Posts tagged Prenatal
What is Group B Strep (GBS) - And why should I care?
Group B Strep
 

Group B streptococcus (GBS) is one of the many digestive tract bacteria that live in the body. It can come and go many times throughout a person’s lifetime without it ever causing any issue or illness, and it is not a sexually transmitted infection (STI). Anywhere from 10-30% of pregnant people are “colonized” with or carry GBS in their bodies without ever knowing it.

Due to the close proximity of the rectum, vagina, and urethra, the bacteria can easily migrate from the digestive system to urogenital tracts. This means that there is a possibility that GBS can be passed to the baby during labor. This is rare and happens to 1 or 2 babies out of 100 when the pregnant person is not treated with antibiotics during labor. It is very rare for the healthy newborn to contract GBS, but the chances of them becoming ill may be lower when treated.

Screening for GBS is a part of routine prenatal care and is usually done by taking a vaginal/rectal swab culture between 35 and 37 weeks of pregnancy. You may request to take the test at 38 weeks if you are wanting more time to self-treat. If the test comes back positive for GBS colonization, an antibiotic called penicillin will be suggested/given intravenously when your birthing time begins. If you are allergic to penicillin, another similar antibiotic will be offered in its place.

If you have had a previous child with GBS disease, have GBS bacteria in your urine at any point during your pregnancy, your GBS status is not known when you go into labor, or if you have tested positive for GBS in a past pregnancy, intravenous antibiotics may also be offered/recommended.

One alternative to the universal approach is the “risk-based approach.” This is when you receive antibiotics based on other risk factors such as having a fever or your water being broken for more than 18 hours. Especially if baby is less than 37 weeks gestation. (This is the method currently employed by care providers in the UK.)

You do have the right to decline antibiotic prophylaxis in labor, and taking the watch and wait approach to see if baby develops symptoms and then treating if they do. If you are GBS positive and you decline abx, while there is an overall very low likelihood (approx 2% chance) that your baby will develop early onset GBS infection.

Now that we know a little more about GBS…Let’s talk about your vaginal microbiome!

This information is for you if you are pregnant or trying to conceive, and would like to try to try to prevent or reduce the colonization of GBS and a subsequent positive test. The possible prevention of GBS and the recommendation for antibiotics starts with optimizing your vaginal bacteria from the get-go. It’s up to you, as your care providers are probably not going to give you information beyond what GBS is, and how and why it is treated during childbirth.

By the time you get tested for GBS, it’s already late in your pregnancy. If you happen to test positive, there aren’t many options offered by medical providers besides IV antibiotics. As you can imagine, the suggestion for IV antibiotics can throw a wrench in your plans for staying home during the early phase of your birthing time. Especially if your waters have released before surges pick up. Most likely, you would be asked to come in as soon as your waters released or labor began so that you were able to receive a minimum of one dose of antibiotics at least 4 hours before the birth of your baby.

Urogenital and gastrointestinal infections are often caused by an imbalance in “good” and “bad” bacteria. Certain infections such as UTI, BV (bacterial vaginosis), and GBS… have been said to be caused by the decrease in, or depletion of the indigenous flora Lactobacilli. Studies have found that probiotic therapies containing Lactobacilli strongly inhibit the growth of GBS by increasing the acidity of the environment and that they may be effective in returning the vaginal flora microbiome to a healthy normal state. Another Study has shown Lactobacillus Salivarus greatly reduces the chance of GBS colonization. So adding that probiotic to your normal regimen of Lactobacillus Reuteri and Rhamnosus strains should be even more effective.

With all of this information about GBS, probiotics, and scientific data to back it all up, trying to decrease or prevent GBS colonization during pregnancy seems like an excellent choice for a reduction/prevention wellness protocol — especially if someone is really wanting to avoid IV antibiotics. Another good reason to prioritize your vaginal flora to prevent or reduce the chance of testing positive for GBS is because many people planning for an unmedicated birth will prefer to spend the early phases of birthing time at home to maximize comfort and to reduce the chance of unnecessary interventions at the hospital. Even those birthing in birth centers will have to worry about coming in early for antibiotics if their waters have released before birthing waves begin, and the possibility of facing a transfer of care if their birthing waves “take too long” to begin… putting them in a higher risk category and leading to the suggestion of induction for PROM (Pre-labor rupture of membranes.) This applies to everyone, but more so for those who have tested positive for GBS. Those who test positive don’t usually have the luxury of waiting for their birthing waves to really pick up and get moving, as someone who tests GBS negative might.

For more information on the benefits of avoiding IV antibiotics, Birthful has a podcast all about the microbiome. I highly recommend that everyone listen to this!!

There are many probiotics on the market. Which ones would I want to take if I am trying to reduce or prevent GBS colonization during pregnancy?


Jarrow Formulas is one brand that has been clinically tested, and contains the strains that are believed to be most effective against GBS and other urogenital infections such as BV and UTI. It can be found in many pharmacies and is also available on Amazon (of course - what can’t we find on Amazon these days?) There are a few different formulas, some with more strains and capsules that are vegetarian and non. Here are a couple different product examples. Seed is a symbiotic and has pre as well as probiotic!

 
 

There are other brands on the market, but you want to make sure that if you choose another brand that it contains Lactobacilli strains, specifically Lactobacillus rhamnosus GR-1, Lactobacillus reuteri RC-14, and Lactobacillus Salivarus. You may have to buy a separate Salivarus to add to the other combo.

What else can we do to support gastrointestinal and urogenital health during pregnancy?

  • Limit sugar and processed food intake. These things can feed bad bacteria colonization.

  • Eat a balanced diet and make sure to get enough fruits and vegetables, complex carbs, protein, and healthy fats, and even add in some cultured foods that support healthy gut and vaginal health, such as yogurt, sauerkraut, kefir, and kombucha.

  • Stay hydrated: Drink at least 10-12 cups of water every day.

  • Practice good hygiene and frequent hand-washing protocols.

  • Boost your immune system with vitamins and supplements

  • Reduce stress

  • Other holistic and wellness methods, such as Aviva Romm’s Protocol

Would you try to minimize your chances of testing GBS+ by taking a probiotic during pregnancy? Why or why not? What, if anything, have you done to prevent GBS during your pregnancy?

References

https://www.parishealingarts.com/group-b-strept-gbs/

https://www.acog.org/Patients/FAQs/Group-B-Strep-and-Pregnancy?IsMobileSet=false

https://www.ncbi.nlm.nih.gov/pubmed/19295645

https://www.ncbi.nlm.nih.gov/pubmed/16869901

https://evidencebasedbirth.com/groupbstrep/

https://mommypotamus.com/group-b-strep/?fbclid=IwAR1krNyaLKes844bVRDSaYGzuDXG1xCG-rXNjGVpJDJQL-j5WoTCNsXcd2g

Disclaimer: The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this website is for general information purposes only. Northern Star Doula makes no representation and assumes no responsibility for the accuracy of information contained on or available through this web site, and such information is subject to change without notice. You are encouraged to confirm any information obtained from or through this web site with other sources, and review all information regarding any medical condition or treatment with your physician.

NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE OR DELAY SEEKING MEDICAL TREATMENT BECAUSE OF SOMETHING YOU HAVE READ ON OR ACCESSED THROUGH THIS WEB SITE. NORTHERN STAR DOULA IS NOT RESPONSIBLE NOR LIABLE FOR ANY ADVICE, COURSE OF TREATMENT, DIAGNOSIS OR ANY OTHER INFORMATION THAT YOU OBTAIN THROUGH THIS WEB SITE.

Cervical Exams During Pregnancy?
Photo by Thandy Yung on Unsplash

Photo by Thandy Yung on Unsplash

Let’s talk about cervical exams. To have… or not to have, prenatally?


Well, besides the fact that a cervical exam doesn’t tell us much of anything at all before birthing time actually begins, there are also risks involved.


What are the risks?

  • They can be extremely uncomfortable, especially in the weeks leading up to your birthing time when the cervix is supposed to be high, firm, closed, and posterior.

  • They can give us an unnecessary, false sense of hope or discouragement.

  • An increased risk of infection.

  • Bleeding and cramping.

  • A signal to your body that there is a threat.

  • A chance for premature rupture of membranes, especially if there is a “stretch and sweep”, or stripping of membranes performed. (Sometimes additional consent for a sweep isn’t always obtained first, and is thought of by some providers as “part of the exam” which is unacceptable.)

It’s not uncommon for providers to begin wanting to check the cervix in the last few weeks of pregnancy. Sometimes as early as the 36th week of pregnancy. Usually well-meaning providers are looking for information to share with you as you approach the home stretch. Sometime they are requested because people falsely believe the information is important. Most times this is done out of tradition and routine.

What exactly are we hoping to accomplish by assessing the cervix prenatally?


Let’s ask ourselves a few questions.

  • What is the purpose of the exam?

  • What is it that we are looking for?

  • What are we going to do with this information?

  • Does the information we gather change the intended course of action?

  • If not, then why are we doing it?

 
 
Photo by Jon Tyson on Unsplash

Photo by Jon Tyson on Unsplash

 

If we know that cervical dilation is only a very small part of the equation, what are we expecting to gain by learning of the cervix’s current status — and what the cervix is doing before birthing time even begins?

If we know that the cervix can change very quickly, or stay unchanged for an extended period of time... even during birthing time, what exactly are we able to do with the information before birthing time even begins? There are many other important, and often unmeasurable things at play.

In my experience, a cervix can go from completely closed to 10cm in four hours. In contrast, a cervix has the ability to remain at 3/4cm for a few weeks before birthing time even begins. Both are normal scenarios.


The #1 reason for prenatal cervical checks is pure curiosity, and tradition.


If you would like to know your cervical status in the weeks leading up to your guess date, and before birthing time begins, that’s your choice. Just keep in mind that it doesn’t mean much before labor begins. It ONLY tells you what your cervix is doing at that exact point in time and that’s about it. As long as you are aware that your cervix is not a crystal ball, and will not indicate when your birthing time will begin or how your birth will go in terms of length or difficulty. The cervix has a mind of its own and can be very unpredictable before and even during the early and active phases of the birth process.


Besides, who wants to hear their provider say, “You’re only 1cm dilated.”

ONLY???


The word “only” has a negative connotation when speaking in terms of progress, which is what most people are hoping is going on. It can be very discouraging and counterproductive.


Photo by Nathan Dumlao on Unsplash
 

Your cervix has a job. That job is to do nothing until it’s time to do something!

But it’s not exactly doing nothing. It has a few main functions in relation to pregnancy and birthing. One main function is to keep your baby protected and safe until it’s time to be born. I’d say a cervix that was “only” 1cm dilated before the baby was ready to be born is doing a great job at performing one of its main functions. When the baby and the body are ready, the cervix will assume its other very important function which is to soften and dilate - usually in conjunction with (and not before) a continuous pattern of uterine surges.

For the data driven, here are a few quotes about the underlying mechanisms and functions of the cervix.

“During pregnancy, the primary biomechanical function of the cervix is to maintain the fetus within the uterus. This requires withstanding multiple forces from the uterus, including the weight of the growing fetus and amniotic sac, as well as passive pressure from the uterine wall.”

“The structure of the cervix is integral to the maintenance of pregnancy, keeping the developing baby in utero and forming a barrier to the ascent of microorganisms from the vagina.”

“The function of the cervix from this moment is to retain and protect the growing conceptus. An effective barrier is primarily accomplished through retaining a sufficient length of closed cervix within which the mucus plug can deter ascent of microbes from the lower genital tract. This is aided by maintaining sufficient strength at the level of the internal os to discourage descent of the fetal membranes and conceptus down the cervical canal, which may shorten this barrier and/or dislodge the mucus plug.”

“Throughout the latter stages of pregnancy, the cervix undergoes this process as a result of increased collagenase activity. Labour onset at term is governed by fetal and placental endocrine signalling, which triggers an inflammatory cascade of cytokines, prostaglandins, and oxytocin release. In response to uterine contractions, the already softened cervix begins to efface and dilate as a result of the pressure being exerted either by the fetal membranes and/or the presenting part.”


Your cervix is performing its job - Isn’t that great news?!


Remember…

  • It is your right to refuse cervical exams if you are not comfortable or don’t see a point with having them.

  • You can simply say, “No thank you, I will not be having a cervical exam today.”

  • And if you’re a go-with-the-flow kind of patient, and it makes it easier, you can just keep your pants on if the only reason for undressing during your appointment is to receive a “routine cervical exam.”


Your body, your choice.

ALWAYS.


Have you had cervical exams during pregnancy? Why or why not?



References:

https://www.sciencedirect.com/science/article/pii/S2214854X1530008X

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4459908/

https://evidencebasedbirth.com/evidence-prenatal-checks/

https://www.ncbi.nlm.nih.gov/pubmed/?term=lenihan+antepartum+pelvic

https://www.ncbi.nlm.nih.gov/pubmed/?term=mcduffie+weekly+cervical+examinations


Disclaimer: The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this website is for general information purposes only. Northern Star Doula makes no representation and assumes no responsibility for the accuracy of information contained on or available through this web site, and such information is subject to change without notice. You are encouraged to confirm any information obtained from or through this web site with other sources, and review all information regarding any medical condition or treatment with your physician.

NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE OR DELAY SEEKING MEDICAL TREATMENT BECAUSE OF SOMETHING YOU HAVE READ ON OR ACCESSED THROUGH THIS WEB SITE. NORTHERN STAR DOULA IS NOT RESPONSIBLE NOR LIABLE FOR ANY ADVICE, COURSE OF TREATMENT, DIAGNOSIS OR ANY OTHER INFORMATION THAT YOU OBTAIN THROUGH THIS WEB SITE.