Group B Strep

Not a catchy title, huh?  It's a test that all pregnant women are offered around 36 weeks.  I'm not going to lie to you, it's not my favorite topic, mostly because I don't like how it's handled, regardless of where you are giving birth. I've been doing a lot of research on GBS lately.  Allow me to share my findings.

What is Group B Strep, or GBS? 

Group B Strep, or GBS, is a bacteria that lives in the intestines, urinary, and genital tracts of many healthy people. It is generally not serious in adults, but can be life-threatening to a newborn. Most adults do not have symptoms, but occasionally will develop an infection, such as a bladder infection or urinary tract infection. 

Testing:

The Center for Disease Control (CDC) and the American Congress of Obstetricians and Gynecologists (ACOG) recommend that all pregnant women be screened between 35-37 weeks of their pregnancies to determine if they are carriers of GBS. The pregnant woman's vaginal and rectal areas are swabbed during the screening. According to The March of Dimes and the CDC, approximately 25% of pregnant women are found to be colonized with GBS. 

Treatment:

If found positive, antibiotics are administered through an IV during labor. Ideally, antibiotics are given at least 4 hours before the birth. Oral antibiotics given before labor begins has been found to be ineffective, as the bacteria reproduces very rapidly. To date, the only proven strategy to protect a baby from early-onset GBS is IV antibiotics.

 

Two types of Group B Strep: 

1.  Early-onset GBS:  Can cause pneumonia, sepsis, or meningitis.  Symptoms include fever, trouble breathing, and drowsiness.  Symptoms often begin on the first day.  About half of all GBS infections are early-onset. Babies who develop early-onset GBS are more easily treated than late-onset GBS.

2.  Late-onset GBS:  Usually begins between 7 days and 3 months of age.  Symptoms include fever, coughing, congestion, trouble eating, drowsiness, or seizures.   Treatment of antibiotics during labor does not prevent late-onset GBS.   After birth, baby can get GBS from other people who have the infection.  Babies who develop late-onset GBS are not easily treated and are more likely to die.  At this time, there is no prevention for late-onset GBS.

If left untreated, the chances of a baby developing a GBS infection (born to a GBS-positive mother) is 1 in 200. If the mother does receive antibiotics in labor, however, the odds are 1 in 4000 of the baby developing GBS.

There are three significant risk factors that place a GBS-positive woman at risk for her baby developing Group B Strep: 

1.  Fever during labor

2.  Prolonged rupture of membranes (PROM) - water is broken 18 hours or more prior to delivery

3.  Pre-term labor (PTL) - labor begins prior to 37 weeks

If a woman tests positive (or does not know if she is positive or not) and does not receive antibiotics during labor, her baby will receive antibiotics after he/she is born. 

Written by Donna Ryan, Birth Boot Camp.  Adapted from:

GBS Prevention in Newborns, Centers for Disease Control and Prevention, http://www.cdc.gov/groupbstrep/about/prevention.html, May 7, 2012.

Group B Strep Infection, March of Dimes, http://www.marchofdimes.com/pregnancy/prenatalcare_groupbstrep.html, March 2010.

What I Think:

Now that the facts are out of the way....  I've seen this handled so many different ways, and to be honest, they all make me feel kinda yucky.  The CDC is working on a vaccine for GBS, so more options will likely one day be available to pregnant women.  

If a woman is having her baby in the hospital, this is pretty cut and dry.  If she tests positive, she'll have antibiotics in labor.  If she has her baby before she has time to have a full round of antibiotics, they'll treat the baby with antibiotics.

But what about the woman birthing outside the hospital? I've seen several women told to follow a certain regimen so she will test negative at 36 weeks -- tricking the test, in my opinion.  Like mentioned above, if GBS is present, it will grown very rapidly.  I've also seen a number of women prescribed a "vaginal wash" which does not necessarily kill the Group B Strep but does reportedly kill the beneficial bacteria in the vagina.  One of the benefits to a baby being born vaginally is being exposed to that beneficial bacteria.

You should be able to have antibiotics, however, regardless of where you are having your baby.  Check with your care provider on her protocol.  

I've written about my personal feelings about antibiotics here before. I'm not a fan unless truly required.  The GBS symptoms in a baby with early-onset GBS are pretty clear, pretty quick.  The antibiotics given in labor will not prevent a baby from developing late-onset GBS.  With that being said, you still cannot ignore the numbers.   The use of antibiotics during labor in a woman who tested positive for Group B Strep significantly decreases the chances of her baby developing Group B Strep.

Personally, I was never tested for Group B Strep with any of my pregnancies.  Knowing what I know now, maybe I would have been.  If I would have tested positive, I can't say what my choice would have been.  And I'm not about to tell you what your choice should be.  The numbers quoted by the CDC and March of Dimes are lower than what I've read elsewhere.  Some areas of the country report as high as 40% of women test positive for GBS. 

Talk to your care provider and to your partner.  As with everything else, do your research.  Make an informed decision.  If you are planning an unmedicated birth, this is but a blip on the radar.  Not a big deal, just something to be aware of and plan accordingly.

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POOP

That's right, you read the title right. Let's talk about poop for a few minutes. Did you know that you might poop when you push your baby out? Most people never think about this, and others are completely obsessed with the possibility of this happening. I've even had one of my couples have a c-section over this topic. She made it to a 7, everything was going great, and she opted for a c-section. She just could never let go of the fear.

Approximately 30% of women poop when they push their baby out. There is a trend I'm starting to see pop up of offering/pushing enemas to women when they are in labor. I got an email from a friend this week and here is a portion of it: "They gave her an enema before starting pitocin because the doctor didn't want to be pooped on. Yes, he personally told the mom this."  Gotta love the OB that does things for his comfort and not the mom's. 

At any rate, the body, typically at the beginning of labor, will naturally get rid of waste.  She'll usually have loose bowels, sometimes even diarrhea.  She should eat and drink throughout her labor though, which means more waste.  And that's ok!  So, along with all the questions I've given you over the years to ask your care provider, here's another one:

"How do you feel about poop?"

If you are super concerned with pooping when you are pushing your baby out, do the enema.  If it makes you feel more confident, by all means.  Know that I am not advocating the enema whatsoever!  In fact, I'd really just like to see women comfortable with their bodies and not afraid to eat and possibly poop in labor.  But, like all interventions, I believe there is a time and place. 

Let's go back to the mom who just can't let it go, no matter how much her husband and care provider tells her it's ok, it's normal.  They don't care if she poops.  There are some other issues associated with this fear.  At the top of this list is sexual abuse.  Pooping during pushing is not about vanity.  I strongly suggest counseling in this situation.  To most, this topic is funny and only slightly embarrassing.  To others, it's completely paralyzing.  

Last I read, approximately 1 in 4 women have been sexually abused or molested.  Poop has the potential to be a big issue for many women -- even one million per year -- about to give birth.  I can't help but wonder about the women who elect to have a c-section and never experience any labor.  It's a question that simply cannot be asked, and yet, I can't help but wonder.  Is sexual abuse a part of their history?  Labor and birth is an extremely vulnerable time in a woman's life.  She is exposed in every way possible.  It's a lot for a woman who has not been abused or molested to come to grips with.  But for a woman who has endured abuse or molestation, vaginal birth  may be much too overwhelming.  

If you have seen Orgasmic Birth, they address sexual abuse and birth in a very tender story.  The woman is terrified to surrender to the power of her birth.  When she does, she comes out stronger on the other side.  If you have not seen the movie, check it out.  It's about much more than just "orgasmic" birth!

What started out as a funny post, took a very serious turn.  You know me, I can't end like this.  So, in class, the mamas planning a water birth always want to know about pooping in the water.  (My water birth is the only birth I didn't poop!)  I tell them that if they are really worried about it, if the dad will just throw a bunch of tootsie rolls in the water at the time of birth, she'll never know if she pooped or not.  (I've never had anyone actually do it, but it would be a very funny trick to play on a midwife.)

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It's Just an IV -- What's the Big Deal?

I posed a question on my Facebook page this weekend asking if an IV was required at your place of birth.  As expected, the majority of those birthing in the hospital said yes.  I recently had an IV when I went for a colonoscopy, and I must admit, I did not like it.  My number one complaint is that feeling of cold fluid running through my veins.  Not a fan. 

What about for labor though?  Should an IV be a part of a normal labor?  The hospitals think so.

Let's face it -- nearly everyone who finds themselves on the Labor & Delivery floor will have an epidural.  Or an induction.  Likely both.  Before an epidural is placed, a mom will receive a couple of bags of IV fluid.  Epidurals are notorious for causing the blood pressure to drop, so these fluids are necessary.  Here's why they want you to have an IV when you walk through the door:  The minute you say you want an epidural, they can give it to you.  Otherwise, they have to wait for these IV fluids to be administered.  They believe that you will eventually beg for the epidural, no matter how many times you say that you want an unmedicated birth.  I hate to sound paranoid - or make others paranoid - but the truth is quite ugly when we talk about IVs.  You will very likely have other things running through an IV besides saline water, with pitocin at the top of that list.  Even if you don't have pitocin during the labor, you will assuredly have it after your baby is born to "aid" in the delivery of the placenta.  If you have an IV, you won't even know pitocin was added.  They simply do not ask your permission. 

Antibiotics are often added to an IV.  This is given, typically, under three scenarios: 

1) Mom develops a fever.  This could be due to infection, but epidurals cause fevers in many women.  Since we aren't sure either way, antibiotics are administered.
 
2) Water is broken so antibiotics are given routinely, you know, just in case she might develop a fever.  (Can you hear my eye roll?)   

3) Mom tested positive at 36 weeks for Group B Strep and antibiotics are standard procedure.  This post is not a post about GBS, but suffice to say, antibiotics are very necessary if the baby actually acquires GBS on the way out of the birth canal, but only 2 out of 1000 babies that are born to GBS-positive mothers will be affected.   One-third of women will test positive, so that is a lot of women receiving antibiotics -- just in case.   I have strong feelings about antibiotics from my own personal experiences, but you may not care one way or another.  Maybe you feel that it is better to be safe than sorry.  It's a decision each parent needs to make for themselves.

Is an IV ever necessary in labor?  In short, yes.  A woman in labor should be eating and drinking plenty of water.  Water is crucial in helping the uterus work effectively.  Without it, the uterus can become "irritable," often making an IV necessary.  Under these conditions, she'll often experience contractions close together and intense, but only lasting about 30 seconds.  An IV might help her stay hydrated and therefore causing more effective contractions.  If a mom can't keep fluids down, she might also require an IV.  As with all interventions, there is a time and place for everything.  IVs should not, however, be a routine part of a normal labor. 

 It seems that many moms end up consenting to a hep-lock, which is an open vein.  If they need to give you an IV quickly, they won't have to "fumble" to find a vein.  To quote one of my Facebook readers, "They said it was in case there was an emergency and I started to bleed out.   I said "If you're telling me if there isn't anyone here that can save me in an emergency if I dont have an IV line in already then I need to leave because I don't feel safe." They laughed, said good point and left me alone."  The hospital group I refer to in the Fort Worth area, the UNT Health Nurse-Midwives, have not required even a hep-lock for my students unless there was a medical reason to do so.  

One more thing I found extremely interesting about IV use in labor.  This can have a negative effect on breastfeeding.  Mellanie Sheppard, IBCLC, explained this at a Tarrant County Birth Network meeting one evening:  When a woman has IV fluids, she becomes swollen and puffy until the extra fluid has time to leave her body.  This can include extra fluid in the breast.  A woman who didn't think she had flat nipples before now may have a problem with the baby latching properly.  She might be started on a nipple shield and thus started down a road that could have been prevented by simply avoiding the IV in the first place.  

Last week I wrote about various policies that contribute to the high c-section rates and neglectfully left routine IVs off that list.  It should have been there.  Drink your water.  Talk to your care providers.  If you are choosing to birth in the hospital, search out the care providers who practice evidence-based maternity care.  You will likely have to concede on some issues, but choose your "battles" carefully and thoughtfully.   

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The Birth Nazi

I am continuously amazed at the way people twist my words all around.  I have a friend that said that to me the other day.  She said the comments I get on my blog are consistently 50/50 -- some supportive, some thinking I'm void of any compassion whatsoever and have totally lost my marbles.

Most of you don't know me in real life, but suffice it to say, I am very much the same sitting here at the computer as I am in person.  I will tell you what I think, and I'm OK with you telling me what you think, as long as it is kept respectful.  That's why I do not delete comments from my blog, even the ones that more or less call me a Birth Nazi.  You have the right to your opinion, just as I have the right to mine.

Before I go any further, I want to address my use of the word "Nazi" in this post.  I am using this word because I have heard myself referred to in this manner.  The "Soup Nazi" episode of Seinfeld has been laughed about for years, but when used in this manner, it's not funny.  At least I don't think it's funny.  I, personally, am quite offended by the use of the word, especially in reference to myself.  

Let's address a very interesting topic that I read several blog posts and Facebook statuses about this week:  Is it OK, even good, to expect a good birth experience?  According to most of them, no!  At least this is my interpretation:  You shouldn't get your hopes up because you might be let down.

A very fast recap of my birth experiences:  I have had 4 different births.  My first was an epidural birth where I narrowly escaped a c-section.  My second was my most emotional where I definitely experienced that "birth high." My third sucked and was my hardest (no one's fault but my own), and my fourth was the "easiest" but emotionally hard knowing it was my last and my son would never have a brother.  The only birth I cried tears of joy was my second.  The others, I was just mostly glad they were over.  Does that mean they were bad births because I didn't weep with joy?  Of course not.  They were all just different.  I learned very different things from each experience.  I hope those things I learned, I am able to pass on to my students.  Sometimes it's a case of "Do as I say, not as I did!"

There is this idea that Donna Ryan is an unforgiving natural childbirth educator.  If you have an epidural, I will make you feel awful about it.  And a c-section, forget it!  You might-as-well crawl into a hole!

OK, this is what Donna Ryan teaches.  Pay attention, Donna-haters!  I believe that there are some really awful OBs out there that are happiest when they are performing surgery.  They know nothing about natural childbirth and frankly, don't want to know.  They will scare you into an induction or make you beg for an epidural ("haha, let's keep her pit turned high and strap her to a monitor!"), or they will give you an episiotomy so long you will wish you had a c-section.  (Yes, I've heard a nurse say she heard an OB say this.) Are all OBs like this?  Of course not.  They do exist.  I think that the majority of them have not attended natural, intervention-free births enough to know what that looks like, sounds like, or how to help and encourage a couple on this journey.  Most of them will find a way to put you on their turf, where they are comfortable -- in a bed, strapped to a monitor, legs in stirrups, epidural, pitocin, etc.  See past blog post.

There are other resources in your community.  You may have to dig around to find them, but they likely exist.  Resources that support and encourage natural normal birth.  In Fort Worth, Texas there are so many resources available to families -- amazing midwives, in and out of the hospital.  With choices available, you need to use them.  These are the people who will help you have the birth you want -- or in some cases avoid the birth you don't want!  They encourage you to do the opposite of the (bad) OBs;  things like walking, intermittent monitoring, light food and drink throughout labor, choice of pushing positions, and just plain ole encouragement!  What a difference between a nurse (or midwife) saying, "You got this!  You sound wonderful.  Keep making those low, slow sounds," and "Oh, honey, if you think this is hard now, just wait till you're an 8!  Are you sure you don't want an epidural?"  Well, when you put it that way, of course I want an epidural!

I expect my couples to make the appropriate changes if necessary.  Don't ignore the red flags!  Nearly everyone that sits through my class does change their care provider and/or hospital if they see those red flags.  If you ignore them -- now, this does sound harsh, but it's true -- you have no one to blame but yourself for a "bad" birth if you do not make the necessary changes during the pregnancy.  It's not much fun to be left wondering if that c-section really was necessary. 

Your labor should be a wonderful, yet challenging, time in your life.  Your birth team is critical.  I've said that a million times here over the last three years.  Birth is probably the hardest thing you will ever do.  I never paint a rosy picture.  We don't get to pick the way your birth is going to play out, but you will have a very good idea of what normal birth looks like.  We go through lots of variations of normal too.

This is what I teach about an epidural:  You know what normal birth looks like.  You know what to do, what not to do, you have prepared in every way possible (birth team, relaxation, exercise, nutrition, hired a doula), and you know when you are out of the "normal" range, which can mean a lot of different things.  You have the education to know when you are on the path to a c-section.  Many an epidural has saved a mom from a c-section.  We all hope that an epidural is not a part of the birth equation, but sometimes it is, and sometimes it's even a good thing, a necessary intervention that saves a mom from a c-section.

I have never -- not even once -- told a mom that she failed when she had that epidural.  Or a c-section.  I would never do that.  In many instances, I've put myself in their shoes, and have no doubt that I would have made the exact same decision.  Now, I can't say that a mom won't beat herself up over it, but it's not because I made her feel bad. 

Here's the reality:  When people sit through my class and do all the "right" things and their birth does not go as they had hoped (epidural, transfer, c-section), rarely do I have someone seem to dwell on it and have a hard time getting over it.  Most people know that there are things in birth that are not within our control, but you do your part, roll with the punches, understand why those things became necessary in your birth, and move on!  Learn from them.  Don't become a victim of your birth!  I am seeing this all the time.  It's exhausting.  Your birth does not define who you are as a person.  How you deal with things that happen in your life is more important than the actual things that happen. 

There are some midwives that have told me that the reason they refer to my classes is not necessarily because they love The Bradley Method®, but because my couples seem to bounce back easier when things go differently from their original plans.  My couples also know that they can trust them to help them on this road and if they say they need intervention or medication, it's OK to trust them.  Attitude is everything.

I simply want to see women believe in themselves enough to give birth their all.  Sometimes, that may not mean an unmedicated birth.  It might even mean a c-section in the end.  But if you do your part -- not just become a victim of a very broken maternity system -- you will have a good birth!  Does that make me a Birth Nazi?  Then so be it.

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The "F" Word

What is the "F" word in birth?  Got your attention?  You're thinking I'm going to start using profanity here, don't you?  OK, I'm not.  My least favorite word that is thrown around in regards to a laboring woman and a new mom is "Failed."

I've heard references here and other places about failing natural birth because they had an epidural or c-section.  I hate to think of a woman starting out motherhood with this forced -- or self-inflicted -- label.

"Failure to Progress" is the second most common reason given for a c-section -- second only to having had a c-section previously. If you have taken my class, you know how I feel about this "diagnosis."  I can't imagine who thought it was a good idea to tell a woman she "failed to progress."  What was the thought process, who agreed it was a good name, and why on earth do we keep calling it this?!   I don't really believe that it even exists.  I believe that what it really means is: 
1) You did not dilate on our time-clock and your time is out;
2) This induction has failed but we are in too deep at this point and you are expecting a baby out of this ordeal, so we'll throw the blame back on you by telling you that you failed to progress;
3) We might even throw in a CPD diagnosis (the your-baby-is-too-big phenomenon) for good measure;  
4) This is not the Olive Garden -- you cannot sit at this table all night.  The lobby is full and your table is needed.  The servers only have 3 tables and they need to make money.  They can't do that if you occupy this table for their entire shift.

There are many things that contribute to labor taking a long time, but that is not really the point of this post.  Suffice to say,  if a woman is treated respectfully and with encouragement and patience, with care providers trying to get to the root of the "problem," we would have more women birthing their babies vaginally.  

For the sake of this post, let's say that the first-time mom, recovering from a "failed-to-progress" c-section is now trying to breastfeed her baby.  Is she confident that her body is going to produce milk for her baby?  Her body just "failed" her in childbirth, so why should she expect any different from breastfeeding?  It may not even be a conscious thought, but the subconscious is very powerful.  Women who have a c-section are only half as likely to breastfeed their babies as women who birth vaginally.

I believe that people who get information, practice their childbirth method of choice (no matter what that may be), choose their care providers carefully, hire a doula, and basically put their ducks in a row, stack the odds in their favor.  Things might not go as planned, but you did what was necessary on the front end.

I may have told this story before, but indulge me -- now's a great time to bring it out again.  After my friend Jenni gave birth to her first baby (without pain medication), her baby was very lethargic.  She simply could not get the baby to latch on for hours.  There was so much pressure in the hospital to either get the baby to latch or to give the baby a bottle of formula.  She was pretty upset because she really wanted to breastfeed.  We were on the phone (I was in Albuquerque and she was in Salt Lake) and she made a comment about "one out of two wasn't bad."  She had had her natural birth, but just wasn't going to be able to breastfeed.  I told her if she was going to choose one of the two, it should have been breastfeeding.  Her response?  A very hoarse, "Now you tell me!"  Jenni went on to breastfeed her baby for 19 months.

So, yes, birth is so very important, but it is also a few hours of your entire life.  (It's hard for me to say those words, as you can imagine.)  If a mom is so upset about the birth, breastfeeding can be a lifeline for her and her baby.  The Pregnancy Edition of Mothering magazine just had a great article on this topic.  Those hours you will spend breastfeeding and holding your baby are gold.  Wearing your baby, holding your baby, sleeping side by side, getting to know his/her cues.  The kind of parent you become to your child -- this is what ultimately matters.

I am getting off on a tangent.  Coming back to the "F" word -- Ladies, let's not beat ourselves up!  Let's just remove the "F" word from our vocabulary, shall we?  It has no place in our lives.  It's impossible to build self-esteem in ourselves or our children when this word is a part of our lives.   I can't think of a single good reason to use the word "failure" or "failed."  For the record, I would never tell any of my students they "failed" if they had an epidural or c-section.  That is the absolute last thing I would ever want them to think or believe about themselves.  Motherhood is hard enough without being called the "F" word.

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Why I Recommend the UNT Midwives

I am doing something quite different for this post. Instead of picking a topic, I've chosen a group of local midwives to write about. I am continuously sending natural birthing couples their way and I decided to make a post out of it. If you do not live in the Ft. Worth area, I suggest you use this standard in finding a similar type group in your area. I have nothing to gain by promoting this group, by the way. Simply giving information on a group of midwives who are working hard to provide Mother-Friendly care.

If you read my blog regularly, you know how I feel about homebirth. About 25% of the couples that take my class do give birth outside of the hospital. But that leaves 75% in the hospital. That is alright. I understand, having had 2 hospital births before my two homebirths, why couples want to birth in the hospital. The hospitals, however, are not all created equal.

Let me tell you, in a nutshell, why I am singling the UNT Midwives out for this post. They are all CNMs, or Certified Nurse Midwives, and there are five in the group. To be perfectly honest, some are more medically minded than others, as in any group.

There are three reasons I choose this group over the other CNM groups in the area:

1) They are doing water birth at the hospital. Even if you do not think that you want to have a water birth, the fact that you have this option is huge. It's all about options, really. They are not telling you, like the majority of the other hospitals, that they want you chained to a monitor in the bed. Water birth, or at least laboring in water (often called "a midwife's epidural") is a lovely option for moms and babies, and it's wonderful that it has become an option in a hospital setting.

2) They give you the full 14 days "over" your "due date" before they start talking induction. I have decided in my seven years of teaching that the majority of women truly believe that this won't happen to them. "Going 'overdue' and long labors are things that happen to other women, not to me." OK, it's not said outloud or sometimes even consciously, but it's real. So many women are not prepared for this possibility at the end of pregnancy. So much can happen in those extra days that the UNT midwives are willing to give you. A lot of other groups and/or hospitals have a 7-10 day rule. Me no likey.

3) They are VBAC friendly and so is the doctor that backs them. Again, huge. Even if you have never had a c-section and are not having a VBAC, this philosophy, mindset, and belief is important to all pregnant women. No one wants to have a doctor who has a no-VBAC policy. He or she is preoccupied with legal issues and does not believe in the inherent safety of birth. They have a what-if mindset. A woman with a doctor like that will have a c-section. Also, their back-up doctors believe in their midwives. There are other local CNMs that are not "allowed" by their back-up doctors to do VBACs. Huge. This might seem like a big who-cares, but it's not. It speaks volumes about what is going on in their hospitals.

Ultimately, you do not have to fight to have a natural birth. As long as you do not have drugs, you will have intermittent monitoring, allowing you the freedom to walk or be in the water. You will be encouraged to eat and drink. You will have very limited vaginal exams. Other hospitals require an IV, continuous fetal monitoring, no walking if your water has broken, and vaginal exams every two hours. These "policies" contribute to the high c-section rates.

I should mention that not every experience at Harris has been great. I have had a handful of couples birth there where I was disappointed in how things were handled. Overall, however, these instances have been few and far between. I also believe that they are working extra hard to lower their rates of intervention, including c-sections. Bottom line: if you are birthing in a hospital in the Ft. Worth area, I am most comfortable with how the UNT Midwives do things.

I had a couple give birth with the UNT midwives this past weekend and I would just briefly like to share why they did not have a c-section. I believe that just about any other hospital in the area, she'd be recovering from surgery this week.

This mom had been having some strong contractions about 7-8 minutes apart for about 4 days. She had had a difficult time sleeping and was exhausted by the time she showed up at the hospital Saturday morning. She had some Demerol to help her sleep and by late afternoon without a whole lot of dilation, she had an epidural. Eventually, she had pitocin to pick things up, but the baby didn't like that so much. Instead of doing a c-section -- as just about any care provider around would have done, calling it fetal distress and fearing a lawsuit -- the midwife turned off the pitocin and told this mom to go back to sleep. They'd try again later.

Eventually, the epidural wore off, after the mom had gotten in some good sleep, and she was able to squat her baby out! Her midwife believed in her ability to do have a vaginal birth. Except for exhaustion, mom was fine and baby was fine. She recognized what was working for them and what wasn't.

I also must add, when her doula showed up at the hospital, all the lights were on, monitors beeping loudly, and family all standing around watching this laboring woman. Her wise doula created an atmosphere of quietness, dim lighting, head massage, snuggle time with the hubby, and things moved along quickly afterwards. She probably should have been there sooner!

"I like my doctor" is not a reason to stay at your hospital. He or she will very likely not be at your birth. The nurses run the show at the hospital. You want nurses who are used to working with midwives and have a respect and belief in the natural process of birth. If all they ever see is inductions, epidurals, and c-sections, this is what they are comfortable with. Get the heck out of Dodge and run over to the UNT Midwives.

Now, if you decide to birth outside of the hospital, you have lots more options available to you. That's another story for another day!

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More Evidence About the Dangers of Ultrasound

I found a link about some other studies on ultrasound. There are a couple of posts under this link. They are short and easy to understand. The evidence is compelling. Check it out.

Next time your doctor says, "I don't know why 'Bradley' is so concerned about ultrasound," and tries to tell you how safe it is and that Bradley Instructors are the only people out there who care, they couldn't be further from the truth.

Evidence is mounting. Check it out.

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Autism Links to Ultrasound and Other Obstetrical Procedures

I teach in my Bradley class about the risks of ultrasound. This is so controversial to begin with. No one wants to believe that there could be complications or problems with using this device that American parents are so in love with!

Simply put, ultrasound changes the way cells grow. Ultrasound has been linked to a number of things, but the one I want to focus on here is autism.

One in every 150 kids has a form of autism in the United States. This rate has grown tremendously over the last decade. Now let's talk about ultrasound for a moment. When I had my first baby, in 1996, nearly 13 years ago, I remember desperately hoping that my insurance would cover it. Back then, they didn't do them unless there was a "medical reason." (I don't remember my "medical reason".) Gradually, the reasons started including things such as accuracy of the estimated due date. Now, everyone's insurance covers ultrasound, usually not just one, but several. I even had a student last year who had a doctor who routinely did ultrasounds every week starting at 36 weeks. Parents are excited about this, not knowing the risks they are taking with their baby's well-being. Rates of increased ultrasound usage correlate with the rate of autism diagnosis. They have both risen dramatically, simultaneously.

I had read about the possible link between ultrasound and autism about 5 or 6 years ago. It made so much sense to me. There has always been warnings linked to ultrasound, but I rarely talk with a pregnant woman who has been made aware of any warnings before having an ultrasound.

For example, a study in 1993 found that babies exposed to ultrasound were twice as likely to develop delayed speech. According to the FDA, "While ultrasound has been around for many years, expectant women and their families need to know that the long-term effects of repeated ultrasound exposures on the fetus are not fully known."

Researchers reported, in 2005, "Obstetric ultrasound should only be done for medical reasons, and exposure should be kept as low as reasonably achievable (ALARA) because of the potential for tissue heating. Temperature increases in utero have been shown to cause damage to the developing central nervous system of the fetus." In 2006, a study warned that exposure to ultrasound can affect fetal brain development.

Because there are no obvious deformities or problems at birth, we assume that all is well and "normal." It is likely several months or even years later, as the parents are going through testing, no one asks -- yet -- "How many ultrasounds did you have in your pregnancy?" I think that day will come though. As a side note -- what did you learn from all those ultrasounds? Probably that everything was just fine. Even if you were checking for something periodically, what would the difference have been in just waiting until the baby was born? Rarely can anything be done in utero. So why have all these ultrasounds to begin with?

Ultrasound, just like ANY drug in labor or pregnancy, has NOT been proven to be safe. Think about that for a minute. Take Tylenol for example. Women are told that it is "safe" to take it, but that is not necessarily true. It just hasn't been proven to be unsafe. Ibuprofen, on the other hand, has been proven to be unsafe. We know ultrasound changes cellular growth, we just aren't sure exactly what this means long-term. Links are starting to be made now, finally, after 30 years of use -- and damage.

Other research shows that populations exposed to ultrasound have a quadrupled perinatal death rate, increased rates of brain damage, nerve cell demlyienation, dyslexia, speech delays, epilepsy, and learning difficulties.

One more interesting note about ultrasound and the development of the baby. Ultrasounds, along with many obstetrical testing practices, has a high false-positive rate, meaning that parents are told something is, or may be, wrong with the baby. This causes the production of stress hormones in the mother which can have long-term effects on the baby's neurological development and behavior.

It is important to know that ultrasound is not just the scan where you see the pictures of the baby. Ultrasound includes the doptone used to hear the baby's heartbeat at your appointments with your doctor or midwife. (You can hear the baby's heartbeat with a stethoscope after about 20 weeks. This takes more skill, and if your provider is younger, they probably have no idea how to find the heartbeat of the baby without the doptone. If this at all concerns you, you should request to hear the heartbeat by stethoscope.) Another form, and perhaps the worst of them all, the Electronic Fetal Monitor, or EFM. This is often strapped to the mom for hours in labor, especially if she has drugs in her system. Once again, I have just given you another reason to not have drugs in labor. You'll still be monitored, but only a fraction of the time will be required, or needed.

I have to end this post with a simple, trust your body. Trust your baby. You will be seeing him or her in a short time. The risk of ultrasound simply is not worth it. If your doctor or midwife is pushing you to have more than one ultrasound (I understand wanting one to check things out), examine the reasons and the possible results. Can anything really be done during the pregnancy? Usually not.

For those of you who are curious, I pulled this information from a magazine called "Pathways to Family Wellness". Other obstetrical procedures linked to autism include: mercury in pregnancy, including the Rhogam shot, flu shot, dental fillings, and fish. Other procedures linked to autism: induction, epidurals, restricted laboring positions, forceps and vacuum extraction, C-sections, and umbilical cord clamping. Of all these things, ultrasound was at the top of the list.

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Appropriate Use of Intervention & Medication for Labor

By now, you know that I believe that fear is NOT a reason to have an epidural. The lack of education and preparation are the reasons, I believe, that the majority of American women choose to have pain medications in labor. This is also why women are choosing to have a C-section, never experiencing a single contraction -- fear.

You might be shocked to know that I believe that there are appropriate times for intervention and/or medication. I'd like to share such an experience one of my "DVD couples" had this past week. It's been several days since I spoke with her and I've had a birthday party for my 3rd child, a baptism, company, and Easter, all take place since our conversation. Some of the details are fuzzy, but you'll understand my point without all the details.

They were planning a homebirth and this was their first baby. Labor started on its own, as it should, and she labored for a number of hours with contractions about five minutes apart. They spaced out to 10,15, 20 minutes apart after a time. It would pick back up though and continue for hours at five minutes apart again. Several hours into the labor, she had an appointment with her midwife. She had a vaginal exam and found that her water had broken -- probably in the bathtub because she wasn't aware of that happening -- and was told she was 100% effaced and dilated 3 cm.

She continued laboring at home throughout the day. Her midwife checked in on her that evening and still, she was dilated to a three. This is where my memory fails me. I do not remember at what point they decided to go to the hospital, and really, it doesn't matter. She was near the 24-hour mark of water breaking, but everyone was doing fine. Her cervix just was not dilating. When she arrived at the hospital, they did start her on pitocin, but not terribly high. They also started her on antibiotics as a precautionary measure because of the ruptured membranes. It should be noted, there was no sign of infection. She labored this way for 4 hours and still did not dilate past a three.

I just knew this story was going to end with surgery. The doctor, who was the back-up doctor for the LM, suggested at this point that they increase the pitocin and she have an epidural. She had only slept a few hours during the labor and was exhausted. This was a hard decision for her -- I could hear it in her voice when she told me that she consented to the epidural -- but she made the right decision.

She slept during the next few hours while the pitocin took over. The next time she was checked, she had good news! Her cervix was dilating! She labored the last hour without pitocin or the epidural and pushed her baby out on her own.

Had she not listened to her medical team, who, I must add, was giving good advice, she would have had a C-section. Yes, she did not have the quiet, undisturbed homebirth she had planned for, and there will be some emotions there to deal with. But she avoided surgery. Why did this happen to her? Who knows. Maybe it was about the baby's position. Maybe she couldn't relax enough. Maybe she was apprehensive about giving birth at home, even subconsciously. She may never know. But she will, I believe, be able to have a peace about her birth. She used intervention and medication, not because she was afraid of the process, but because she needed that assistance.

I have another example from another DVD couple last fall. This was to be another out-of-hospital birth, but she went almost 3 weeks over her "due date." Her biophysical profile, etc., had been good, up until this point. Her midwife had become concerned, if I remember correctly, with fluid levels and thought she should go ahead and be induced at the hospital. She had a great back-up doctor. This mom was induced and labored without an epidural for many hours. She remained dialated to a nine for several hours when the cervix started to swell. This is not a good thing. They recommended an epidural so she could relax and sleep. It worked. She had a vaginal birth.

Sometimes, we (okay, I) focus so much on the "evils" of medicated birth, we loose sight that it can sometimes help avoid surgery. I would absolutely rather see a mom have a medicated birth than a C-section. These were good doctors who wanted the same thing for these moms. They respected their wishes and were anxious to help them achieve this goal. Many doctors would have just done a C-section on both of these women.

I can honestly say that I don't know what could have been done differently to avoid having medication or intervention in either of these labors. Had they not been planning out-of-hospital births to begin with, they likely would have ended up with c-sections earlier on. I do believe that planning homebirths, even though they both transported, were contributing factors to still having vaginal births.

Both of these women were educated and prepared. It reminds me of something our midwife with our 3rd baby told us: "Birth is 90% in your head and 10% what happens to you."

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