. Babies with more fluid in the translucent space described above (during the first trimester), cause this space to be larger, indicating potential problems. Babies accumulating more fluid at the back of their neck during the first trimester are more likely to have abnormalities, although this test is not conclusive.
To begin the test, the sonographer confirms your baby’s gestational age. This is done by measuring the length of your baby from head to rump and comparing the measurement to standard data to determine if he/she is about the right size for his/her age. Next, a sensor (transducer) is positioned over Mom’s abdomen so that baby’s nuchal fold area shows up on the monitor. Finally, the sonographer uses a caliper (measuring device) to measure the thickness of the space in the fold.
Your baby’s nuchal fold measurement (which normally gets thicker every day) will be used in a formula (which includes your baby’s gestational age and your age) to determine your baby’s chances of having a chromosomal abnormality. Previous data gathered from this test (from thousands of babies) have allowed researchers to build a statistical database, which makes this possible. In general, the thicker the nuchal fold measurement at a given gestational age, the higher chance for chromosomal problems.
Knowledge is power! The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at http://www.coastalfamilybirthretreat.com/.
Thursday, August 21, 2008
Informed Consent and Your Birthing Expeience
Informed Consent and Your Birthing Experience
By Valerie Jacques, RN, CPM, NHCM
Informed consent is consent given by a client (pregnant mom) after having received detailed information regarding the proposal of any medical treatment. Every woman is entitled to decide whatever is performed on her body…any procedure done without her explicit consent may be construed as bodily assault.
The purpose of informed consent is many fold, and includes: maintaining trust between Mom and Midwives (or other health professionals), enabling Mom to participate in the decision making process when it comes to her care, avert patronizing attitudes by practitioners, minimize doubt and maximize information, and to ensure control by Mom against infringement of privacy.
Explanations given to Mom before informed consent is obtained include: detailed information as to the nature of Mom’s care (purpose, benefits, chances of success), risks associated with care (including potential side effects), and chances and risks associated with alternative therapies or lack of treatment.
Moms are encouraged to discuss topics of concern with several health professionals as well as to research other available resources. One final note… due to variability of any given situation, not all circumstances can be predicted. Your health professional will provide the best information available in order to help you make the best possible decisions for you and your baby.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at www.coastalfamilybirthretreat.com.
By Valerie Jacques, RN, CPM, NHCM
Informed consent is consent given by a client (pregnant mom) after having received detailed information regarding the proposal of any medical treatment. Every woman is entitled to decide whatever is performed on her body…any procedure done without her explicit consent may be construed as bodily assault.
The purpose of informed consent is many fold, and includes: maintaining trust between Mom and Midwives (or other health professionals), enabling Mom to participate in the decision making process when it comes to her care, avert patronizing attitudes by practitioners, minimize doubt and maximize information, and to ensure control by Mom against infringement of privacy.
Explanations given to Mom before informed consent is obtained include: detailed information as to the nature of Mom’s care (purpose, benefits, chances of success), risks associated with care (including potential side effects), and chances and risks associated with alternative therapies or lack of treatment.
Moms are encouraged to discuss topics of concern with several health professionals as well as to research other available resources. One final note… due to variability of any given situation, not all circumstances can be predicted. Your health professional will provide the best information available in order to help you make the best possible decisions for you and your baby.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at www.coastalfamilybirthretreat.com.
What's your "position" on delivery?
What’s your “position” on delivery?
By Valerie Jacques, RN, NHPM
Today In the US, most births occur with Mom in the traditional supine position. Not so long ago, however, (1800’s) most mothers used a squatting or sitting (even kneeling) posture to facilitate the birthing process.
In the 1900’s, with increasing regularity, the supine position was paired with ideas such as the delivery table, stirrups, and the increased use of forceps. Along with increased use of anesthesia, these ideas formed the basis for the late labor and delivery standard, which is still in use today.
There is evidence suggesting that delivering your child in the supine position (especially when using stirrups) decreases circulation and increases the chances of perineal tearing. On the other hand, women who choose a naturally comfortable labor/delivery position usually gain advantages. The squatting position, for example, provides a larger pelvic outlet opening (obvious advantage) than the supine position.
There has been, and still is, much discussion as to what the “proper” position should be in the late laboring phases. What’s the bottom line…it’s what is the most comfortable and safe position for Mom and baby. Kneeling, squatting, sitting (birthing chair), warm birth tub, lying down (sideways most preferred), even hands and knees. Combinations of these positions during labor and delivery can help ease stress on Mom and baby, and provide for a more enjoyable birthing experience.
Valerie Jacques is a NH Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-580-2327, or at www.coastalfamilybirthretreat.com.
By Valerie Jacques, RN, NHPM
Today In the US, most births occur with Mom in the traditional supine position. Not so long ago, however, (1800’s) most mothers used a squatting or sitting (even kneeling) posture to facilitate the birthing process.
In the 1900’s, with increasing regularity, the supine position was paired with ideas such as the delivery table, stirrups, and the increased use of forceps. Along with increased use of anesthesia, these ideas formed the basis for the late labor and delivery standard, which is still in use today.
There is evidence suggesting that delivering your child in the supine position (especially when using stirrups) decreases circulation and increases the chances of perineal tearing. On the other hand, women who choose a naturally comfortable labor/delivery position usually gain advantages. The squatting position, for example, provides a larger pelvic outlet opening (obvious advantage) than the supine position.
There has been, and still is, much discussion as to what the “proper” position should be in the late laboring phases. What’s the bottom line…it’s what is the most comfortable and safe position for Mom and baby. Kneeling, squatting, sitting (birthing chair), warm birth tub, lying down (sideways most preferred), even hands and knees. Combinations of these positions during labor and delivery can help ease stress on Mom and baby, and provide for a more enjoyable birthing experience.
Valerie Jacques is a NH Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-580-2327, or at www.coastalfamilybirthretreat.com.
Non-Stress Test / Biophysical Profile / Contraction Stress Test
Non-Stress Test / Biophysical Profile / Contraction Stress Test
Optional Testing During Pregnancy
By Valerie Jacques, RN, CPM, NHCM
This is the sixth in a series of articles exploring testing procedures available for you and your baby during pregnancy.
These three tests, the Non-Stress Test (NST), Biophysical Profile (BPP), and the Contraction Stress Test (CST) are designed to monitor your baby’s well being. They are usually run when there is a question concerning abnormal heart tones, maternal disease, post-maturity, lack of baby movement, or other questions concerning the health of your child.
The NST is usually performed in your health professional’s office or in a hospital. The test requires Mom to wear an external electronic fetal monitor (EFM) for a period of time, The EFM records the baby’s heart rate, displaying variability, movement, and reactivity.
The BPP offers an overall well-rounded assessment of placental, cord, and baby well- being. The test requires Mom to wear an external electronic fetal monitor and also requires a sonogram (Ultrasound). Information obtained from the BPP allows your health professional to determine important information about your baby’s health, including: muscle tone, reactivity, gross body movements, volume of amniotic fluid in the uterus, the condition or grade of the placenta, and baby’s breathing movements.
The CST is similar to the NST, except the test is conducted with the uterus contracting. Contractions are stimulated by using a low dose of oxytocin (in an IV drip), or by nipple stimulation. This test assesses the well being of your baby, but beyond that, it is a predictor of how well your baby will stand up to the stress of labor. This test runs the risk of placing Mom in premature labor, and therefore should not be conducted unless your health professional indicates (after discussion with you) that it is necessary for the continued health of you and your child.
Since the risks, accuracy, and interpretation of these tests include many variables, they should not be performed unless there is a specific need as explained to you by your health professional.
Knowledge is power. The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at www.coastalfamilybirthretreat.com.
Optional Testing During Pregnancy
By Valerie Jacques, RN, CPM, NHCM
This is the sixth in a series of articles exploring testing procedures available for you and your baby during pregnancy.
These three tests, the Non-Stress Test (NST), Biophysical Profile (BPP), and the Contraction Stress Test (CST) are designed to monitor your baby’s well being. They are usually run when there is a question concerning abnormal heart tones, maternal disease, post-maturity, lack of baby movement, or other questions concerning the health of your child.
The NST is usually performed in your health professional’s office or in a hospital. The test requires Mom to wear an external electronic fetal monitor (EFM) for a period of time, The EFM records the baby’s heart rate, displaying variability, movement, and reactivity.
The BPP offers an overall well-rounded assessment of placental, cord, and baby well- being. The test requires Mom to wear an external electronic fetal monitor and also requires a sonogram (Ultrasound). Information obtained from the BPP allows your health professional to determine important information about your baby’s health, including: muscle tone, reactivity, gross body movements, volume of amniotic fluid in the uterus, the condition or grade of the placenta, and baby’s breathing movements.
The CST is similar to the NST, except the test is conducted with the uterus contracting. Contractions are stimulated by using a low dose of oxytocin (in an IV drip), or by nipple stimulation. This test assesses the well being of your baby, but beyond that, it is a predictor of how well your baby will stand up to the stress of labor. This test runs the risk of placing Mom in premature labor, and therefore should not be conducted unless your health professional indicates (after discussion with you) that it is necessary for the continued health of you and your child.
Since the risks, accuracy, and interpretation of these tests include many variables, they should not be performed unless there is a specific need as explained to you by your health professional.
Knowledge is power. The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at www.coastalfamilybirthretreat.com.
Chorionic Villus Sampling... Optional Testing During Pregnancy
Chorionic Villus Sampling…
Optional Testing During Pregnancy
By Valerie Jacques, RN, CPM, NHCM
This is the fifth in a series of articles exploring testing procedures available for you and your baby during pregnancy
Chorionic Villus Sampling (CVS) is a testing procedure performed during the first tri-nester of pregnancy, usually between 10 and 12 weeks gestation. CVS tests for early detection of fetal abnormalities such as muscular dystrophy, genetic mutations, cystic fibrosis, downs syndrome, amino acid disorders, hemophilia, and fetal infection.
Moms who should consider CVS testing include those who already have children with disorders, those who are carriers of inheritable disorders, and those whose health professional otherwise indicate the need.
In order to test for potential problems, a small number of chorionic villus cells must be removed from Mom’ placenta. This can be done in one of three ways; cells can be removed from the abdomen using a long sterile needle, from the vagina, using the same procedure, and finally, from the cervix using a thin catheter. The procedure is carried out in a clinic or hospital setting, with ultrasound equipment used to guide the catheter or needle, depending on which method is chosen.
Risks associated with the above described procedure include; infection, cervical lacerations, damage to your unborn child, miscarriage, and hemorrhage. False positive test results are possible, and as with other pregnancy tests, a normal result does not guarantee a normal baby at birth. Mom and Dad should seriously weigh the benefits versus the risks of this procedure before proceeding.
Knowledge is power! The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at www.coastalfamilybirthretreat.com.
Optional Testing During Pregnancy
By Valerie Jacques, RN, CPM, NHCM
This is the fifth in a series of articles exploring testing procedures available for you and your baby during pregnancy
Chorionic Villus Sampling (CVS) is a testing procedure performed during the first tri-nester of pregnancy, usually between 10 and 12 weeks gestation. CVS tests for early detection of fetal abnormalities such as muscular dystrophy, genetic mutations, cystic fibrosis, downs syndrome, amino acid disorders, hemophilia, and fetal infection.
Moms who should consider CVS testing include those who already have children with disorders, those who are carriers of inheritable disorders, and those whose health professional otherwise indicate the need.
In order to test for potential problems, a small number of chorionic villus cells must be removed from Mom’ placenta. This can be done in one of three ways; cells can be removed from the abdomen using a long sterile needle, from the vagina, using the same procedure, and finally, from the cervix using a thin catheter. The procedure is carried out in a clinic or hospital setting, with ultrasound equipment used to guide the catheter or needle, depending on which method is chosen.
Risks associated with the above described procedure include; infection, cervical lacerations, damage to your unborn child, miscarriage, and hemorrhage. False positive test results are possible, and as with other pregnancy tests, a normal result does not guarantee a normal baby at birth. Mom and Dad should seriously weigh the benefits versus the risks of this procedure before proceeding.
Knowledge is power! The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at www.coastalfamilybirthretreat.com.
Toxoplasmosis... Optional Testing During Pregnancy
Toxoplasmosis…
Optional Testing During Pregnancy
By Valerie Jacques, RN, CPM, NHCM
This is the fourth in a series of articles exploring testing procedures available for you and your baby during pregnancy.
Toxoplasmosis is a parasite, usually transmitted to humans by handling or eating poorly cooked or raw meats. The parasite can also be transmitted via cat, bird, rodent and other animal feces. The infection is asymptomatic (Mom may be without symptoms), but may cause numerous serious birth defects such as liver/spleen enlargement, blindness, and brain damage.
The test for toxoplasmosis is best performed very early in pregnancy. If Mom tests negative for the parasite, a second test is usually suggested again at about 20 weeks. The test consists of a simple blood draw followed by laboratory analysis. The results of testing will show if Mom is (1) immune to toxoplasmosis, (2) has previously been infected, or (3) is presently infected.
In the case of a positive test result (active infection), treatment with medication may inhibit or prevent harm to your baby. However there is no guarantee, and the determination of a successful treatment cannot be established until after your baby is born. Therefore it is essential that Mom avoid all exposure to risk of parasite transmission.
You may want to consider asking a friend or relative to board your cat or pet bird for the duration of your pregnancy, as the presence of active birdcages or cat litter boxes pose a potential threat. If you decide to keep your pets during pregnancy, make sure you do not clean cages or litter boxes. While the toxoplasmosis parasite seldom causes direct harm to adults, it can be devastating to your baby.
The severity of the effects on the baby depend on the stage in the pregnancy at which the disease was caught. If the infection occurs early in the pregnancy, the baby may be miscarried or stillborn. If infected between the third and sixth month of pregnancy, the baby may develop some or all of the following severe symptoms:
· Hydrocephalus (an excess of fluid on the brain)
· Brain lesions (scarring of the brain tissue)
· Eye damage (retinochoroditis)
Hydrocephalus and brain lesions can cause mental retardation and epilepsy while retinochoroditis causes partial sight or may cause blindness. The symptoms, particularly retinochoroditis, may sometimes develop at any stage of childhood or adulthood.
Knowledge is power. The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at www.coastalfamilybirthretreat.com.
Optional Testing During Pregnancy
By Valerie Jacques, RN, CPM, NHCM
This is the fourth in a series of articles exploring testing procedures available for you and your baby during pregnancy.
Toxoplasmosis is a parasite, usually transmitted to humans by handling or eating poorly cooked or raw meats. The parasite can also be transmitted via cat, bird, rodent and other animal feces. The infection is asymptomatic (Mom may be without symptoms), but may cause numerous serious birth defects such as liver/spleen enlargement, blindness, and brain damage.
The test for toxoplasmosis is best performed very early in pregnancy. If Mom tests negative for the parasite, a second test is usually suggested again at about 20 weeks. The test consists of a simple blood draw followed by laboratory analysis. The results of testing will show if Mom is (1) immune to toxoplasmosis, (2) has previously been infected, or (3) is presently infected.
In the case of a positive test result (active infection), treatment with medication may inhibit or prevent harm to your baby. However there is no guarantee, and the determination of a successful treatment cannot be established until after your baby is born. Therefore it is essential that Mom avoid all exposure to risk of parasite transmission.
You may want to consider asking a friend or relative to board your cat or pet bird for the duration of your pregnancy, as the presence of active birdcages or cat litter boxes pose a potential threat. If you decide to keep your pets during pregnancy, make sure you do not clean cages or litter boxes. While the toxoplasmosis parasite seldom causes direct harm to adults, it can be devastating to your baby.
The severity of the effects on the baby depend on the stage in the pregnancy at which the disease was caught. If the infection occurs early in the pregnancy, the baby may be miscarried or stillborn. If infected between the third and sixth month of pregnancy, the baby may develop some or all of the following severe symptoms:
· Hydrocephalus (an excess of fluid on the brain)
· Brain lesions (scarring of the brain tissue)
· Eye damage (retinochoroditis)
Hydrocephalus and brain lesions can cause mental retardation and epilepsy while retinochoroditis causes partial sight or may cause blindness. The symptoms, particularly retinochoroditis, may sometimes develop at any stage of childhood or adulthood.
Knowledge is power. The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at www.coastalfamilybirthretreat.com.
Neonatal Conjunctivitis...Optional Testing During Pregnancy
Neonatal Conjunctivitis…
Optional Testing During Pregnancy
By Valerie Jacques, RN, CPM, NHCM
This is the third in a series of articles exploring testing procedures available for you and your baby during pregnancy.
Neonatal Conjunctivitis is a red eye condition in your newborn, which can be caused by an irritation, an infection, or a blocked tear duct. Conjunctivitis is also known by other names, such as Conjunctivitis of the newborn, Newborn conjunctivitis, and Opthalmia Neonatorum
If Newborn Conjunctivitis is caused by a blocked tear duct, or by an irritation (usually from antibiotic eye drops given shortly after birth), it is not considered a serious condition. If, however the cause is determined to be from infection, then the condition can be very serious. The most common bacterial infections causing Newborn Conjunctivitis are Gonorrhea and Chlamydia. Both are easily passed from Mom to baby during birth. Gonorrhea induced conjunctivitis may cause perforation of the cornea along with severe damage of other deeper eye structures…Chlamydia induced conjunctivitis is usually less destructive.
Genital and oral herpes viruses can also cause neonatal conjunctivitis, with severe eye damage a real possibility. As with Gonorrhea and Chlamydia, these viruses are usually passed to your baby as he/she passes through the birth canal, however herpes conjunctivitis is less common than Gonorrhea and Chlamydia.
The previous named viruses are usually transferred to Mom as sexually transmitted diseases (STD’s). Chlamydia is thought to be the most common STD in the US today and therefore Chlamydia conjunctivitis is seen on average 10 times greater than that of gonorrheal conjunctivitis. Mom may be without symptoms at delivery time, yet still pass bacteria or viruses to her newborn, which are capable of causing conjunctivitis.
In order to help prevent disease, all hospitals routinely administer some form of eye drops to every newborn. Silver nitrate used to be the standard, however some form of antibiotic drops (such as erythromycin) is becoming more standard.
Symptoms include:
Watery, bloody drainage from your baby’s eye(s)
Thick puss-like drainage from your baby’s eye(s)
Swollen, tender, or puffy red eyelids
Available testing:
Laboratory culture of the drainage from the eye
Slit-lamp examination – detects corneal ulcerations, perforations and other abnormal eye conditions.
Standard ophthalmologic exam
Complications can include:
· Corneal scarring
· Blindness
· Perforation of the cornea
· Inflammation of the iris
· Chlamydial pneumonia
Treatment depends on the severity of your baby’s condition. Topical antibiotic eye drops and ointments may be prescribed for mild cases. For more severe conditions, oral or intravenous antibiotics may be necessary in conjunction with ointment and eye drops. The eye(s) are usually irrigated with a saline solution on a regular schedule in order to remove accumulated drainage.
Conjunctivitis caused by irritation from the eye drops given routinely after birth at a hospital usually corrects itself. And if your baby develops conjunctivitis from a blocked tear duct, a warm gentle massage between the eye and nose may help.
Babies who develop conjunctivitis, and are quickly treated, generally have good outcomes. Early recognition and treatment of infected Moms (for STD’s) has helped to keep conjunctivitis to relatively low levels. If Mom’s infection goes unnoticed, then the standard regiment of eye drops given to newborns help prevent infection.
So what are your options? First, consult your copy of the Informed Consent Agreement, which was given to you by your health provider; this will answer many of your questions. Second, if you suspect that you have an STD, you should seriously consider testing, and if the presence of an STD is found, treatment should be obtained to prevent transmission to your baby during birth. Although administration of antibiotics to newborns is the standard of care, discussing your STD with your provider may offer other options.
The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional. Knowledge is power.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at http://www.coastalfamilybirthretreat.com/.
Optional Testing During Pregnancy
By Valerie Jacques, RN, CPM, NHCM
This is the third in a series of articles exploring testing procedures available for you and your baby during pregnancy.
Neonatal Conjunctivitis is a red eye condition in your newborn, which can be caused by an irritation, an infection, or a blocked tear duct. Conjunctivitis is also known by other names, such as Conjunctivitis of the newborn, Newborn conjunctivitis, and Opthalmia Neonatorum
If Newborn Conjunctivitis is caused by a blocked tear duct, or by an irritation (usually from antibiotic eye drops given shortly after birth), it is not considered a serious condition. If, however the cause is determined to be from infection, then the condition can be very serious. The most common bacterial infections causing Newborn Conjunctivitis are Gonorrhea and Chlamydia. Both are easily passed from Mom to baby during birth. Gonorrhea induced conjunctivitis may cause perforation of the cornea along with severe damage of other deeper eye structures…Chlamydia induced conjunctivitis is usually less destructive.
Genital and oral herpes viruses can also cause neonatal conjunctivitis, with severe eye damage a real possibility. As with Gonorrhea and Chlamydia, these viruses are usually passed to your baby as he/she passes through the birth canal, however herpes conjunctivitis is less common than Gonorrhea and Chlamydia.
The previous named viruses are usually transferred to Mom as sexually transmitted diseases (STD’s). Chlamydia is thought to be the most common STD in the US today and therefore Chlamydia conjunctivitis is seen on average 10 times greater than that of gonorrheal conjunctivitis. Mom may be without symptoms at delivery time, yet still pass bacteria or viruses to her newborn, which are capable of causing conjunctivitis.
In order to help prevent disease, all hospitals routinely administer some form of eye drops to every newborn. Silver nitrate used to be the standard, however some form of antibiotic drops (such as erythromycin) is becoming more standard.
Symptoms include:
Watery, bloody drainage from your baby’s eye(s)
Thick puss-like drainage from your baby’s eye(s)
Swollen, tender, or puffy red eyelids
Available testing:
Laboratory culture of the drainage from the eye
Slit-lamp examination – detects corneal ulcerations, perforations and other abnormal eye conditions.
Standard ophthalmologic exam
Complications can include:
· Corneal scarring
· Blindness
· Perforation of the cornea
· Inflammation of the iris
· Chlamydial pneumonia
Treatment depends on the severity of your baby’s condition. Topical antibiotic eye drops and ointments may be prescribed for mild cases. For more severe conditions, oral or intravenous antibiotics may be necessary in conjunction with ointment and eye drops. The eye(s) are usually irrigated with a saline solution on a regular schedule in order to remove accumulated drainage.
Conjunctivitis caused by irritation from the eye drops given routinely after birth at a hospital usually corrects itself. And if your baby develops conjunctivitis from a blocked tear duct, a warm gentle massage between the eye and nose may help.
Babies who develop conjunctivitis, and are quickly treated, generally have good outcomes. Early recognition and treatment of infected Moms (for STD’s) has helped to keep conjunctivitis to relatively low levels. If Mom’s infection goes unnoticed, then the standard regiment of eye drops given to newborns help prevent infection.
So what are your options? First, consult your copy of the Informed Consent Agreement, which was given to you by your health provider; this will answer many of your questions. Second, if you suspect that you have an STD, you should seriously consider testing, and if the presence of an STD is found, treatment should be obtained to prevent transmission to your baby during birth. Although administration of antibiotics to newborns is the standard of care, discussing your STD with your provider may offer other options.
The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional. Knowledge is power.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at http://www.coastalfamilybirthretreat.com/.
Gestational Diabetes...Optional Testing During Pregnancy
Gestational Diabetes…
Optional Testing During Pregnancy
By Valerie Jacques, RN, CPM, NHCM
This is the second in a series of articles exploring testing procedures available for you and your baby during pregnancy.
Gestational diabetes is a form of the disease, which manifests itself in 2% to 5% of pregnant woman (only occurring during pregnancy). As with other forms of diabetes, the body is unable to effectively use glucose (a simple sugar that your body converts into energy). Normally, glucose is used by the cells of your body with the help of insulin (a hormone produced by the pancreas).
In the case of the pregnant Mom, insulin is blocked from doing its intended job by certain pregnancy hormones. When this happens, glucose builds up in Mom’s blood, and if not treated, can harm both Mom and baby. The risks associated with gestational diabetes include:
· Newborn hypoglycemia - low blood sugar in your baby
· Jaundice - your baby has a yellowish skin tone, which is associated with a buildup of red bile pigment (bilirubin) in his/her bloodstream.
· High blood pressure (Mom)
· Premature birth
· Macrosomia - birthing a very large baby (10 pounds or more), which occurs because your baby was exposed to high glucose levels in your body and has stored the glucose as fat.
· Birth trauma (for Mom and baby) – due to birthing a large baby
· Miscarriage
· Birth defects (rare)
· Stillbirth (rare)
Gestational diabetes usually manifests itself about halfway through the pregnancy, therefore the test for the disease is generally administered between 24 and 28 weeks into the pregnancy. The test requires Mom to give a blood sample, which is analyzed for glucose content. If the initial test is positive, it may be necessary to conduct a second, more sensitive test for the disease.
There may be no apparent symptoms prior to testing for the disease, therefore it important to have screening. If symptoms do occur however, they may include the following: increased thirst, increased urination, fatigue, nausea, vomiting, blurred vision and frequent infections (especially bladder, vaginal and skin infections).
Risk factors for gestational diabetes include: history of diabetes in your family, a previous pregnancy with gestational diabetes, age (Mom is over 25 years old), weight (Mom was overweight before becoming pregnant), having glucose present in Mom’s urine (glucosuria), hypertension, having too much amniotic fluid (polyhydramnios), having given birth previously to a very large baby, stillbirth, and race (Black, Hispanic, and Indian women are at more risk…the reasons are yet unclear).
Treatment consists of controlling the level of glucose in Mom’s bloodstream, and is essential in order to keep Mom and her baby healthy. The good new is that most Moms are able to control their blood sugar with diet and exercise. In some cases, however lifestyle changes and/or medication may be necessary in addition. If Mom is diagnosed with gestational diabetes, it will be necessary to monitor the level of glucose in her blood closely for the balance of the pregnancy, assuring that levels are staying in the normal range.
The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional. Knowledge is power.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at http://www.coastalfamilybirthretreat.com/.
Optional Testing During Pregnancy
Optional Testing During Pregnancy
Group Beta Streptococcus
By Valerie Jacques, RN, CPM, NHCM
This is the first in a series of articles exploring testing procedures available for you and your baby during pregnancy.
There are many decisions to be made when you become pregnant; one of the most important is the continued health of your baby. This article (and others to follow) will help explain the various testing procedures, when a particular test should be run (if at all), and what the benefits and drawbacks are.
Group Beta Streptococcus (GBS) is a common strain of bacteria found in about 4 out of 10 adults. Ordinarily, GBS does not cause a problem; in fact it is considered a normal organism. However, it does cause a potential problem for pregnant women. It is possible to pass the GBS organism from Mom to baby during birth, and it can be fatal in itself to your newborn (5%-15% fatality rate despite antibiotic treatment). Sepsis, serious infection throughout your baby’s body (also referred to as GBS disease) is the culprit. GBS can also be the cause of other potential life-threatening trauma such as pneumonia and meningitis. Permanent neurological damage to your newborn is also a possibility.
Babies who are most likely to develop GBS disease are born of mothers who are carriers of the GBS bacteria AND have one or more specific clinical risk factors. Those factors are: Previous baby with GBS disease, urinary tract infection during pregnancy (with GBS), onset of labor before 37 weeks, rupture of membranes before 37 weeks, rupture of membranes more than 18 hours before birth, and fever over 100.4 degrees Fahrenheit during labor. Other risks of GBS include: Urinary tract infection (Mom), and pre term labor.
GBS resides in the vaginal and/or rectal areas, and is tested for by a simple swab at or about 36 weeks of pregnancy. This is the best time in the pregnancy to get the most accurate prediction of whether or not Mom is a carrier of GBS. However, GBS can be erratic, appearing and disappearing without treatment. If the test is positive, relatively simple protocols of herbs, oral antibiotics, or intravenous antibiotics administered during labor are available.
But not all interested parties agree on who should be tested or if antibiotics should be administered. Some (the Group B Strep Association, for example) advocate universal testing for all pregnant women and antibiotic treatment for those who test positive for GBS. Others (The Centers for Disease Control and others) recommend one of two strategies: (1) universal testing followed by antibiotics for those testing positive, or (2) no universal testing but antibiotics for those with clinical risk factors (paragraph 3).
So why not test all Moms to be, and administer antibiotics to those who test positive, and be done with it? Because, of those Moms testing positive for GBS, about 95% of their babies would not get GBS even if not treated….and there are risks to administering antibiotics. Risks include: allergic reactions (from mild to possibly fatal…1 in 10,000 for penicillin, even for those with no prior known allergy to penicillin) and the fact that wide spread use of antibiotics can increase the chance that drug resistant strains of an organism will develop. Furthermore, even if Mom’s allergic reaction is not severe, dangerous complications sometimes resulting in permanent disability can occur in the baby.
So, here are your current choices (1) GBS culture and antibiotics during labor if positive for GBS (2) No GBS culture and antibiotics during labor if you have clinical risk factors (3) GBS culture and antibiotics during labor if positive AND you have clinical risk factors (4) No GBS culture and alternative or no treatment.
If you birth your baby at home or in a birth center, your midwives will review signs of infection that you should watch for in your baby. If any signs begin to occur, you or your midwife will need to contact your pre-arranged physician. Regardless of whether you had a GBS culture, or what the results were, if your baby shows signs of infection, the baby’s doctor will probably recommend lab studies and antibiotic treatment for your baby in the hospital.
If your baby is delivered in a hospital, treatment depends on whether you had a previous GBS culture, what the results were, and if you have any clinical risk factors. If your baby shows any signs of infection (as above), lab studies and treatment will likely follow.
If you had a positive GBS culture and received antibiotics for at least 4 hours during labor… with no signs of infection (in your baby) and no clinical risk factors, standard protocol in many hospitals is to perform a blood culture on your baby and observe for signs of infection for 48 hours (in hospital). Antibiotics will not usually be given to your baby unless symptoms occur.
If you had a positive GBS culture and received antibiotics for less than 4 hours during labor (or no antibiotics at all)… protocol in many hospitals is to perform a blood culture on your baby, and begin antibiotics immediately. If the culture comes back negative, the antibiotics are stopped and your baby is discharged.
If you had a negative GBS culture… there will be no prolonged observation, and your baby will usually be discharged when you are.
Knowledge is power. The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at http://www.coastalfamilybirthretreat.com/.
Group Beta Streptococcus
By Valerie Jacques, RN, CPM, NHCM
This is the first in a series of articles exploring testing procedures available for you and your baby during pregnancy.
There are many decisions to be made when you become pregnant; one of the most important is the continued health of your baby. This article (and others to follow) will help explain the various testing procedures, when a particular test should be run (if at all), and what the benefits and drawbacks are.
Group Beta Streptococcus (GBS) is a common strain of bacteria found in about 4 out of 10 adults. Ordinarily, GBS does not cause a problem; in fact it is considered a normal organism. However, it does cause a potential problem for pregnant women. It is possible to pass the GBS organism from Mom to baby during birth, and it can be fatal in itself to your newborn (5%-15% fatality rate despite antibiotic treatment). Sepsis, serious infection throughout your baby’s body (also referred to as GBS disease) is the culprit. GBS can also be the cause of other potential life-threatening trauma such as pneumonia and meningitis. Permanent neurological damage to your newborn is also a possibility.
Babies who are most likely to develop GBS disease are born of mothers who are carriers of the GBS bacteria AND have one or more specific clinical risk factors. Those factors are: Previous baby with GBS disease, urinary tract infection during pregnancy (with GBS), onset of labor before 37 weeks, rupture of membranes before 37 weeks, rupture of membranes more than 18 hours before birth, and fever over 100.4 degrees Fahrenheit during labor. Other risks of GBS include: Urinary tract infection (Mom), and pre term labor.
GBS resides in the vaginal and/or rectal areas, and is tested for by a simple swab at or about 36 weeks of pregnancy. This is the best time in the pregnancy to get the most accurate prediction of whether or not Mom is a carrier of GBS. However, GBS can be erratic, appearing and disappearing without treatment. If the test is positive, relatively simple protocols of herbs, oral antibiotics, or intravenous antibiotics administered during labor are available.
But not all interested parties agree on who should be tested or if antibiotics should be administered. Some (the Group B Strep Association, for example) advocate universal testing for all pregnant women and antibiotic treatment for those who test positive for GBS. Others (The Centers for Disease Control and others) recommend one of two strategies: (1) universal testing followed by antibiotics for those testing positive, or (2) no universal testing but antibiotics for those with clinical risk factors (paragraph 3).
So why not test all Moms to be, and administer antibiotics to those who test positive, and be done with it? Because, of those Moms testing positive for GBS, about 95% of their babies would not get GBS even if not treated….and there are risks to administering antibiotics. Risks include: allergic reactions (from mild to possibly fatal…1 in 10,000 for penicillin, even for those with no prior known allergy to penicillin) and the fact that wide spread use of antibiotics can increase the chance that drug resistant strains of an organism will develop. Furthermore, even if Mom’s allergic reaction is not severe, dangerous complications sometimes resulting in permanent disability can occur in the baby.
So, here are your current choices (1) GBS culture and antibiotics during labor if positive for GBS (2) No GBS culture and antibiotics during labor if you have clinical risk factors (3) GBS culture and antibiotics during labor if positive AND you have clinical risk factors (4) No GBS culture and alternative or no treatment.
If you birth your baby at home or in a birth center, your midwives will review signs of infection that you should watch for in your baby. If any signs begin to occur, you or your midwife will need to contact your pre-arranged physician. Regardless of whether you had a GBS culture, or what the results were, if your baby shows signs of infection, the baby’s doctor will probably recommend lab studies and antibiotic treatment for your baby in the hospital.
If your baby is delivered in a hospital, treatment depends on whether you had a previous GBS culture, what the results were, and if you have any clinical risk factors. If your baby shows any signs of infection (as above), lab studies and treatment will likely follow.
If you had a positive GBS culture and received antibiotics for at least 4 hours during labor… with no signs of infection (in your baby) and no clinical risk factors, standard protocol in many hospitals is to perform a blood culture on your baby and observe for signs of infection for 48 hours (in hospital). Antibiotics will not usually be given to your baby unless symptoms occur.
If you had a positive GBS culture and received antibiotics for less than 4 hours during labor (or no antibiotics at all)… protocol in many hospitals is to perform a blood culture on your baby, and begin antibiotics immediately. If the culture comes back negative, the antibiotics are stopped and your baby is discharged.
If you had a negative GBS culture… there will be no prolonged observation, and your baby will usually be discharged when you are.
Knowledge is power. The more informed you are, the better prepared you will be to make decisions regarding your health and the health of your baby. For more information on these and other tests during pregnancy, speak with your health provider. Also, look for more information contained in the Informed Consent Agreement provided by your health professional.
Valerie Jacques is a NH Certified Midwife, a Certified Professional Midwife, an RN, and the owner/operator of Coastal Family Birth Retreat in Stratham, NH. She can be reached at 603-502-9452, or at http://www.coastalfamilybirthretreat.com/.
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