Jun 022013
 

I have known Brenda Parrish for a couple of decades. We met online and did not meet in real life until a year or so ago at a breastfeeding rally. She had just recently moved from south Georgia to the metro area. She is a fabulous home birth certified professional midwife. I in fact am awaiting a birth with her to happen soon. Here is her protocol for women to kill the GBS bacteria that sometimes lives within us- in fact some say 40% of women have it at any given time. It is not dangerous unless you are giving birth when it is present. If the baby picks it up once your water breaks, it can be fatal to the newborn. Ironically the only baby I have ever been the doula for who went to the NICU with GBS+ status was a mom who had tested negative! But here is her wonderful protocol that has proven to be very effective in her home birth moms!

brenda

 

Sometimes being forced to think “out of the box” leads to accidental discoveries that end up being quite important.  Such has always been the case of midwives who are open to alternative remedies, especially when the medical alternatives tend to have unwanted side effects.

GBS (group beta strep) is the most common cause of sepsis and meningitis in newborns and can cause newborn pneumonia.  Many people carry GBS in their bodies but do not become ill.  Because it can be present and not cause problems, many women are colonized and do not know it.  A baby can become colonized if the mothers is colonized in the rectum or vagina at birth.  This normally happens during labor or birth.  The standard of care is for mothers who test positive to GBS to receive intravenous antibiotics every 4 hours during labor to help prevent the baby from becoming sick.

Many CPMs (Certified Professional Midwives) do not have access to the recommended intravenous antibiotics to treat GBS.  So we have always looked for alternative ways to reduce the colonization in expectant mothers who have tested positive.  For many years, I have encouraged women to insert a peeled clove of garlic vaginally at bedtime-either one week on and one week off or every other evening  until delivery.  We followup with the use of Hibiclens disinfectant solution to rinse the outmost vaginal canal and perineum during labor.  While this has actually served me well for many years, I’m sure it is not the most pleasant experience for the mothers.

Several years ago, a study was presented at a MANA (Midwives Alliance of North America) Conference detailing the use of a specific probiotic to actually keep GBS bacteria in check or significantly reduce the colonization, thus increasing the number of mothers who would test negative.  The product was FemDophilus and it contained a strain of good bacteria called L. Rhamnosus.  This made such good sense to me.  If we could help moms to simply naturally control GBS colonization without the use of antibiotics, it was a win-win situation, because even though the antibiotic normally works pretty well, it is not without side effects for both mother and baby.  If we could do something that had only GOOD side effects, how much better would that be?

I looked around for this product and didn’t find it right away but after reading a few labels, I realized Jarrow made yet another formula called “Jarro-Dophilus EPS” which was readily available locally and also had a significant amount of the desired L. Rhamnosus.  So, a little over two years ago I began to strongly recommend that all the clients in my care take this probiotic formula daily as a preventative to GBS.

jarrow

In that period of time, until recently, I had not had a SINGLE mother test positive.  Recently I had one mother who was positive with her first pregnancy test positive again.  I have not questioned her yet as to how closely she followed the protocol.  Another mom was in her fourth pregnancy and had never tested positive before so she did not take the probiotic on a regular basis.  The third was an expectant mom who transferred to my care one week before we ran the GBS lab and had earlier tested positive in a urine culture so she is very highly colonized and one week was not a sufficient amount of time to make much difference to her digestive tract.  So, that’s a pretty good track record.

My protocol is this:

New client in the first trimester-no previous GBS history and no UTIs–just take one of the EPS formula probiotic a day.

New client in the first trimester-previous positive GBS or a positive urine culture–take three probiotics a day for a week, then 2 a day for a week, then one for the balance of pregnancy.

Late transfer-3 probiotic a day for a week, 2 a day for a week, then 1 a day for the balance of pregnancy.

Once I question the mom who tested positive recently that had a previous positive GBS in her other pregnancy, I may tweak that protocol in the future to stay on three a day for a longer period of time.

But so far, this probiotic is having very good success. Nice side effect is several moms have mentioned that is also seems to be helping them with regularity.

 

 

Brenda Parrish, CPM, CLC is a homebirth midwife who currently lives in Marietta and serves metro-Atlanta area mothers in their quest for a natural birth.  Originally from south Georgia, she served women there for many years before relocating her practice.  Her first primary “catch” was the late in life “surprise” baby born to her former preceptor, 18 years ago.  Many babies later, she is still enjoying her midwifery career.  She is a mother to three grown children and “Nana” to seven delightful grandchildren.  She loves music and singing (used to work in a recording studio and in a traveling music group), photography and scrapbooking, crafts, sewing and good food.

Traditional  Birth Services, LLC

http://traditionalbirthservices.com

 

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Apr 302013
 

formula gift

I went to a blessingway last night. The pregnant mother being honored mentioned that although she has every intention to breastfeed, she thought it odd that she received two large containers of powered infant formula in the mail. I asked if she had registered at BabiesRUs and of course she had. What she did not realize is they sell her name to the formula companies to get free samples!

Today on facebook a fellow doula and friend of mine posted this picture. A gift the mom received at the hospital. These hospitals get free formula for their hospital by giving away free gifts to each mom who has had a baby. The bottle feeding moms get a huge supply while the breastfeeding moms get a smaller sampler.

It is no wonder that in the metro area of Atlanta we still don’t have a Mother- Baby Friendly hospital.  Our local hospitals may have IBCLCs on staff- others only have limited access to these trained women, but they also hand out nipple shields, pacifiers and formula with great regularity.  There are ten steps to becoming classified as Mother Baby Friendly.

The Ten Steps to Successful Breastfeeding are:

  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in the skills necessary to implement this policy.
  3. Inform all pregnant women about the benefits and management of breastfeeding.
  4. Help mothers initiate breastfeeding within one hour of birth.
  5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
  6. Give infants no food or drink other than breast-milk, unless medically indicated.
  7. Practice rooming in – allow mothers and infants to remain together 24 hours a day.
  8. Encourage breastfeeding on demand.
  9. Give no pacifiers or artificial nipples to breastfeeding infants.
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.

How do you think offering pacifiers, throwing nipple shields at moms who have latch issues and handing out free formula fits into this initiative?

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Apr 012013
 

I hear women say, “I had an emergency cesarean.”  I have attended well over 500 births and I have to say there have only been three that were real emergencies. If you have time to discuss things with your care provider. Time to get your partner dressed for the birth, and time to have them pack up the room, time to make a phone call, etc… then it is not an emergency situation. Emergency cesareans happen quickly. The room fills up with staff- your bed is unhooked from the wall- they are shouting orders as they wheel you down to the OR… if your care provider is not there they will snag any doctor available… that is an emergency cesarean. If you don’t have an epidural then you are put under general anesthesia and your partner is not invited into the OR suite at all. So, unless that happened, note that you had an unplanned cesarean. And according to the statistics those will more likely occur between 8am and 5pm, next likely between 5pm and 11pm and rarely between 11pm and 7am… why? Because there is less “management” of your labor and your care provider is sleeping or may not even been at the hospital. Then you have to ask yourself was my unplanned cesarean really necessary at all?

After all as in Monty Python’s The Meaning of Life, you are probably not qualified to know how to birth!

meaning-of-life_frame

Recently a doctor wrote an article Top Ten Signs Your Doctor Is Planning To Perform An Unnecessary Cesarean Section On You to forewarn parents of the signs that your doctor really does not like to wait for natural birth to occur. His honesty is profound. I consider this a must read!

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Mar 292013
 

I recently had a birth at a satellite hospital in North Forsyth. It was my first birth here. I had hoped it would be a great facility that supported natural birth since some of the doulas with my company have had good births here. The mom had vacillated about moving to a different facility but due to insurance reasons, made the decision to stay the course. She took a childbirth class with friends of mine and felt really prepared.  We had discussed being prepared to have to stand firm in some areas if she wanted the birth she desired.

She started out with on again off again type contractions that had started Sunday and continued into Monday. She had had an exam in the office on Friday. (Vaginal exam 3- she had had two prior to this appointment) Often times labor gets a kick start by having an exam. But sometimes the exam causes a start that is not quite ready to get going and thus leads to an on again off again irritated uterus. The mom had knowledge of the risks.

I was in touch with them on and off.  I met them at the hospital early on Tuesday morning. She was concerned that she was not yet in active labor. And then we met our nurse, Tammy. She came in and announced we were lucky since she was not only a nurse but a previous midwife. She then told my client that if she was wondering if she was in active labor, she most certainly was not. BOMB!

bomb

Continue reading »

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Feb 262013
 

I just spoke to a mom who is with a practice of midwives and doctors who practice out of the large hospital on the north side of town. And she is with a large insurance company which is a global pay system. She is being told by her practice that they do not allow doulas. She will get either a doc or a midwife- you rotate through both and it is whoever is on call.

And her hospital childbirth educator- was great about teaching her “to stay up and moving- using the birth ball, etc”  but told the students who lived a short distance away (5 to 10 minutes) to arrive when the contractions were ten minutes apart but since she lived almost an hour away- she needs to go to the hospital at 15 minutes apart. I reminded her that that was only four contractions an hour and would be very, very, very early labor! She called me to find out about doulas because the hospital tour person and hospital educator and her friends have all said use a doula, even labor nurses she goes to church with recommend she use one. But she is unsure if she is “allowed” to do so with this practice and wondered if I knew if they would allow us to be there! Continue reading »

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Feb 082013
 

There are two hospitals in the metro area that offer a “Family Centered Cesarean.” One is done at AMC with Brad Bootstaylor with patients of Intown Midwifery and other midwives he provides coverage for. He does that type of cesarean for any non emergency- keep in mind you hear “emergency cesarean” used often for “non planned cesarean.” A true emergency is very different from a non planned surgical birth. So he provides it for any real non emergency situation and tries to offer it then if possible.  One other group provides a family centered surgical birth but only does so for planned cesareans. That is the physicians who back up the ARMC midwives in Athens.

This approach is shown to “enhancing bonding, initiating breastfeeding and reduces postpartum depression”- isn’t that what we all want?

Here are some video links to this new approach as well as the traditional approach.

Family Centered Cesarean

This is a modified skin to skin after the birth cesarean- not really a full experience but better than most:

Modified skin to skin cesarean

A unique natural expulsion technique:

Natural Expulsion

Malpositioned baby was born via cesarean:

Malpositioned Cesarean

And for comparison sake- here is a “normal” cesarean:

“Normal” Cesarean

A local cesarean including some of the pre surgery prep:

Kennestone Cesarean Birth

You may be asking yourself, why is this not available elsewhere and why does ARMC require it to be a planned event. ARMC says it takes more staff when Dr Bootstaylor says that it does not take more staff when he does it. Elsewhere I think women are not demanding the opportunity for this type of experience. If you demand it, often the powers within the medical center will listen. Change comes from creating the voice within many. Ask your hospital why they can not follow suit and help women have a good birth experience no matter if it is vaginal or cesarean!

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